Providing healthcare cover

Universal Health Coverage: are we heading in the right direction?

Providing healthcare cover


ealth is a fundamental right of every human being. In order to deliver quality healthcare, a qualified and skilled workforce is needed.

Health indicators have generally worsened following the Covid-19 pandemic. The global prevalence of many diseases has significantly increased. Huge efforts are required to ameliorate these in order to make the healthcare system efficient and cost-effective. Universal Health Coverage (UHC’s) action agenda consist of eight agendas focusing on how countries and regions can make advancements in UHC and deliver health for all by the year 2030.

With a view to understanding what universal health coverage entails and what it means for a low-middle-income country like Pakistan, let’s look at the larger picture and find out answers to the question: Are we getting closer to the target of achieving Sustainable Development Goals (SDGs)?

The 17 interlinked SDGs are global goals adopted by United Nations in 2015 to promote equity and prosperity. SDG target 3.8 is Universal Health Coverage, i.e. having access to quality and essential health services without financial hardship.

At the national level, is our approach to addressing inequalities in health appropriate? Is our health system geared to provide essential health services? The essential package of health services (EPHS) includes a set of services to which all populations have guaranteed access. These include reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases (NCDs) and health services. The EPHS has been developed to ensure the provision of essential services through an integrated approach.

Do we have a trained workforce to provide these integrated, people-centred services? Are we utilising the existing resources aptly? Despite the identification of health problems, there is no management and facilitation of primary care. Public health objectives can only be achieved through a robust primary care system. This, in turn, will lead to the strengthening of the public healthcare delivery system.

We barely have seven years left to achieve these targets. Are we expecting miracles to happen?

Let’s break down big problems into smaller problems in order to solve them. Is it possible to achieve UHC without having robust primary care? No, it is not.

Is our current primary healthcare (PHC) system capable of achieving UHC and delivering health for all by 2030? Once again, the answer is no.

Pakistan is highly committed to reaching the Sustainable Development Goals. The National Health Vision 2016-2025 has been developed and directed, considering health challenges faced by Pakistan and keeping Universal Health Coverage as its ultimate goal.

The family practice approach is essential for improvement of health indicators and for providing accessible and affordable care. The WHO’s Eastern Mediterranean Regional Committee, in its 63rd session, endorsed a resolution in which they urged member states to incorporate the family practice approach to primary healthcare (PHC) services as a strategy for achieving Universal Health Coverage as it is necessary for the success of and sustainability of any healthcare system.

Training of the health workforce, particularly the primary care physicians (PCPs), also called family physicians (FPs) or general practitioners (GPs), who act as gatekeepers of the healthcare system, can be achieved through training programmes that have been specially designed for capacity building of PC physicians.

Pakistan requires more than 70,000 trained family physicians to achieve the minimum target of three trained family physicians per 10,000 population. The main challenge is the shortage of trained and certified family medicine faculty. Bridging training programmes are needed to overcome this shortage until the speciality has fully developed and doctors get fellowships and higher degrees in family medicine.

The bridging programme can serve only as an interim arrangement for training the existing general practitioners. It’s not a replacement for a complete family physicians training programme. Once the current generation of general practitioners is transformed into family physicians, all new medical graduates should be encouraged to undertake full fellowship training programmes, which the College of Physicians and Surgeons Pakistan already offers.

The entire primary care team or family practice team, including the lady health workers, nurses, medical technologists and general practitioners/ doctors from both public and private sectors, must be included and their educational needs incorporated into the curriculum. Their job descriptions and scope of practice need to be carefully developed and identified. They should be provided adequate education and training to ensure the delivery of essential health services at the PHC level.

Essential services must be provided at the PHC level as the number of first-level healthcare facilities in districts is significantly more than higher centres/ hospitals.

Currently, there is no electronic medical record system. This compromises patient care due to the lack of availability of previous medical history. The plan is to link it with social initiative health insurance and start the referral process to develop a formal patient referral system. Such measures will improve access and utilisation of PHCs which is currently deficient.

A key element for the UHC project’s completion and success is a paradigm shift. To reach fruition, the project must use the bottom-up approach, i.e. include the community in strategic planning. This will increase awareness amongst the population about the need for cost-effective and quality care by family medicine specialists. Investing in primary care will undoubtedly lead to reduced total health expenditures.

Dr Hina Jawaid is an associate professor in family medicine at the University of Health Sciences, Lahore

Dr Abdul Jalil Khan is an associate professor in family medicine at Khyber Medical University, Peshawar

Providing healthcare cover