New WHO report and civil society’s perspective on Universal Health Coverage

“The world is off track to make significant progress towards universal health coverage (UHC) (Sustainable Development Goals (SDGs),” says a new WHO and World Bank global monitoring report of universal health coverage. Civil society consultations, including in EECA countries, confirm that inadequate health financing by governments is becoming a major barrier to increasing access to services, especially for poor and marginalized groups.

The WHO global monitoring report highlights that the health service delivery environment in the WHO European Region is relatively good compared to other regions, especially in high levels of coverage and affordability. However, global trends leave much to be desired. Data for the EECA region are not detailed in the report. Below are the main findings of the document summarized by the Civil Society Engagement Mechanism (CSEM).

Service coverage (measured by the Service Coverage Index):

1. There have been some improvements in health service coverage since 2001. For example, the number of countries with a high SCI score increased from one to 42 by 2021. However, progress has slowed and further improvements have been minimal or stopped altogether.
2. The largest increases in service coverage occurred in communicable disease services, including antiretroviral therapy for HIV, while service coverage for noncommunicable diseases and reproductive, maternal, newborn and child health improved minimally and further progress largely stopped.
3. Overall, inequalities in health coverage between countries have decreased since 2000, but remain at the national level, as access to health services varies among different population groups. For example, those living in rural areas and in the poorest communities have less coverage than the national average.

Financial constraints:

1. The proportion of the population facing catastrophic levels of personal health care costs has increased, surpassing 1 billion in 2019.
2. Low- and middle-income countries are seeing improvements in coverage, but they also suffer the largest catastrophic increases in health care costs.
3. People below the extreme poverty line experienced an 80% decrease in personal spending leading to impoverishment between 2000 and 2019, while people below the relative poverty line experienced a 42% increase in the same rate over the same period.

Impact of COVID-19:

While there is a significant lack of available data due to disconnections and travel restrictions associated with COVID-19, the available evidence suggests that service coverage and financial hardship worsened during the pandemic.

The response to the WHO and World Bank CSEM report, where the EECA region is represented by Zahedul Islam and Denis Godlevskiy, noted that insufficient public funding and the impact of COVID-19 had a particularly serious impact on the most vulnerable and marginalized groups in society. These issues are often not adequately addressed in the WHO and World Bank document. In its report, CSEM proposes the following 8 actions that are also relevant for EECA countries:

• Increase commitment and political will to achieve universal health coverage,
• Collect, analyze and use disaggregated data to inform decision-making and ensure that no one is left behind,
• Improve the quality and availability of health data,
• Strengthen universal health coverage policies and practices, regulations, including those aimed at reducing financial constraints,
• Invest in health by allocating at least 5% of GDP,
• Involve civil society and communities,
• Ensure gender equality in universal health coverage (including women’s leadership and addressing the underlying reasons why women have lower coverage and higher financial barriers),
• Emphasize the link between UHC and pandemic preparedness and response.

The proposed actions can be a starting point for change and for significant progress towards achieving universal health coverage in the region.