What is Universal Health Coverage? How many people lack health coverage? Is UHC achievable? In this series of explainers, we answer your questions on each proposal in The Elders' new initiative to campaign for Universal Health Coverage.

What is Universal Health Coverage?

Universal Health Coverage is achieved when everybody receives the quality health services they need without suffering financial hardship.

How many people lack health coverage?

According to the World Bank and WHO, across the world at least 400 million people lack access to at least one, of seven, essential health servicesⁱ and 100 million people are tipped into or pushed further into poverty because of health spendingⁱⁱ.

It is likely that these figures underestimate the problem of low coverage because only seven services were assessed in the World Bank / WHO report. Also in India only around 17% of the population have any formal health insuranceⁱⁱⁱ and as public services are grossly underfunded, one could argue that around 1 billion people in India alone lack effective health coverage.

Isn’t UHC rather utopian and unachievable for poor countries?

As the Nobel Laureate, Professor Amartya Sen argued in 2015, UHC is not a fantasy; countries around the world have proved that it is “an affordable dream^iv”.

Success stories like Sri Lanka, Thailand and Rwanda show that, at all income levels, countries can make dramatic progress towards UHC relatively quickly.

What are the main requirements for countries to achieve UHC?

• Genuine and sustained political commitment from the head of state and across government
• A health financing system that is dominated by adequate levels of public financing, so that healthy-wealthy people subsidise the sick and the poor
• Public health funds allocated equitably to meet the needs of the population with a high priority given to meeting the needs of the poor and vulnerable
• Well functioning health systems specifically concerning human resources, health infrastructure and access to medicines.

What is the connection between UHC and health systems strengthening?

UHC is the goal the world is aspiring to where everyone gets the services they need. This is achieved through strengthening health systems including the health financing system.

Which countries have achieved UHC?

Strictly speaking no country has reached a perfect state of UHC where everyone gets every service, immediately, with ideal quality but with no financial burden at all. However, virtually all high-income countries have made very good progress towards this goal.

The United States is a notable exception where 33 million people (10.4% of the population) still don’t have any health insurance.

There are also good examples of middle and even low-income countries that are UHC success stories including: Thailand, Malaysia, Sri Lanka, Bhutan, Mexico, Brazil, Costa Rica, Kyrgyzstan, Turkey, Georgia, Rwanda and Ethiopia.

Where are women and babies being detained in health units because they can’t pay their medical bills?

There is recent evidence of this happening in Nigeria, Cameroon, DR Congo, Zimbabwe, Ghana, India and it is likely to occur in other countries charging user fees for maternal and child health services.

^{_{i World Bank and World Health Organisation 2015 Tracking Universal Health Coverage 1st Global Monitoring Report}}

^{ii _{Evans D et al World Health Organisation 2010 Health Systems Financing the Path to Universal Coverage  The World Health Report}
iii _{Mehra P Only 17% have health insurance The Hindu 22nd December 2014}
iv _{Sen A Universal Health Care the Affordable Dream The Guardian 6 January 2015}}