Professor Edmund Anthony Severn Nelson, representing the Commonwealth Health Professions Alliance (CHPA), gave ministers an update on the Commonwealth Civil Society Forum on ‘Investing in health: An economic imperative for sustainable development’. He also provided an update on the roundtable with the High Commissioners held at Marlborough House in July 2014, which provided input into the Commonwealth Civil Society Forum convened on 16 May 2015. He said the forum focused on the implementation of universal health coverage and challenges such as the social determinants of health, financing, the health workforce, NCDs, ageing and different funding models, particularly public funding. He said the forum was honoured to hear Sir George Alleyne speak about investment in the health workforce and The Lancet ‘Report on the World Converging Within a Generation in 2035’. He said that evidence was growing that health was fundamental to economic and social development, and that there were now better measures to demonstrate return on investment in health in terms of growth and health gains.
Professor Nelson said that Mr Gopakumar from the Third World Network spoke about access to medicines in relation to universal health coverage, showing the need for public financing, rational use, research and development, and appropriate trade and regulatory frameworks. Finally, Dr Ravi Ranan from Sri Lanka spoke about different ways to fund universal health coverage, such as the social health insurance (SHI) model – also called the Bismarck model, National Health Service (NHS) model or Beveridge model. Most Commonwealth countries had no history of universal health coverage and many lacked the tax base to fund a full NHS system. The third route to achieving universal health coverage was a mix of the NHS and private system models, which a number of Commonwealth countries – such as Jamaica and Sri Lanka – have successfully used to provide an acceptable level of coverage with a limited public budget. He said that this approach was rarely addressed in international forums and required the special attention of the Commonwealth.
- Investing in health was fundamental to economic and social development.
- High income was not a necessary condition for universal health coverage.
- Public health systems were more efficient because they ensured economies of scale, lower transaction costs and performed additional beneficial tasks not directly linked to care, such as disease surveillance.
- New regulatory frameworks were needed to provide medicines, vaccines and diagnostics at affordable prices.
- Funds would always be limited, but evidence suggested that public funding should provide interventions to all and that user fees should be removed.
- No country had achieved universal health coverage using out-of-pocket spending, community health insurance or private insurance alone. All countries achieving universal coverage relied on taxation and social health insurance.
- The standard NHS and SHI models of universal health coverage were hard to implement in most LMICs and the new mix provided an alternative.
- Some LICs would continue to have significant funding gaps and external resources would still be required.
- Growing evidence suggested that countries should develop individual national plans, define their own priorities, which were specific to their national context, and universally implement these with public financing.
Professor Nelson said that the Commonwealth needed to share experiences of models that had been shown to work within the Commonwealth and more widely in the global community.
A selection of presentations given at the forum are provided below
Dr Nicolaus Henke: Opportunities to enable Universal Health Coverage
Prof Kath McCourt: Investing in health: an economic imperative for sustainable development
Sir George Alleyne: What works, what it costs and who pays
Mr KM Gopakumar: Challenges for access to medicines within universal health coverage
Dr Ravi Rannan Eliya: Universal health coverage: facts and patterns in financing and attainment