Measuring universal health coverage
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Measuring universal health coverage A framework which can measure universal health coverage (UHC) in countries across the world and track performance over time is expected to enable the addressing of challenges in achieving the WHO’s Thirteenth General Programme of Work (GPW13) and UN Sustainable Development Goals (SDGs) objectives, say authors of an analysis for the Global Burden of Disease Study 2019 published in The Lancet.1 UHC effective coverage in 204 countries and territories between 1990 and 2019 was assessed based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with 23 effective coverage indicators mapped to a matrix of health services across five age groups ranging from newborn to 65 years of age and over to construct a UHC effective coverage index. Global UHC was then projected from 2018 to 2023. Although global performance on the UHC effective coverage index improved from 45.8 in 1990 to 60.3 in 2019, country-level coverage performance in 2019 ranged from below 25 (in Somalia and the Central African Republic) to 95 or over (in Japan and Iceland). In many countries, performance on effective coverage indicators was lower for noncommunicable diseases than for communicable diseases, and for maternal and child healthcare. It was estimated that with maximum efficiency, pooled health expenditure of $1398* per capita would need to be attained to achieve 80 on the UHC effective coverage index. It was projected that 388.9 million more people would have effective coverage between 2018 and 2023 (well below the GPW13 target of 1.billion) but 3.1 billion people, including 968 million people in south Asia, would lack UHC effective coverage in 2023. "This study provides a new measurement framework and metric on UHC effective coverage, supporting country and global stakeholders in their efforts to track improved performance over time . . . If current trends hold, the world will fall short of delivering on its UHC ambitions for the GPW13 and SDGs," said the authors. "Although domestic funding is the necessary base, global actors should be prepared to shift resources towards helping countries produce national data that are most useful to local actors working to build high-quality health systems. Without nationally meaningful measures and governments’ accountability to their population, UHC may become an empty signifier: a non-threatening tool for enhancing a country’s global status rather than maintaining and improving health for all its citizens," commented Margaret Kruk from the Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA, and colleagues in an accompanying editorial published in The Lancet.2 * US dollars adjusted for purchasing power parity 1. GBD 2019 Universal Health Coverage Collaborators, et al. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019 Lancet : 27 Aug 2
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