“ Universal health coverage embodies the world’s agreement on the need for quality health care for all, without discrimination or financial hardship”
that local transport can reach her and take her to a healthcare centre that is open all hours and where qualified, trusted staff, who understand her needs, will refer her to specialist care if necessary. Or think of a teenager, unable to cope with the stress of school and the effects of the Covid-19 pandemic. They need an education system that promotes health, understands their fears, and provides them with the information and support they need to stay active and healthy, including mental health services. Universal health coverage embodies the world’s agreement on the need for quality health care for all, without discrimination or financial hardship. It means that services are delivered in an integrated, people-centred way, close to where they live and work, in ways that respect their values, human rights, dignity and equality. REFOCUSING HEALTH SYSTEMS Refocusing national health systems on primary health care is the most equitable, effective and cost-efficient way to deliver on the promise of universal health coverage and health security. A health system that is founded on the principles of primary health care can better protect and serve communities by treating people when they are sick and helping to prevent diseases by addressing the external factors that affect health and well-being. Such a system is key to the long-term resilience of health systems – the fragility of which has been exposed by the Covid-19 pandemic. As the first point of contact between individuals, communities and national systems, for example, a PHC system can effectively control disease outbreaks through immunisation and prevention and maintain essential health and social care services when hospitals are overwhelmed. Strengthening resilience is critical to providing continued care, and to ensuring timely and effective responses to, and recovery from, shocks and crises. Focusing health systems on primary health care requires government and governance, backed by strong and aligned financing systems. Many continue to rely on external assistance to fund their health systems. This external assistance is still too often heavily earmarked to support specific diseases or interventions that drive fragmentation and separate delivery channels, making it difficult
for country decision makers to finance and deliver a universal package with comprehensive services. Even when external funds are moved ‘on budget’, fragmented fund flows will persist without specific efforts to improve coordination. We need international and national actors to unite on a common vision to avoid this. This September, three high-level meetings on health took place at the United Nations General Assembly, providing world leaders a unique opportunity to make progress on these issues: to bolster health systems to achieve universal health coverage, end tuberculosis, strengthen pandemic prevention, preparedness and response, and invigorate progress on SDG3 – to ensure healthy lives and well-being for all. This is a chance to elevate health to the highest political level, to generate clear political commitment, and align national and international actors. Governments must agree on ways forward to scale up progress on communicable diseases, address the rising burdens caused by non-communicable diseases and mental health, and the growing threats posed by climate change and antimicrobial resistance. Civil society, healthcare representatives and more of us can support them by raising our voices and sharing a common vision of people-centred, integrated health services for all. In all countries, a PHC approach can be critical to achieving that vision. Investing in a PHC approach is vital for the health and well-being of all people, for their prosperity, and for the planet that sustains us. ▪
AMINA J MOHAMMED Amina J Mohammed is deputy secretary- general of the United Nations and chair of the United Nations Sustainable Development Group. Previously she served as the minister of environment of Nigeria. She first joined the UN in 2012 as special adviser to Secretary-General Ban Ki-moon with the responsibility for post- 2015 development planning. In Nigeria, she served as an advocate for increasing access to education and other social services, and advised four successive presidents on poverty, public sector reform and sustainable development.
X-TWITTER @AminaJMohammed un.org/sg/en/dsg
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Health: A Political Choice – From Fragmentation to Integration
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