Ensuring the right to health for all

Days back, the International Universal Health Coverage (UHC) Day was observed across the world – thereby urging nations to hasten their progress towards achieving the UHC. It stresses the need for healthcare system that provides good healthcare facilities to everyone. This global initiative emphasises the belief that access to affordable and high-quality healthcare is a fundamental human right. The UHC is a comprehensive system designed to deliver quality medical care to every citizen irrespective of their financial means.

In 2017, the United Nations General Assembly (UNGA) proclaimed 12 December as the International Universal Health Coverage Day (UHC Day) by resolution – thereby making it an official UN-designated day. On the occasion, the UHC advocates raised their voices to call on leaders to make bigger and smarter investments in health, and to remind the world that Health for All is a human right and an imperative to create equitable and resilient societies.

The theme of the day this year was ‘Health for All: Time for Action’. The theme emphasises the need for immediate and tangible steps following the 2023 Political Declaration on the UHC. It urges leaders to enact policies that guarantee equitable access to essential health services without financial hardship. It also reminds us that, in a world that continues to experience a growing number of climate-related health threats, now is the time to invest in resilient health systems that will ensure health for all.

Covid-19 pandemic with its unpredictability and deadly consequences underscored crucial lessons in healthcare and how the system needed to be more resilient and adaptable in the coming times. The rapid spread of the virus overwhelmed hospitals, strained supply chains, and caught us unaware. With China and US battling a new set of respiratory infections, it's time for the healthcare system to evolve and emerge much stronger to fight future pandemics and diseases.

As per the World Health Organisation (WHO), UHC means all the people are able to access full range of quality health services they need, when and where they need them, without financial issues. It includes all essential health services, from prevention, treatment, rehabilitation and palliative care. It is important for countries to have a robust primary health care (PHC).

Health is a fundamental right of every human being, but this is not a right enjoyed by everyone in Bangladesh. While the concept of the UHC is laudable, it comes with challenges in our country. These include prolonged wait times for medical services, healthcare costs straining government budgets, and the financial burden on healthy individuals who contribute to the care of the sickest.

Bangladesh has recently made remarkable improvement in population health outcomes, reducing maternal, infant, and under-five mortality rates. Despite these achievements, however, the health system in Bangladesh struggles to provide quality, affordable health services to its population, particularly the poor.

There are a lot of challenges for achieving the UHC. First one is mobilising resources for health. It does not mean that a country has to have more wealth. Actually, it is the process of mobilising resources. The second challenge is reducing the out-of-pocket expenditure. The third is reducing inefficient and inequitable use of resources.

Other challenges are improving the responsiveness, equity, quality of healthcare services, and use of IT for achieving the UHC, etc. WHO report proposes three interrelated health financing strategic options: 1. Raising sufficient fund for health, 2. Reducing heavy reliance on direct out-of-pocket money, 3. Reducing and eliminating inefficient and inequitable use of resources. Bangladesh has shortage of approximately 100,000 doctors and approximately 800,000 health care providers compared to the global standard.

In Bangladesh, an inequity exists among the health indicators of different socio-economic groups and geographical locations. Currently, in Bangladesh, among the total health expenditure, 64% is paid out of pocket. Every year, almost 4% of the population is impoverished due to high out-of-pocket expenditure. Catastrophic health expenditure is highest in Bangladesh among the countries of the Asia Pacific region.

In this scenario, Bangladesh requires proper implementation of the UHC. Thus, Bangladesh needs minimum 15% of the total budget for the health sector while current allocation is just over 4%. ‘Health for All’ agenda set by the Alma Ata Declaration in 1978 has now the new dimension of commitment by the Global community through the SDGs of 2030. The solution stays in the UHC. The world has agreed to try to achieve UHC by 2030, as part of the SDGs.

UHC means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship. Moving towards UHC needs sustainable financing, skilled health workers, good governance, reliable service delivery, meticulous data management, and comprehensive access to medicines.

But one of the often-overlooked aspects is the fact that UHC requires a strong legal framework. Strong laws are essential to protect and promote the right to health, as well as equity, quality, efficiency and accountability.

The main message of SDGs is to ‘‘leave no one behind”. That’s exactly what UHC aims to do. We cannot tolerate a world in which people are forced to choose between sickness and financial hardship. The world is moving towards this important achievement. We want to honour a promise that is bold yet simple, and that will change the lives of millions of people across the World – health coverage that is universal; health coverage that is for everyone, everywhere and leaves no one behind – ensuring right to health.

UHC is a revolutionary concept adopted by World Health Organization (WHO) and recently incorporated as a target in Sustainable Development Goal (SDG). The basic concept of UHC is, without suffering any financial hardship, all people should have access to quality health care according to their needs. UHC has three dimensions: population coverage, quality service coverage (including preventive, curative, promotive, palliative, and rehabilitative health care services), and financial risk protection.

The Article 15(a) of Bangladesh's Constitution has distinctly recognised healthcare as a fundamental right of all citizens, and it has been stipulated by the Article 18(1) that raising nutrition level and improving the quality of public health should be a top priority of the state. Therefore, introducing and implementing the concept of the UHC by overcoming all the challenges is, indeed, imperative for Bangladesh. We can also utilise the workforce and potentials of Ayurveda and Unani, alternative and natural system of treatment, for achieving the objective.

The author is former Executive Director of Public Health Foundation, Bangladesh.