Universal Health Coverage And Nepal
Dr. Prakash Budhathoky
At least half of the people in the world do not receive the health services as per their need at present. About 100 million people are pushed to extreme poverty each year because of their inability to spending on health.
The universal health coverage means that all people should have access to the health services they need, when and where they require them, without any financial hardship. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation and palliative care.
Universal coverage is firmly enshrined in the WHO constitution of 1948 declaring health a fundamental human right and on the Health for All agenda set by the Alma-Ata declaration in 1978.
Equal access is paramount and should be based on strong, people-centred primary health care. They focus not only on preventing and treating disease and illness but also on helping to improve well-being and quality of life. In Nepal, it is named as Basic Health Service.
Requirement
For a community to realise this basic health right, several factors must be in place. Some of these factors are:
A strong, efficient, well-run health system that meets priority health needs through people-centred integrated care
Affordability – a system for financing health services so people do not suffer financial hardship when using them.
Availability of essential medicines and technologies to diagnose and treat medical problems.
A sufficient capacity of well-trained, motivated health workers to provide the services to meet patients’ needs based on the best available evidence.
Actions to address social determinants of health such as education, living conditions and household income which affect people’s health and their access to services
Free Health Care Policy
Free health care (FHC)policies aim to reduce the financial barriers that people may experience when trying to access health services. They eliminate formal user fees at the point of service. Examples of the services under a free health care policy include antenatal care, assisted deliveries, caesarean sections, health services for children below a defined age (often 5 years), health services for elderly people above a certain age (often 65 years).
The defined geographical areas, socio-demographic criteria and services are chosen to protect population groups deemed to be especially vulnerable, particularly low-income groups. But in Nepal, there is a tendency of providing free services on a blanket approach.
When introducing an FHC policy, a government explicitly intends to make progress towards UHC in two ways: 1.increasing service utilization for specific services, in line with people's health needs.2.improving financial protection. FHC policies also aim to enhance the quality of the health services guaranteed through this policy. Transparency and accountability are important aspects, as eligible people need to know if the policy applies to them.
While FHC policies may trigger an increase in the use of services, evidence on improved financial protection is mixed. People may still have to make direct payments for other services they need. Moreover, if not properly anticipated and backed by increased supplies and medicines, FHC may have negative unintended consequences, such as patients having to pay for this scarce supply informally or in the private sector.
Also, if user fees previously retained at the facility level are abolished, their effect as a direct incentive for health workers disappears, possibly leading to demotivated staff.
Finance
Universal health coverage is fundamental to ensuring social protection for health. The poorest populations often face the highest health risks and need more health services. A key element of financing for universal health coverage is sharing resources to spread the financial risks of ill-health across the population.
The system should collect large pools of prepaid funds that can be used to cover the health care costs of those in need, regardless of their ability to pay. The countries that have made the most progress on providing universal health coverage have implemented mandatory contributions for people who can afford to pay through taxation, and/or compulsory earmarked contributions for health insurance. Reducing the reliance on direct, out-of-pocket payments lowers the financial barriers to access and reduces the impoverishing impact of health payments
Countries at all income levels can take steps to move closer to universal health coverage. Nepal, where free universal health care was introduced in 2008, is now on track to achieve its health-related MDGs.Thailand has just celebrated ten years of its universal coverage scheme which has dramatically reduced impoverishment caused by out-of-pocket payments.
Impacts
Universal health coverage has a direct impact on a population’s health. Access to health services enables people to be more productive and active contributors to their families and communities. It also ensures that children can go to school and learn.
At the same time, financial risk protection prevents people from being pushed into poverty when they have to pay for health services out of their own pockets. Universal health coverage is thus a critical component of sustainable development and poverty reduction, and a key element of any effort to reduce social inequities. Universal coverage is the hallmark of a government's commitment to improving the wellbeing of all its citizens.
The theme of UHC Day 2020 was 'Health for all: protect everyone. To end this crisis and build a safer and healthier future, we must invest in health systems that protect us all — now' UHC Day Campaign on 12 December 2020 marked one year since the first cases of COVID-19 were reported.
Call on policy and decision-makers to focus on improving all of the three pillars of Healthy systems for universal health coverage - a joint vision for healthy lives (joint vision): service delivery, health financing and governance.
At last, to make health for all a reality, we need individuals and communities who have access to high-quality health services so that they take care of their health and the health of their families; skilled health workers providing quality, people-centred care; and policy-makers committed to investing in universal health coverage.
Universal health coverage is not something that can be achieved overnight, but all countries can take action to move more rapidly towards it or to maintain the gains they have already made.
(Dr. Budhathoky is central treasurer Of Nepal Medical Association)