In December 2012, the United Nations General Assembly called upon all governments to “urgently and significantly scale up efforts to accelerate the transition towards universal access to affordable and quality healthcare services”.1 The evolving momentum for universal health coverage (UHC), with its principles of equity and social justice, aims to ensure that all members of a society can access the health-care services they need without incurring financial hardship.2,3 UHC encompasses the three dimensions of who is covered (population coverage), what is covered (health-care benefits) and how much of the cost is covered (financial protection), all of which may expand over time.4 Addressing these three dimensions of UHC5–7 within the boundaries of fiscal space8 is challenging for all countries. It requires continuing political commitment and leadership to distribute available resources, especially human resources for health (HRH),9 in an efficient, equitable and sustainable manner to match population needs. Overcoming the inequitable distribution of services is particularly critical.10
High-, middle- and low-income countries alike are facing fundamental health challenges stemming from demographic changes, ageing populations, the growing burden of noncommunicable diseases and emerging public health threats such as drug-resistant malaria, tuberculosis and pandemics. Several countries of the Organisation for Economic Co-operation and Development (OECD), hit by the global financial crisis, are revisiting health benefits, coverage and protection – either to reaffirm commitments or cut services.11 In low- and middleincome countries, other evolving dynamics will shape efforts to achieve UHC, including epidemiological transitions,12 economic growth, increased health expenditure and diminishing international health aid – or its reprioritization.13–15 In the next decade, an increasing number of African and Asian countries will become able to finance essential health services from domestic resources and will then face critical decisions on how to invest these funds most effectively to accelerate progress towards UHC.16 The health workforce is central to a country’s response to these challenges. Reaching a greater percentage of the population, extending the benefit package and improving the qual
Abstract
In December 2012, the United Nations General Assembly called upon all governments to “urgently and significantly scale up efforts to accelerate the transition towards universal access to affordable and quality healthcare services”.1 The evolving momentum for universal health coverage (UHC), with its principles of equity and social justice, aims to ensure that all members of a society can access the health-care services they need without incurring financial hardship.2,3 UHC encompasses the three dimensions of who is covered (population coverage), what is covered (health-care benefits) and how much of the cost is covered (financial protection), all of which may expand over time.4 Addressing these three dimensions of UHC5–7 within the boundaries of fiscal space8 is challenging for all countries. It requires continuing political commitment and leadership to distribute available resources, especially human resources for health (HRH),9 in an efficient, equitable and sustainable manner to match population needs. Overcoming the inequitable distribution of services is particularly critical.10High-, middle- and low-income countries alike are facing fundamental health challenges stemming from demographic changes, ageing populations, the growing burden of noncommunicable diseases and emerging public health threats such as drug-resistant malaria, tuberculosis and pandemics. Several countries of the Organisation for Economic Co-operation and Development (OECD), hit by the global financial crisis, are revisiting health benefits, coverage and protection – either to reaffirm commitments or cut services.11 In low- and middleincome countries, other evolving dynamics will shape efforts to achieve UHC, including epidemiological transitions,12 economic growth, increased health expenditure and diminishing international health aid – or its reprioritization.13–15 In the next decade, an increasing number of African and Asian countries will become able to finance essential health services from domestic resources and will then face critical decisions on how to invest these funds most effectively to accelerate progress towards UHC.16 The health workforce is central to a country’s response to these challenges. Reaching a greater percentage of the population, extending the benefit package and improving the qualAbstract
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