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In June 2012, Marly Aparecida Dias Gaya’s life in Sao Paulo, Brazil changed dramatically when she fell down the stairs and hit her head. Her injury had doctors worried she might never walk, talk, or even recognise her family again.
Marly underwent two successful brain operations, as well as treatment for her other injuries, and slowly began to recover. She spent a month in the hospital – including 10 days in intensive care – before she was finally able to return home to her family.
Fortunately, in the wake of such a debilitating event, she will not have to worry about medical expenses. She did not have to pay anything for her treatment because all costs were covered by the Sistema Unico de Saude, Brazil’s health system.
Brazil is one of many countries on the path towards universal health coverage. Almost a year ago, the United Nations passed a historic resolution on universal health coverage stating that no man, woman, or child should fall into poverty because he or she cannot afford the necessary health services needed to live a healthy, productive life.
Earlier this month in Tokyo, momentum continued as World Bank President Jim Kim declared that access to affordable health care for all people is a crucial factor in alleviating poverty, promoting economic growth and creating more equitable societies.
He stated that universal health coverage should be firmly embedded within the post-2015 development agenda. However, with 1 billion people still unable to access high quality basic health services and 100 million being forced into poverty each year due to high out-of-pocket spending on health care, huge challenges remain.
Low- and middle-income countries are increasingly reforming their health systems based on the principles of universalisation, equity, and sustainability. For more than a decade, Rwanda, a low-income country, has implemented health reforms specifically aimed at making quality and affordable health services accessible to all.
When they started, many experts said it was impossible – but Rwanda trained a team of 45,000 community health workers to help their fellow citizens understand the importance of prevention, screening, and early treatment. Rwanda also implemented a community insurance scheme and a web-based system for managing quality patient care.
Results were not achieved overnight and long-term planning and investment were critical, but Rwanda can now point to several successes. Since 1994, HIV infections have been halved, malaria deaths have been reduced by three quarters, and child mortality is down 70 percent – one of the fastest rates of decline in the world. More than ninety percent of Rwanda’s population is now covered, and Rwanda is one of the only countries on track to meet the Millennium Development Goals.
The experience from Rwanda and Brazil contributes to the growing body of international evidence that universal health coverage is the next logical step to improve health and reduce poverty for people worldwide, particularly those in low- and middle-income countries.
Bangladesh, Ethiopia, Ghana, Indonesia, Peru, Thailand, Turkey, Rwanda, and Vietnam all stand at various points on the path towards universal health coverage. We must help empower them to prioritise UHC through efforts that encourage joint knowledge sharing and problem solving, to ensure that they are able to deliver the promise of affordable, quality health care.
Now is the time to be bold. Universal health coverage is a powerful means of increasing equitable access to quality care and bolstering the financial resilience of poor and vulnerable populations.
The Rockefeller Foundation, with its century of public health expertise and through its current work on transforming health systems, believes that improving health could have a transformative effect in the battle against poverty – and universal health coverage is a proven way to increase coverage, decrease out-of-pocket expenses, and create a situation where all people can use the critical health services they need without the fear of impoverishment.
As discussions move forward on identifying future global health objectives after the Millennium Development Goals expire, and countries strive to find ways of simultaneously improving health outcomes, reducing poverty and stimulating their economies, one thing is certain: universal health coverage is both a human right and a smart economic choice.
Jeanette Vega is managing director of the Rockefeller Foundation, leading the foundation’s work in health including the development of strategy, the implementation of the foundation’s current Transforming Health Systems Initiative and the pursuit of new work in the field