Free and Public

Half the world’s population can’t access essential healthcare by Anna Marriott, Public Services Policy Manager, Oxfam GB

Underlying the goal of Universal Health Coverage (UHC) is a very simple principle – everybody, everywhere, must be able to access decent, effective healthcare without facing financial hardship or being pushed into poverty. Underlying this principle is an equally simple truth – as long as people have to pay out of their pockets for treatment at the time of need there will be vast inequalities and injustices in access to healthcare.

The right to health is a fundamental human right. It cannot be realised if getting treatment or care is subject to the amount of money in your pocket or how much you can beg from your neighbour – who is likely to be equally poor.

A new World Health Organisation and World Bank Global UHC Monitoring report launched yesterday reveals some uncomfortable truths about the state of the world’s progress. These are a damning indictment of government action:

  • At least half of the world’s 7.3 billion people do not have full coverage of essential health services. Healthcare coverage has been increasing at an unacceptably slow rate of just over 1% a year.
  • 3 people every second are pushed into extreme poverty by paying for healthcare.
  • 800 million a year face severe financial difficulties because of health expenditure. The number facing financial ruin has been growing sharply since 2000.
  • The richest mothers and infants are four and half times more likely than the poorest to receive essential maternal and child health interventions in low and lower middle-income countries.
  • Sub-Saharan Africa and Southern Asia have the worst healthcare coverage – scoring just 42 out of 100 and 53 out of 100 respectively in the new global UHC service coverage index.
  • Latin America and the Caribbean has the highest percentage of people facing unmanageable healthcare costs (14.8 percent). Africa and Asia have seen the fastest rate of increase in people facing unmanageable out-of-pocket healthcare costs – with numbers rising by an average of 5.9 percent a year in Africa and 3.6 percent a year in Asia.

Healthcare – a basic human right – has become a luxury only the wealthy can afford. Millions of people are facing unimaginable suffering as a result: parents reduced to watching their children die; children pulled out of school so they can help pay off their families’ healthcare debts; and women working themselves into the ground caring for sick family members. There are even patients imprisoned in hospitals, held hostage until they can pay their fees. Just one of these powerful stories can be viewed in our film here.

A radical change of approach is needed. Governments must massively increase spending on public healthcare services and end all fees for healthcare and essential medicines. It is the only proven route to achieving UHC.  The additional money needed should be raised through progressive tax reform – not expensive private finance or unworkable health insurance schemes that exclude millions of ordinary people.

Governments must stop looking to poor vulnerable people, including those in the informal economy, to pay what they can’t afford. Contributory insurance schemes have become the health financing model of choice in many low and middle income countries. But with large informal economies these schemes become de facto voluntary and fail to cross-subsidise between the wealthy and healthy to the sick and the poor. They fail to reach scale and they leave the poor behind.

Instead, we as a global health community need to pay more attention to growing and extreme levels of economic inequality. The concentration of wealth and power in the hands of a minority is an obstruction to human development, and tackling this can provide the financing needed to deliver health for all. Today 8 men own as much wealth as the poorest half of humanity. Poor countries lose an estimated $170 billion a year because of tax dodging by corporations and the super-rich. Unfair tax systems cost them even more – Nigeria loses $2.9 billion a year because of unfair corporate tax incentives alone – equivalent to 13 times the countries total health budget in 2015. And if Kenya increased its tax to GDP ratio by 3 percentage points in 2014 – from 17.9 to 20.9 percent –  it could have raised enough additional funds to ensure all Kenyans had access to free, quality healthcare.

In light of the scale of the challenge described in yesterday’s UHC report, business as usual is just not acceptable. We need urgent action from governments to deliver on their duty to fulfil the right to health. The resources are there, what is missing is the political will to redistribute them!

 

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Global Health Check was created by Anna Marriott and is currently edited by Mohga Kamal-Yanni