Nobody should be pushed into poverty for needing surgical care

Imagine the following situation. You’re walking home from work on a day like any other, until you suddenly become part of a road traffic accident. Urgently needing transportation to the nearest emergency care center to receive life-saving surgery, your nation’s health care system requires you to pay out-of-pocket, ultimately leading to catastrophic expenditure and the loss of the few assets you possessed. Your life has been saved, yet you are left without life as you knew it.
<Dominique Vervoort>
Depending on where you come from and what your experiences are, the story above may seem either doubtfully unlikely or the sad truth. Even today, during times of relative global wealth, technological advances and medical heights, such situations continue to happen, both in high- (HICs) and lower- and middle-income countries (LMICs).  
Many countries already provide(d) some sort of health coverage for their population, yet often unequally, with some people receiving deeper coverage than others, regardless of their actual needs. Inequity not only exists between regions and countries, but also within, with many countries providing (more and better) care only for those able to pay, thus negatively affecting the people who need it most, being the poorest part of a population.

Health coverage should not only be extended to those “uncovered”, but also in a way (how deep and what should be covered) that prevents the creation or sustainment of health system gaps. It is therefore important to consider Universal Health Coverage (UHC) as a concept that provides everyone -rich and poor- with the health services they need (i.e., correct and adequate care), and makes sure that nobody suffers undue financial hardship as a result of getting the care they need.

The Case for UHC & Access to Surgery

Health financing mechanisms that offer financial risk protection are needed to protect people from impoverishing and catastrophic expenditure due to out-of-pocket payments. In many countries, these costs are often high, especially when access to surgical care is needed. LMICs have to move away from out-of-pocket user fees to indirect financing methods, including general taxation or insurance models. The latter could then lead to UHC packages, aiming to promote equity and equality, hand-in-hand with financial risk protection within national health systems. These packages should cover, at minimum, a basic package of essential surgical, anaesthesia and obstetric care, based on the needs of the respective country.

One could say that some nations don’t have the needed funds to allocate to investments in their health care systems, yet the WHO published their WHO Health Systems Financing Report in 2010, which indicates that every country is able to mobilize the funds to move toward UHC. (1)

In 2013, the Lancet Commission on Investing in Health found that better health status drove 24% of full-income growth over a decade, with every $1 invested able to return 9-20 times the benefits. (2) Thus, UHC has proven to be cost-effective, resulting in social and economic dividends for nations as a whole, and as a result, the question that arises is not “if”, but “when” more governments will start investing in UHC. Nevertheless, today, still far too many governments fail to invest enough in their health care systems.


December, 12th 2016 will mark the 3rd consecutive UHC Day, a day on which several hundreds of organizations from over 100 countries across the globe join forces as part of the UHC Coalition to spread awareness and organize activities regarding UHC. Even today, hundreds of millions of people’s lives and finances are jeopardized by the existence of health system gaps.

Even though there is still a long way to go, many steps forward have been taken in 2015 and 2016, partially due to the success of the first two UHC Days. In June 2015, a few months after the costly Ebola crisis -which would have cost less to prevent- the first UHC Global Monitoring Report was published by the WHO and World Bank Group. It was the first report measuring health coverage and financial protections in countries, in order to assess their progress towards UHC. The report showed that 400 million people do not have access to one or more essential health services, 17% of people are impoverished by health costs and 6% of people in LMICs are tipped or pushed further into extreme poverty. (3) As a result, in September 2015, the goal of achieving UHC became part of the Sustainable Development Goals (SDG 3.8). (4)

After the G7 endorsed UHC in May 2016, African leaders united in August 2016 to launch a framework to work towards UHC, driven by the investment of $24 billion by the World Bank and Global Fund. One month later, WHO Director-General Dr. Margaret Chan announced the International Health Partnership for UHC 2030. (5)

African countries can become more competitive in the global economy by making several strategic investments, including investing more in their people, their most prized resource. A critical part of this commitment is to accelerate progress on universal health coverage—ensuring that everyone, everywhere has the opportunity to live a healthy and productive life.” – Jim Yong Kim, President of the World Bank Group

This year, the UHC Coalition aims to “act with ambition”, saying that:

  • Countries making the greatest strides toward UHC put the poorest and most marginalized populations first, not last;
  • Leaders can and must invest in policies and health systems that reach every person and community based on need, not ability to pay, with services that are free at the point of use;
  • People have diverse health needs over a lifetime and valid concerns about cost and quality of care. Health care systems should ensure high-performing primary care in every community, supported by well-trained, well-paid health care workers;
  • Proactively safeguarding everyone, everywhere, will prevent the next pandemic, expand economic opportunities and promote shared prosperity;
  • Data should measure what matters, i.e., whether systems, services and medicines are accessible, high-quality and affordable for all.

Establishing universal health coverage in nations is imperative for reaching the health-related Sustainable Development Goals by 2030. International and nations’ leaders should be held accountable for current health system gaps, in order to promote more and smarter investments in health systems. To achieve these goals, we can all help by spreading awareness and further pushing UHC on the global health agenda as, after all, everyone, everywhere should inherently be safeguarded from health expenditure.


  1. World Health Organization. Health Systems Financing: The Path To Universal Coverage. Geneva: World Health Organization; 2010.
  2. Jamison DT, Summers LH, Alleyne G, Arrow KJ, Berkley S, Binagwaho A, et al. Global health 2035: a world converging within a generation. Lancet. 2013;382:1898–955. doi: 10.1016/S0140-6736(13)62105-4.
  3. World Health Organization, World Bank Group. Tracking Universal Health Coverage: First Global Monitoring Report. Geneva: World Health Organization; 2015.
  4. United Nations. Transforming Our World: The 2030 Agenda For Sustainable Development. United Nations; 2015.
  5. World Bank. Partners Launch Framework To Accelerate Universal Health Coverage In Africa; World Bank And Global Fund Commit $24 Billion.; 2016.


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