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Universal Health Coverage: Robust Policy and Systems Research (Still) Needed

We must learn from what has worked—and more importantly, what hasn’t. 

Following the Fourth Global Forum on Human Resources for Health in Dublin and looking forward to the Universal Health Coverage Forum 2017 in Tokyo in December, it seems clearer than ever that achieving the goal of universal health coverage (UHC) will require ongoing and targeted health policy and systems research.

As many countries seek to apply the latest evidence to strengthen their health systems, it needs to be coupled with research into new policies as they are implemented.

Only this ingrained and integrated approach will allow the global health community to learn from every failure and success on the path to UHC.

The cost of UHC?

To reach the day when we have a global UHC system (and I am not holding my breath), each country will require a unique set of health and fiscal policies. As the excellent Three Case Studies in Making Fair Choices on the Path to Universal Health Coverage points out, the World Health Organization’s (WHO’s) definition of UHC—“all people receiving quality health services that meet their needs without being exposed to financial hardship in paying for them”—leaves much room for interpretation.

Without continued research, we cannot know what impact policies will ultimately have on health.

“To achieve UHC, countries must advance in at least three dimensions,” WHO authors say: “expanding priority services, including more people, and reducing out-of-pocket payments.” There will always be trade-offs—and always decisions to make between covering more people (equitably) or including more health services in a basic package.

Without continued policy and systems research, we cannot know what impact policies will ultimately have on access to services—and the health of a population.

It also will be challenging to predict exactly how much UHC will cost in advance, which is especially important as a primary goal of UHC is to not expose people to financial hardship. This will require ongoing specific policy analysis.

People are at the heart of change

Financing is important, yes—but human resources are critical.

Just as the combination of policies each country needs to create the fiscal space for a basic UHC package will be unique, so will the configuration of health workers that country needs to meet its goal. As Koon and Mayhew explained in Global Health Action in 2013, decisions about human resources for health (HRH) are inherently political—and specific to context. They noted that “actors—and their relative power—play a crucial role in the policy process,” and that both UHC and HRH policies are influenced by politics, both local and global.

They also noted that UHC, in particular, will remain highly politicized as decisions are made, ultimately, about who gets what.

We must learn from what has worked and—more importantly—what hasn’t. 

The WHO has finalized and is rolling out the Global strategy on human resources for health: Workforce 2030, which offers solid policy options at the country, regional, and global levels. And now that the findings of the High-level Commission on Health Employment and Economic Growth, Working for health and growth: investing in the health workforce, provide the evidence that health workers are, indeed, an investment, ministries of health and finance can work together to develop fiscal policies that results in healthier populations and economies. And private investors will follow suit.

Health for all by 2030?

UHC ultimately needs financing and a strong health workforce. But it’s also essential that we maintain a focus on primary health care—people-centered care that benefits the most people with the best-quality basic services.

The global health community must learn from what has worked—and, more importantly, what hasn’t—since primary health care was first defined in the declaration of Alma Ata in 1978. The Alma Ata Declaration sought universal coverage that was sustainable and affordable, and those are still the goals.

At the country level, we must support and encourage strong, evidence-based fiscal policies and programs, allowing nations to build systems capable of addressing both long-standing challenges related to maternal and child health and infectious diseases, and relatively new challenges such as chronic care for both infectious and non-communicable diseases.

Tackling global health challenges one by one will require the “great convergence,” financing health care through a combination of well-spent domestic resources (as economies in low- and middle-income countries grow) and smart investments by the international community in new technologies, research, and development that can have global impact.

This post originally appeared on Health Systems Global as part of a wider HSG blog series in the lead up to the Universal Health Coverage Forum 2017, which takes place in Tokyo, Japan, 12-15 December. In this series, HSG members provide their perspectives on how health policy and systems research is fundamental to acheiving universal health coverage by 2030.