Universal Health Coverage: a promise unfulfilled

Islamabad: Universal Health Coverage (UHC) can be a nation’s promise to its people, remarked Dr Sania Nishtar, Pakistan’s internationally renowned health expert, whose views on the UHC and other major global health trends were sought during an exclusive interview arranged on the eve of World Health Day. This year’s theme of the annual April 7 celebration is the UHC.

Amongst many other roles, Dr Sania is co-chair of the Global High-Level Global Commission on Non-Communicable Diseases (NCDs), along with the Presidents of Uruguay, Finland and Sri-Lanka. It is not every day that a Pakistani woman co-chairs a Commission with heads of states, which is why ‘The News’ chose her for the World Health Day interview, excerpts from which follow:

The News: What is the significance of World Health Day and UHC for Pakistan?

Dr Sania Nishtar: There are three important dimensions of the UHC. One is a geographic access, which means healthcare should be within reach; people shouldn’t have to walk or drive miles on end to reach a healthcare facility. The other is financial access, which means people shouldn’t come under financial stress while seeking treatment; they shouldn’t have to borrow or sell, or forego care because of inability to pay. The third dimension is quality—services and healthcare must be of quality in order to have impact. It is critically important to address these issues in Pakistan since geographic and financial barriers and quality compromises are well-recognised.

TN: How can we achieve UHC in Pakistan?

SN: The UHC has implications, not just for health policy but also for overall social and fiscal policies. It is not just a technical decision of a ministry of health. Governments must have a long-term social policy vision and commitment for the UHC, and that needs to be insulated from policy vacillations that are inherent to change in government.

Governments also need to have institutional capacity to conceptualise, plan, and implement reform in the health sector and the agility to adapt reform, based on lessons learnt. For Pakistan, it means a multi-dimensional effort aimed at reforming primary healthcare, hospitals, harnessing the outreach of private providers, reform of regulatory agencies, broadening the base of financing through legislative instruments, expanding insurance where relevant and deepening social protection for health.

TN: What is the relevance of NCDs within the connect of the UHC?

SN: NCDs (a collective name for diabetes, cancers and heart and lung diseases) are the majo global killers. They account for an annual estimated 38 million death toll, which is more than the death toll of malaria, tuberculosis, HIV and AIDs and maternal conditions combined. NCDs pose a huge burden on economies; they are projected to incur economic losses of US $7 trillion over the next 15 years, if left un-addressed. Through the Commission on NCDs, we are identifying innovative ways to curb the world’s biggest causes of death and extend life expectancy for millions of people.

TN: What is the connection between NCDs and the UHC?

SN: For decades, the healthcare needs of the developing countries were thought of as being synonymous with maternal and child health and infectious diseases. But now it is clear that NCDs incur the major burden of disease. So, when governments underwrite entitlements for citizens in UHC plans and insurance initiatives, they must factor in NCDs. Primary Healthcare (PHC) must also focus on NCDs. A recently conducted survey by my organisation found that 93% and 86% of health workers including doctors and non-doctors respectively, reported “not having seen” heart disease and diabetes management guidelines in PHC facilities in Pakistan; 79% doctors, 93% nurses and 86% health workers at PHC facilities respectively, reported no training in heart disease, diabetes and cancer management. Medicines for heart diseases and diabetes were not available in over 65% of the facilities. Of course, there are provincial variations, with some strong and other weak areas. We must address these gaps.

TN: What do you think are the biggest health challenges of the century?

SN: Infectious outbreaks and emergencies with health consequences, antibiotic resistance and the silent pandemic of NCDs are the biggest immediate threats to the collective health of people worldwide. These, together with the longer-term threat of climate change, threaten to wipe out the development gains of the last century. Health is one of the top concerns of the 130 million people who are affected by humanitarian crises across the globe today. Health security is also a critical dimension of human security. In 1918, more than 30 million people died due to the Spanish flu pandemic. If such a virus hits today’s interconnected world, over 300 million people could die, and the world can plunge in a deep recession.