Feature story

WHO World health report: The road to universal coverage

22 November 2010


If countries are to guarantee a good quality of life and ensure socio-economic development for people then promoting and protecting health is crucial. Without greater emphasis on health systems financing, however, this goal will remain unattainable for the poor, says the World Health Organization’s (WHO) World Health Report 2010, launched today.

Subtitled Health systems financing: the path to universal coverage, the report provides a detailed analysis of how this can be achieved with the provision of timely access to high-quality, affordable health services.  

The concept of universal coverage emerged from a commitment from WHO member states in 2005 to develop their health financing systems. As the report has it, in an era of “globalisation of diseases” and increasing demands for chronic care from, for example people living with HIV on long term antiretroviral treatment, universal coverage will be of paramount importance.   

According to the World Health Report, the lack of universal coverage has consequences for the poor. In some countries, for instance, the proportion of births attended by a skilled worker can be as low as 10%. This figure is close to 100% for richer nations.

Attaining universal coverage is considered relatively straightforward in principle but difficult in practice, and among others these two key actions are highlighted in the report.

Raising sufficient resources for health

Firstly, countries must raise sufficient funds. For many lower-income nations this may prove impossible in the short-term and the international community will need to financially support their efforts. Such nations currently spend around $US 32 per capita on health. To provide universal coverage this should be raised to US$ 60 by 2015.

Recipient countries can also increase their own health funding by reprioritising their budgets. Few African countries, for example, spend the 15% of their government budget on health they committed to in the 2001 Abuja Declaration. In fact, 20 countries in the region who signed the commitment actually allocate less now than they did nine years ago; although several, including Tanzania and Liberia, have exceeded this goal.

Another example is Rwanda’s donation of US$ 1 million in this year’s replenishment round of the Global Fund to fight AIDS, Tuberculosis and Malaria and South Africa’s announcement earlier this year of a US$ 1.1 million domestic investment in the country’s AIDS response.

Investing for health must be shared responsibility between development partners and national government

Michel Sidibé, UNAIDS Executive Director.

“Investing for health must be shared responsibility between development partners and national government,” said Mr Michel Sidibé, UNAIDS Executive Director. 

Innovative financing may also be explored. Increasing taxes on air tickets, foreign exchange transactions and tobacco could be used to augment health budgets. The report states that, for example, a 50% increase in tobacco excise taxes would generate $US 1.42 billion in additional funds in 22 low income countries for which data are available. In countries such as the Lao People’s Democratic Republic, Madagascar and Viet Nam, the extra revenue would represent a 10% increase or more in total health expenditure, and a more than 25% in crease in the government’s total health budget.

Promoting efficiency and eliminating waste

Finally, the report suggests that inefficiency and waste can be extremely damaging for healthcare systems. It is argued that some 20-40% of resources spent on health are wasted. A 5% saving in health expenditure can be made if unnecessary spending on medicines is reduced, they are more appropriately used and quality control is improved.

Other ways to increase efficiency include; getting the most out of technologies and health services; motivating health workers; reducing medical errors and eliminating corruption.