Today is Universal Health Coverage (UHC) Day. In reflecting on the past year, we have much to celebrate. In September, the Sustainable Development Goals were formally adopted, with Target 3.8 calling for UHC; at the same time, a group of more than 260 economists from 44 countries issued a declaration on UHC that was published in The Lancet. To date, more than 100 countries are in the process of adopting or embarking on UHC to expand availability and accessibility of health services and to extend financial risk protection.
Despite this momentum, significant challenges remain. “400 million people lack access to one or more of seven life-saving health services,” including reproductive health, according to a recent World Bank Group-WHO progress report on UHC.
Health programs and reforms, such as UHC, can succeed only if all people have access to high-quality essential medicines. Equitable provision of reproductive health services requires universal access to reproductive health products, with reproductive health commodity security (RHCS) assurance. UHC and RHCS are intertwined and share values. The definition of UHC and its core principles (equity, access, coverage, quality) are much like the definition of RHCS, which is achieved when ”every person is able to choose, obtain, and use high-quality RH supplies whenever s/he needs them.”
In fact, the lessons and approaches to support RHCS can guide navigation of UHC reforms:
- Family planning is cost-effective and critical to the realization of UHC. A growing number of low- and middle-income countries are embarking on complex and often overwhelming UHC reforms. When countries are prioritizing health programs and defining health packages, RH supplies man be left behind, as we have seen in past health reforms, such as sector-wide approaches (SWAp) and decentralization and integration of health services. RH supplies (and their supporting supply chains) must be part of the design, implementation, and monitoring processes for the UHC reforms.
- All stakeholders working on RH have important roles in advocating, planning for, implementing, and monitoring the availability of RH supplies in the context of UHC. This includes donors, policymakers, and advocates, as well as service providers and supply chain managers in the public, private, and nongovernmental organization sectors. In particular, country governments must serve as stewards and coordinate stakeholders to ensure that RH supplies are part of reforms and available to those who need them.
- UHC presents the RH community with the opportunity to make the case for a total market approach for RH supplies. As low- and middle-income countries embark on UHC, governments will need to make difficult decisions, such as which RH services and commodities will be provided and which population segments will be prioritized for coverage within the public sector. Governments will need work with the private, commercial, and NGO to ensure that the entire country’s RH needs are equitably and reliably satisfied.
The UHC reform process may be challenging to navigate and it may be difficult to identify entry points for RH supply stakeholders. Yet we must seize the UHC opportunity to strengthen RHCS. Just as there is no single best path to UHC, there is no single way to ensure availability and access to RH supplies. We must be flexible and adapt to each country’s context. The resulting strengthened and equitable access to quality, affordable RH supplies will be worth our efforts.
A variation of this post was published by the UHC Steering Team of the Reproductive Health Supplies Coalition (RHSC) on the RHSC Blog; Leslie Patykewich and Safia Ahsan serve on this UHC Steering Team.