Costing universal health coverage
by Joseph Wong, Kimberly Skead
WHO Bulletin 2019;12():849-50 DOI: 10.2471/BLT.19.229799 (Open access)
The sustainable development goals (SDGs) are audacious and clear. SDG 1 aims to eliminate poverty in all its forms everywhere, meaning that no one is to be left behind. SDG 3 focuses on health and well-being and targets to achieve universal health coverage (UHC) by 2030. However, health – and development interventions in general – must reach everyone if these goals are to be achieved. To ensure that no one is left behind, we need to reach the hardest-to-reach: the poorest of the poor, the geographically isolated, the administratively invisible, those without identification documents or an address, and the marginalized. Achieving UHC requires meeting the challenge of delivering services to those most in need and more specifically to those who are hardest-to-reach.
The Reach Project at the University of Toronto is investigating how reach can be achieved…. The case studies offer important insights for governments, nongovernmental organizations, firms and international donors. These studies include: the pivotal role that effective monitoring plays in reaching the hard-to-reach; creative efforts to accurately identify and locate the poorest of the poor; the generation of political will to overcome legacies of mistrust and marginalization among certain population segments; the importance of mobile units and digital platforms to actively reach those who live far from urban centres; the interaction of computer mapping technology and local knowledge to facilitate route optimization for cold-chain delivery of essential medicines; and the critical role played by community health workers, and specifically the balance between coordinated protocols with adaptive local knowledge so that frontline workers can deliver interventions in local contexts. Reaching the hard-to-reach demands innovative delivery mechanisms, but also attention to the economic and financial cost of reaching the previously unreached….
In other words, ensuring no one is left behind is expensive….