COVID-19 (coronavirus): Universal health coverage in times of crisis

By ILONA KICKBUSCH & DR. GITHINJI GITAHI

Worldwide, we are all watching and experiencing the extraordinarily tough and at times horrific impact of COVID-19 (coronavirus). We can see multiple effects on the lives, livelihoods, and well-being of people and communities, on health systems and services, and on economies.

With the crisis expected to deepen before it improves, there are some foundational issues relating to health systems and people’s access to health services that, from our position as co-chairs of the International Partnership for Universal Health -Coverage 2030 (UHC2030), we want to highlight.

UHC2030 is the global movement to build stronger health systems in order to achieve universal health coverage (UHC). Right now, health systems and UHC are what will make the difference to each country’s response to COVID-19.  They affect whether all or only some receive treatment, as well as rates of recovery and the level of protection afforded to health workers.

UHC and health emergencies

The pandemic brings into sharp focus two core truths. First, the premise of UHC – to ensure health for all without causing financial hardship – is absolutely fundamental to make sure that everyone, no matter who they are or where they live, has access to the free-of-charge testing  and treatment they need for COVID-19. Second, strong health systems are crucial in order to respond to health crises.

The pandemic is a stark reminder that governments in countries around the world carry the primary responsibility to ensure people’s health as part of the social contract.  Health services for all are critical to ensuring that the women and the most vulnerable and marginalized groups can fully access opportunity.

We all know that many countries around the world do not have strong enough health systems and economies to cope with a massive health crisis. The tragedy of the pandemic is unfolding in places with limited and underfunded health services, too few and often unprotected health workers, and health systems thoroughly unable to cope. People who will suffer the most, and even lose their lives, will be the most vulnerable members of the population: the poorest, the oldest, those with existing underlying health conditions.

This is why we, the UHC movement, urgently want to highlight the interconnectedness of UHC and capacity to address health emergencies.  In fact, we say that UHC and health crisis management are two sides of the same coin. We are not alone in this view. In recent years, G7 and G20 leaders have also promoted strong and resilient health systems as vital to making progress toward UHC and ensuring effective health crisis management.

Calling leaders to keep UHC promises

The UHC movement now urgently calls on leaders to recognize this interconnectedness with health emergencies and to stand by their UHC commitments.

The UHC2030 movement, which includes governments, parliamentarians, civil society, the private sector, international agencies, global health networks, and academia, came together around a set of UHC Key Asks. These fed into the key targets, commitments, and actions in the declaration from the UN High-level Meeting on Universal Health Coverage: Moving Together to Build a Healthier World. This was one of the most ambitious and comprehensive declarations on global health in history.  

Actions for UHC in a health crisis

As countries make vital decisions in their response to the pandemic, and as we look to a future in which health crises will inevitably occur, we ask that leaders take into consideration the following UHC Key Asks which are applied here to the context of COVID-19.  These are mutually reinforcing with the seven urgent actions to prepare the world for health emergencies that were issued by the Global Preparedness Monitoring Board in 2019.  

Ensure political leadership beyond health. COVID-19 requires bold political decisions and responsible leadership at the highest levels. Health crisis preparedness and response are public goods that are primarily the responsibility of governments.

Leave no one behind. No one should face financial, geographical, and cultural barriers that prevent access to relevant information, appropriately prioritized testing, or treatment for COVID-19.  Safety nets are essential to ensure people can afford to isolate and minimize the spread of infection. These measures should especially recognize the needs of vulnerable people, older people, and those with underlying health conditions.

Regulate and legislate. Health crises such as COVID-19 require bold emergency measures. Transparency, inclusiveness, and accountability build trust. Regulatory measures must ensure patient safety while enabling urgent innovative solutions.

Uphold quality of care. COVID-19 is placing huge strain on health systems and services. Governments must pay special attention to protect health workers and take urgent action so that essential medicines and equipment are available where they are most needed. Context-specific guidance on triage and referral is essential to meet urgent needs while protecting health systems to the greatest extent possible. 

Invest more, invest better. COVID-19 highlights pre-existing needs to increase domestic investment into health and preparedness, especially via public financing (including social insurance contributions where relevant), and reduce reliance on impoverishing out-of-pocket payments. Where countries require external support, this should be harmonized to reduce fragmentation. Governments must also step up investment in innovation (including vaccines, diagnostics, medicines and digital solutions).

Move together. COVID-19 demonstrates that health is everyone’s business. Countries must come together, with the international community, to ensure coherent action. The G7, G20, G77, and regional inter-governmental organizations should lead by example. At all levels, social solidarity and public trust are essential: governments must meaningfully and transparently engage the whole of society in their responses.

Ensure gender-equitable responses. At times of crisis, the needs and rights of women and girls are often neglected. This pandemic suggests more COVID-19 deaths among men than women. Countries should report sex-disaggregated data on testing, confirmed infections, and deaths – and be sensitive to gender throughout their actions.

In reminding world leaders how their UHC commitments can guide action during this global emergency, the UHC movement stands in solidarity with the hardest-hit communities, brave political leaders, and health workers on the front line. 

Prof. Ilona Kickbusch, Chair, International Advisory Board, Global Health Centre, Graduate Institute for International and Development Studies Geneva and Co-Chair of UHC2030

Dr. Githinji Gitahi, Global CEO, AMREF Health Africa and Co-Chair of UHC2030

For further information:

• UHC2030 Co-Chairs’ statement on COVID-19 and UHC
• G7 Ise-Shima Leaders’ Declaration (2016)
• G7 Ise-Shima Vision for Global Health (2016)
• G20 Leaders´ Declaration Shaping an interconnected world (2017)
• Berlin Declaration of the G20 Health Ministers: Together Today for a Healthy Tomorrow (2017)