Over half the world’s population lacks access to essential health services. More than 800 million people spend more than 10 percent of their household budget on health, and nearly 100 million people are pushed into extreme poverty each year due to high health-related out-of-pocket (OOP) expenditures.
The Tracking Universal Health Coverage: 2017 Global Monitoring Report, released in December 2017 by the World Bank and the World Health Organization, reveals that there’s still a long way to go before we achieve Sustainable Development Goal (SDG) 3 of ensuring healthy lives and promoting well-being for all – and more specifically Target 3.8 of achieving universal health coverage (UHC). However, the encouraging fact is that there is more momentum now than ever before and the global commitment to achieving and measuring UHC is underway.
Measuring Service Coverage and Financial Protection
The new report builds on the 2015 edition by more clearly defining the UHC SDG indicators and increasing the geographic scope of measuring UHC. The 2017 report focuses on monitoring Target 3.8 through two indicators: service coverage and financial protection. Both indicators need to be jointly monitored to get a clear understanding of those who are not able to access health care and those who face financial hardship due to excessive spending on health.
Service coverage is measured through a service coverage index – a single indicator that is computed using the geometric mean from four categories of tracer indicators for coverage of essential services. These four categories include (1) Reproductive, maternal, newborn, and child health; (2) Infectious disease control; (3) Noncommunicable diseases; and (4) Service capacity and access. The goal is for everyone, regardless of living standards, to receive the health services they need.
Financial protection is measured by the proportion of a country’s population with catastrophic spending on health, defined as large household expenditure on health as a share of household total consumption or income. For the SDG monitoring framework, catastrophic spending on health is defined as OOP expenditures exceeding 10 percent and 25 percent of household total income or consumption. The goal here is that the use of health services should not lead to undue financial hardship.
Findings from Global Measurements
Overall, the key takeaways for service coverage reveal that levels of service coverage widely vary across countries; service coverage has increased since 2000, especially with respect to HIV, malaria, and TB treatment; and large wealth inequalities in maternal and child health services persist.
It’s also evident that measuring UHC service coverage is challenging as there is no single dataset that contains all the information required around people receiving the services they need. With respect to financial protection, the incidence of catastrophic health payments (both the percentage and the size of the population) has increased between 2000 and 2010; Latin America and Asia have the highest rates of OOP expenditures; and high OOP expenditures have impoverished roughly 97 million people around the world – primarily concentrated in Africa and Asia.
Going forward, the goal for both indicators is to present more disaggregated data to better understand the equity angle of UHC. Monitoring and presenting these indicators not only promotes accountability, but the hope is that it encourages countries to reflect on and refine their health priorities. We do have a long way to go before achieving UHC – and this has critical implications for the SDGs.
Given the deep interlinkages between the health goal and the 16 other sustainable development goals, it’s clear that good health is fundamental, or even a prerequisite to achieving the rest. If we’re serious about achieving the SDGs, we need to start working harder and faster on UHC than ever before.
Photo credit: World Bank