Yesterday, the UN General Assembly met in New York to adopt a resolution on universal health coverage (UHC).
This UN resolution draws attention to the 100 million people who are driven below the poverty line every year as a result of paying for healthcare, and shows the extent to which direct, out-of-pocket payments discourage people, particularly the poorest, from seeking or continuing care.
It calls on countries to adapt the way in which health systems are financed in order to increase coverage of health services and ensure that individuals are not impoverished as a result of accessing healthcare.
The resolution was drafted and championed by the Foreign Policy and Global Health Group (Brazil, France, Indonesia, Norway, Senegal, South Africa and Thailand) who have been highlighting the relevance and importance of health for foreign policy and development.
There were initial fears that it would be difficult for governments to negotiate a meaningful resolution on UHC, particularly when many countries are so far from achieving it themselves. The opposite turned out to be the case with many countries strongly supporting the issue and even co-sponsoring the resolution.
By adopting this resolution, governments have recognised their responsibility to urgently scale up efforts towards universal coverage of health care services, with a special emphasis on reaching those populations most in need.
Although the resolution falls short of calling for the total removal of direct, out-of-pocket payments it does demonstrate overwhelming global consensus that working towards UHC is not only possible, but necessary for realising the right to health and achieving the health-related MDGs.
A key question now is how the recommendations and principles of the resolution are going to be put into practice. Hopefully the Foreign Policy and Global Health Group, along with the other sponsors of the resolution, will not consider their job to be done with the adoption of the resolution and will take concrete steps to support those countries with the greatest health challenges to adapt their health systems to meet the needs of the whole population.
As discussions about a post-2015 development agenda gain pace, this timely resolution will help to ensure that UHC stays high on the agenda.
Louise Holly is the Senior Health Advocacy Advisor at Save the Children UK. To read Louise’s full blog please click here
In 2001, I stood in front of a huge picture in the UN building in New York. It showed an African woman on her death bed with another woman hold her hand. It said: “You must not die alone”. I screamed: “You must not die full stop! There is treatment!”
My friends in the UK were living and working thanks to treatment provided free through the public health system, so why not this lady?
Today, interviewers ask me: “What are the major challenges for HIV in country X?” My response is that there are four challenges facing all countries dealing with HIV: funding, health systems, medicines and prejudice.
AIDS has uncovered many ills in the world: donors’ lack of long term commitment, weak health systems and flawed drug research and pricing. Not to mention deep-rooted stigma, prejudice and discrimination against marginalised including women, men who have sex with men, drug users, and sex workers.
Achieving the goal of an AIDS-free generation and the control of HIV is in sight but action is needed now.
1. Donors dragging their feet
Firstly, donors are dragging their feet from supporting the Global Fund which provides grants to countries to finance effective prevention, treatment and care programmes. Clearly donors need to re-think their reluctance. The more people we treat now and the more infections we prevent, the less costly the AIDS response will be in the near future and the more lives will be saved. The opposite is also true: ignore scaling up of prevention and treatment now and pay later not only in terms of lives lost but also in terms of money needed to contain an escalating epidemic.
2. Drug companies – part of the problem as well as the solution
Second, drug companies! They are a big part of both the problem and the solution. Thanks to Indian generic companies’ competition, the price of first line antiretrovirals dropped from £10,000 per patient per year to under $100. But now patients need more effective medicines and some need new ones which are still under patent. To avoid the patent block, civil society organisations and others supported UNITAID, the international drug purchasing facility, to establish the Medicine Patent Pool (MPP). MPP acts as a one stop shop where the big international pharmaceutical companies license their medicines to the pool and then generic medicine manufacturers can make the needed combinations – paying royalties on sales in countries that have patent on those drugs.
Yet so far, the big companies are dragging their feet or refusing to join. Only Gilead issued a license, which represents a good start but still needs to be improved. ViiV Healthcare (created by GSK and Pfizer), Boehringer Ingelheim, Bristol-Myers Squibb, Roche and Bristol Myers Squib are taking a long, long time to negotiate with MPP. I am not sure when they will conclude these negotiations with decent licenses. We cannot wait forever!
Other companies – notably Johnson & Johnson, Merck and Abbott – refused to join. Instead, they are trying hard to polish their public image by cutting separate deals with generic medicine manufacturers but the terms of the licenses are not transparent and they exclude patients in many countries. For example, the latest J&J deal on the drug “darunavir” excludes the West Bank and Gaza where the drug is sold at USD 5900 per patient per year!
When will drug companies put patients’ lives before making huge profits?
3. A critical need to invest in public health systems
The need for treatment programmes highlights once again the fact that investing in public health systems must be a priority for all governments and donors. Without qualified health workers (including managers, planners, pharmacists, etc) infrastructure, health information systems, and medical supplies, we will not be able to scale up treatment to reach all who need it. Yet some government donors still see investing in public health system as a remote goal to dream about rather than an urgent action to be performed now. A decade of increased funding for HIV response and most countries still face bottle necks in the drug supply chain – because of a lack of investment.
4. Addressing discrimination
Last but not least, all governments, community and societal leaders must address the deep-rooted discrimination in their societies. Countries cannot continue to ignore the rights of women, girls and marginalised groups under the cover of culture, religion or any other banner. In this age where young people across the world are communicating and sharing views and ideas about rights, it is not possible to continue with discriminatory laws and rules.
For a start, access to prevention, treatment and care is a right for all.
Mohga Kamal-Yanni is a Senior Health and HIV Policy Adviser at Oxfam GB.
This blog was originally posted on Oxfam Policy and Practice website on the 1st December 2012.