Once seen as a distant objective, economic growth and political will are now bringing universal health coverage within reach for the developing world. But great financial and social challenges still remain to be addressed before the vision becomes reality, EURACTIV France reports.
Developing countries in the Middle East, Asia and Africa are quickly catching up with European healthcare standards, although it will take nearly half a century before all can provide comparable treatments.
In just a few years Rwanda, Thailand, Ghana and Turkey have led the way and established national programmes, ensuring access to extended healthcare coverage – while minimising costs – so protecting the most vulnerable among their populations from falling into extreme poverty.
According to a report by the African Development Bank Group, a majority of African countries will be in a position to ensure at least minimal health coverage for their populations, if not full coverage, by 2060.
For now, healthcare insurance is usually limited to certain areas or privileged classes, while millions of people are prevented from seeking treatments by poverty and onerous healthcare costs.
Insurance systems exist but are often restricted to specific groups like government officials, which makes it harder to organise the system on a national level, says Emmanuelle Cathelineau of the French Agency for Development (AFD).
Another serious obstacle along the way to universal healthcare is the informal economy, which makes the establishment of an effective contribution-based healthcare system very difficult.
Governments often have to resort to using tax monies to subsidise insurance for the poorest sections of the population. But in some countries like Kenya or South Africa, the private sector has taken over.
One of the biggest challenges for these countries is adapting to new health demands on these markets, where an aging population, urbanisation and new lifestyles have significantly affected healthcare requirements.
Besides treatments for HIV, tuberculosis and malaria, one increasing aim is ensuring the provision of care for “non-transmissible” diseases such as diabetes, hypertension, cancer or respiratory problems. According to the African Development Bank, these illnesses will represent 46% of the causes of death in the next ten years.
Progress will depend on governments and the budgets they decide to invest, however, as taxes cannot yet finance healthcare systems.
In Rwanda, such taxes are set at €2.40 per person per year. But, according to World Health Organization (WHO) experts, a minimum amount of €44 per person per capita will be required to ensure treatment during the main epidemics as well as prevention against “non-transmissible” diseases.
Expenditure was less than this amount in 29 countries in 2009 – mainly in Africa and Asia – according to the WHO.
National financial resources are at the heart of future healthcare systems, but development aid remains important especially at the start. In Africa, aid still represented on average between 20 and 40% of healthcare expenses in 2010, according to the WHO. And the shares climbed to 47% in Rwanda and 64% in Malawi.
But light may now be visible at the end of the tunnel. A UN resolution adopted in December 2012 aims to include health coverage in the post-2015 development agenda. The World Bank and the WHO are also working on a new framework programme following the progress of moves towards universal health coverage that will be presented at the UN general Assembly in September 2013.
Africa has made considerable headway in improving the health outcomes of its populations, in spite of the challenges posed by pervasive poverty, epidemic diseases, and food insecurity, according to the African Development Bank Group (AfDB).
However, huge challenges remain. African health systems are usually underfunded, overstretched, and understaffed, highlighting the political aspect of health issues in the developing world.
And increased wealth does not necessarily lead to improved health, particularly for the poorest segments of society, according to the AfDB.
- African Development Bank Group (AfDB): Health in Africa over the next 50 years (March 2013)
- World Health Organization (WHO): WHO global health expenditure atlas (2012)
- World Health Organization (WHO): Universal health coverage
- UN High-Level Panel on Post-2015 Development Agenda: Health in the Post-2015 agenda (April 2013)