December 12, 2020 has been designated Universal Health Coverage Day by the World Health Organization (WHO) and the United Nations (UN), supported by a coalition of more than 700 organizations in 116 countries, all collectively urging world leaders to deliver on promises to achieve universal health coverage (UHC) for their respective countries. The theme of UHC Day 2020 is “Health for all: Protect Everyone.”

International Universal Health Coverage Day aims to raise awareness of the need for strong and resilient health care systems and universal health coverage with multi-stakeholder partners. On this day annually, UHC advocates raise their voices to share the stories of the millions of people still waiting for health care services, espouse what has been achieved globally thus far and renew calls for leaders to make bigger and smarter investments in health care services to help move the world closer to UHC by 2030. In affirming support for this year’s commemoration, UN Secretary General Antonio Guterres had this to say: “In responding to the pandemic, we have seen rapid innovative approaches to health service delivery and models of care, and advances in preparedness. We must learn from this experience. For Universal Health Coverage Day, let us commit to end this crisis and build a safer and healthier future by investing in health systems that protect us all — now."

Universal health coverage means that all people of the world should have access to the health care services they need, related to prevention, promotion, treatment, rehabilitation and palliative care, without the risk of financial hardship when paying for these services. This requires an efficient health system that provides entire populations with access to good quality services, trained, motivated health workers, effective medicines and cutting edge technologies. It also requires a financing system that seeks to protect people from the financial hardship and impoverishment that may arise from health care costs. Access to health services ensures people are healthier while financial risk protection prevents people from being pushed into poverty which means therefore that universal health coverage is a critical component of the sustainable development and poverty reduction across global public health sectors and economies in addition to being a key element in reducing social inequalities worldwide. Universal health coverage is not something that can be achieved overnight, but all countries can take action to move more rapidly towards it, or to maintain the gains they have already made.

The pursuit of Universal Health Coverage (UHC) began on December 12, 2012, with the United Nations General Assembly (UNGA) unanimously endorsing a resolution that urged member countries to accelerate their progress towards universal health coverage (UHC) – the idea that everyone, everywhere should have access to quality, affordable health care – as an essential priority for international development. In 2014, the Universal Health Coverage Coalition started to celebrate December 12 as UHC Day, in commemoration of the date on which the UN General Assembly officially recognised the importance of UHC. Since then, the day has become the annual rallying point for the growing global movement for Health for All. Three years later in 2017, the United Nations General Assembly (UNGA) proclaimed December 12 as International Universal Health Coverage Day (UHC Day) by resolution, making it an official UN-designated day. The Universal Health Coverage Coalition is a partner of UHC2030, a global initiative to build stronger health systems for universal health coverage. The year 2020 has been a long moment of reckoning for health systems around the world and whilst the the harsh lessons of COVID-19 are far from new and while fears and injustices now making headlines reflect the daily reality of millions before the pandemic, the sheer scale of this crisis has sparked new urgency around health systems and universal health coverage. Globally, more leaders than ever are paying attention, as evidenced by the endorsing of the most ambitious and comprehensive political declaration on health in history at the 2019 UN High-Level Meeting on Universal Health Coverage and increasingly more of the world’s populations are rising to demand change. 

Why does UHC matter?

According to the 2013 WHO report, “Arguing for Universal Health Coverage”, UHC remains literally a life or death issue for many of the world’s populations as individuals without health coverage face the prospect of untreated sickness and premature death for themselves and their children. UHC can also mean the difference between financial survival and destitution whereby countries with increased coverage for health services show improved health indicators and contribute to stronger economic development, including the reduction of poverty levels. For political leaders, supporting a UHC agenda can deliver considerable political benefits for the simple reason that the majority of people (and of the electorate) want access to affordable, good quality health services and the beneficial effect of increasing coverage with needed health services of good quality is well documented. One recent study of statistical trends from 153 countries published in The Lancet, a highly-regarded, weekly, peer-reviewed general medical journal established in 1823, found that broader health coverage generally leads to better access to necessary care and improved population health, with the largest gains accruing to poorer members of the society. 

But, how can the world achieve Universal Health Coverage?

For a country to achieve universal health coverage, several factors must be in place including:

1. A strong, efficient, well-run health system that meets priority health needs through people-centred integrated care by informing and encouraging people to stay healthy and prevent illness; detecting health conditions early; having the capacity to treat disease; and helping patients with rehabilitation ensuring sensitive palliative care where needed.

1. Affordability – a system for financing health services so people do not suffer financial hardship when using them.

1. Availability of essential medicines and technologies to diagnose and treat medical problems.

1. A sufficient capacity of well-trained, motivated health workers to provide the services to meet patients’ needs based on the best available evidence.

1. Actions to address social determinants of health such as education, living conditions and household income which affect people’s health and their access to services.

And how do we measure UHC?

Since universal health coverage is a combination of whether people obtain the health services they need along with financial risk protection, measurement needs to include both components. Coverage of health services can be measured by the percentage of people receiving the services they need, whether it be women in fertile age groups accessing modern methods of family planning, children being immunized or men and women being screened, diagnosed and treated for various lifestyle diseases like heart attacks and diabetes. Conversely, financial risk protection can be evaluated by a reduction in the number of families that experience severe economic strain or significant financial loss due to health costs. The impact of these steps on population health and household financial wellbeing can also be measured, as can many of the factors that make it easier to increase coverage, some of which . include the availability of essential medicines, for example. The main challenge is that many countries do not have the capacity to measure coverage of all of the many health interventions that their populations require resulting in them needing to choose a set of key indicators to track performance in health service coverage.  

Similarly, universal health coverage has a direct impact on a population’s health and welfare as access and use of health services enables people to be more productive and active contributors to their families and communities ensuring too that children can go to school and learn. This is achievable as long as there are financial risk protection policies in place to ensure the economic viability of these families is not compromised by virtue of them having to pay for health services out of their own pockets. Universal health coverage is thus a critical component of sustainable development and poverty reduction in any country and a key element of any effort to reduce social inequities, representing the hallmark of any government’s commitment to improve the wellbeing of all its citizens.

The International UHC Day Campaign on December 12, 2020 will mark one year since the first cases of COVID-19 were reported and seeks to remind the world that health for all is not a long-term wish, but an urgent priority to end this crisis and emerge stronger. It is this consideration of the global challenge we are collectively facing that led to the 2020 theme: Health for all: Protect Everyone. To end this crisis and build a safer and healthier future, countries must invest in health systems that preserve their populations whereby leaders prioritize investments in strong, equitable health systems that protect everyone, respond to emergencies and ensure no one is left behind in the future. In fact, the United Nations has adopted 17 new Sustainable Development Goals for 2015-2030 aimed at eliminating poverty and building a more resilient planet and one of these goals includes providing universal health coverage. According to Dr Margaret Chan, WHO Director-General: “I regard universal health coverage as the single most powerful concept that public health has to offer. It is inclusive. It unifies services and delivers them in a comprehensive and integrated way, based on primary health care.”

In many nations, inclusive healthcare is very rudimentary and does not include heroic interventions or long term care with a WaterAid report citing that national infrastructure in many countries cannot support first world healthcare delivery mechanisms because they may not even provide potable water, let alone electricity to their citizens. A major WHO and UNICEF survey in 2015 reported that 38% of healthcare facilities surveyed did not have access to a basic water source, and 35% lacked the materials necessary for people to wash their hands effectively. When healthcare workers can’t keep facilities clean and prevent infections, their ability to deliver safe, effective, and dignified care is undermined. The WASH Initiative, (Water, sanitation, and hygiene in healthcare facilities) of the WHO and UNICEF - and their global partners, is part of the UN's Global Action Plan "to ensure that all healthcare facilities in all settings have adequate water, sanitation and hygiene services by 2030.

The goal of universal health coverage (UHC) globally has become more attainable as the world has become richer, leading to greater access to health services and technologies, such as vaccines and antibiotics, and to the most dramatic decline in poverty ever achieved. To ensure that every person benefits from the human right to health, political leaders have to make the right choices, the rational economic, financial and social choice of universal health coverage.