Making Wise Choices as We Move Toward Health for All
Photo above: Patients wait for care at the Centro de Salud Granada health center in Granada, Nicaragua. Photo credit: Billy Weeks.
By: Dave Ross, ScD
Last month, we met with World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus, and among the topics that came up was Universal Health Coverage, a subject that is close to our collective hearts at The Task Force. To my mind, UHC, as many in public health refer to it, is necessary and inevitable. But it’s a slow march as there’s not an infinite supply of doctors and nurses. We need to be smart about growing the health workforce to keep pace with promising access to services for all.
There is no doubt it’s possible within current contexts. For instance, one of our programs in Kenya has revolutionized access to good care by establishing electronic health workforce information systems that provide accurate and real-time data for policy, health program planning and management of the country’s healthcare personnel. And the best part is that this is a completely replicable and financially self-sustaining model. You can read about its transformative impact here.
However, it’s becoming increasingly evident that a thoughtful restructuring of countries’ health systems – including the United States – is essential to maximize the benefits of task shifting such as having nurses do the tasks previously done only by physicians, and community health workers being trained to perform specific tasks usually done by nurses, for example, administering medications. Countries need to develop primary care facilities and make them more robust so patients don’t need to seek tertiary care for non-emergencies.
Even in this most developed country, we struggle to get essential health services to those who need them. When we debate Universal Health Coverage, we are really boiling it down to one of two issues: Cost and Values. Is it a human rights issue or is it an economic issue? If healthcare is a financial transaction, then the alternative is to say, ‘we are willing to let you die because you don’t have access to health care.’ When confronted with those two choices, most people would probably land on the idea that everyone has a right to some sort of healthcare service.
What should start the Universal Health Coverage conversation – values and the value of a life or economics? Where and how values come into this conversation is critical for guiding us to policies that everyone can embrace, support, and fund. There will inevitably be more demand than supply. Therefore, how do we ration care – Who needs the care most or who can pay most?
We must segregate the philosophy that guides a nation’s approach towards Universal Health Coverage from focusing on how it’s delivered to the actual provision of care. I don’t believe that deciding everyone should have access to a basic suite of services necessarily eliminates a private health care approach.
Around the world we see multiple models in play – some based on private insurance schemes, some based on nationalized service delivery. Experience shows that there are effective low-cost ways to operate, and we as a global health community can map out scalable solutions and learn from one another’s approaches.
But before we debate how to deliver care, let’s first agree on why we’re giving care. Is it because I can pay or because I am in need?
I am curious to know your thoughts on this. How do you think we can expand coverage and minimize the cost of healthcare?