- Better equity in health can help the expansion of universal health coverage as a right.
- This is not just an issue for the health services, but requires an ‘all-government’ approach.
- The approach post-2015 must be inclusive, multisectoral, cross-governmental, integrated and comprehensive.
- Efforts should focus on the poorest – the lowest 20 % of the population.
Equity in healthcare is about ensuring equal treatment of individuals or of groups. Participants set out to get a better understanding of the key issues underlying inequities in healthcare and to map out possible post-2015 strategies.
A key issue in this debate is the expansion of universal health coverage (UHC), which should be endorsed by national governments as an obligation and a right. UHC in developing countries is problematic as they only have a limited resource base for taxation.
Emma Iriarte, Executive Secretary of Salud Mesoamerica 2015, pointed out that many governments do have the possibility to sustain investment in healthcare through their existing pubic budgets. A country like Guatemala, she noted, had a health budget of US$ 2 billion dollars in 2012, enough to cover the minimum level of care if used fairly.
She said that in Mesoamerica the poorest have been left behind. While the national averages appear normal, the situation is bad for those at the lowest income level. For example, 80 % of children in Panama are anaemic. Only 30% have the full vaccination needed for their age. Only 3 % of women are using contraception. It is important to target the poorest 20 % of the population and identify which are the best interventions for them.
A further bottleneck in implementing UHC is the shortage of the qualified health workers needed to underpin a universal system. This gap is currently estimated at 7 million health workers and is increasing. In addition, ageing populations with growing care needs is increasing the demand for trained carers.
The expansion of the number of local community health workers is a partial solution, however, it is important to avoid having a dual system with trained doctors for the rich and informal community health workers for the poor.
Remco van de Pas, Head of Human Resources for Health Project at the Wemos Foundation, pointed out that inequity in health is not only an issue for less developed countries. Inequalities are also growing in Europe. In Greece, for example, social protection is being eroded by the collapse of the economy. It is necessary to put the European house in order, he said.
Bart Criel, Associate Professor and Head of the Health Financing Unit at the Institute of Tropical Medicine in Belgium, also pointed to the health inequities that exist in Belgium despite its excellent social protection and health system. People in the weakest socioeconomic groups have shorter lives and spend fewer years in good health.
One of the cornerstones of Belgium’s sustainable development policy and vision is Health For All. To make this work effectively it is important to designate a contact person at all levels of government to increase capacity building, raise awareness and improve involvement regarding health inequities.
There is a need for development cooperation to move beyond aid towards a governmental obligation to provide universal healthcare. There should super-national regulation concerning healthcare rights that can define a minimum level or base.
To strengthen equity in health, governments must change their approach and not just focus on the health sector. A pan-governmental or ‘all-government’ approach is needed to promote health equity. Each country should have a mechanism at government level to implement an all-society approach.
There is no simple single solution. What is needed is an multisectoral, integrated approach with an all-government focus on healthcare needs.