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Expanding social health protection to reach universal health coverage

Healthcare workers wearing protective gear collect samples through a plexiglass wall during a Covid-19 swab test in Medan, North Sumatra, Indonesia, July 2020. Credit: Keystone/EPA/Dedi Sinuhaji

Experts met at the Geneva Health Forum this week to discuss the successes and challenges met in expanding social health protection to achieve Universal Health Coverage (UHC).

Every year, around 100 million people are pushed into “extreme poverty” because they have to pay for health care, and over 800 million people - almost 12 per cent of the world's population - spend at least 10 per cent of their household budget on health care costs, according to WHO figures.

With half of the world's population still not having access to the health services they need because of financial constraints, social health protection - meaning any kind of financial system that assures access to health care, including both free national health insurance or affordable health insurance plans - is vital to bridge this gap and reach the goal of Universal Health Coverage (UHC) set by the 2030 Sustainable Development Agenda.

“A number of countries are trying to strengthen their efforts and expand social health protection as a right - a right to be enjoyed by everybody,” said Claude Meyer from P4H Social Health Protection Network, speaking at a Geneva Health Forum (GHF) event on Tuesday to discuss global efforts to extend social health protection systems to achieve UHC. “But they are often confronted with what we call fragmented systems of coverage, and these fragmented systems of coverage affect equity.”

The GHF invited three experts to reflect on the ways this fragmentation of health care can be reduced while extending coverage, and offer examples of methods in practice across different countries.

Merging social health protection systems. Valeria Schmitt, deputy director of the social protection department at the International Labor Organization (ILO), discussed how merging different systems could serve to reduce admin costs and ensure healthcare services are more widely available.

“Regarding fragmentation of institutions, it's very clear that instead of having two or even three institutions in charge of access to health care, as it is the case in Thailand for instance, merging the operations would reduce admin costs,” said Schmitt.

But such a move is by no means easy. Thailand has been attempting to merge the three systems into one for many years to level up inequalities between the care available for the three different social groups that are protected by each scheme - civil servants, workers in the so-called formal sector, and informal workers .

Aungsumalee Pholpark, lecturer at the department of society and health at Mahidol University in Thailand, explained that, if achieved, combining the three schemes into one would hopefully solve problems that exist in the current systems, where informal workers often receive lower standards of care.

Difficulty reaching the most vulnerable populations. There are also specific challenges within certain populations, the panelists noted, especially hard to reach communities that may be remote from central administrations and institutions. Matthew MacGregor from the Global Fund discussed how, as countries make changes and transition between systems to achieve UHC, the most vulnerable populations are at risk of being left behind.

“At the Global Fund, enhancing equity and making sure that services reach the most vulnerable and are sustained even beyond our financing is a critical and major piece of our work,” said MacGregor. He emphasised the importance of external funding to strengthen public health systems and outreach programmes to make sure health care services, when available, can actually reach the most vulnerable populations.

A new recognition for UHC after Covid-19. The experts also discussed the key lessons of Covid-19 in terms of UHC - primarily the importance of investing in social protection systems for health coverage.

“Countries that already had relatively strong social protection institutions in place were able to react to Covid-19 much more rapidly and efficiently,” said Schmitt, citing the example of Indonesia, which has invested heavily in its national health insurance system for many years and was able to rapidly distribute testing and treatment widely among the population.

Schmitt also noted how Covid-19 had highlighted the need to ensure people at all levels of society had equitable access to a high standard of health care, and the ability of governments to make this happen.

“I think Covid-19 has shown that when you have the political will, you can implement social health protection and social protection in general, and that there is solidarity at the level of the international community,” she said. “So this gives a message of hope that if all the countries want to achieve universal health coverage and universal social protection, they can make this happen.”

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