IFMSA Policy Statement Universal Health Coverage

Adopted during the 64th August Meeting General Assembly in

Ohrid, FYR of Macedonia, 7th August 2015 Summary

In recognition of the lingering inequities in access to health care between and within nations, the International Federation of Medical Students’ Associations (IFMSA) highly supports the global movement for universal health coverage. IFMSA calls on various sectors, such as governments, the World Health Organization, the global academic community, medical schools, civil society, the private sector, and all medical students worldwide to contribute their share in keeping the momentum towards universal health coverage for the reduction of health inequalities and ultimately the achievement of health for all.

Introduction

Despite enormous improvement in health status globally in the last century, inequities in health still remain, and have even widened in some countries [1]. One of the major causes of ill health and early mortality is the lack of access to health care, which is a product of a multitude of health sector and external factors, one of which is inadequate and mismanaged health financing. In many countries, health financing is still marked by high out of pocket expenditures, considerable number of people without social protection, and benefit packages that are so limited that they do not reflect the current burden of disease within countries as well as the health needs and expectations of people [2]. Fortunately today, governments recognize the dire need to strengthen health systems, enhance health-financing mechanisms, and ultimately provide government-funded basic health care service to all citizens. Nearly a hundred countries are now in the race towards universal health coverage [3], while the global scientific community is intensifying research and innovation in health systems strengthening through joint learning initiatives and international symposia [4,5,6]. Universal health Coverage was defined by the World Health Assembly in 2005 as “access to key preventive, curative and rehabilitative health interventions for all at an affordable cost” [7]. For the past years, the World Health Organization (WHO) has strongly advocated for a focus on Universal Health Coverage in order to achieve the long- awaited vision of health for all, which was first articulated in the 1978 Alma Ata Declaration on

Primary Health Care [7,8,9]. In 2012 of the United Nations General Assembly approved a resolution calling for governments “to accelerate the transition towards universal access to affordable and quality health care services”, confirming not only the breadth of consensus regarding the urgency of action on UHC, but also the level of concern about the state of the world’s health systems. The most recent discussions on UHC relates to the UN Post-2015 Negotiations Process, where Universal Health Coverage is being recognized as a critical component of the new Sustainable Development Goals (SDGs) which include a specific health goal: “Ensure healthy lives and promote wellbeing for all at all ages”. [10] Within this health goal, a specific target for UHC has been proposed: “Achieve UHC, including financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. In this context, the opportunity exists to unite global health and the fight against poverty through action that is focused on clear goals. Supporting the right to health and ending extreme poverty can both be pursued through universal health coverage. [11]

Main text

IFMSA believes that:

- UHC is a key component to achieve the human right to health - The worldwide movement towards universal health coverage is an

important major step towards reducing health inequalities and achieving health for all;

- Efforts for universal health coverage should be placed in the context of action on social determinants of health, and universal access to health care should be complemented with whole-of-government actions addressing the socioeconomic determinants of health;

- Universal access to health care will only be achieved if all three dimensions of universal health coverage are tackled – expansion of population coverage, reduction of out-of-pocket expenditures to ensure protection from catastrophic health spending, and increase benefits to include current and emerging population needs and expectations [2,9];

- There is no one-size-fits-all for universal health coverage, and therefore encourage the creation of universal health coverage schemes that fit the social, political, and cultural contexts of every country;

- In order to enhance aid effectiveness and empower recipient countries in the use of aid, international aid for health from developed countries and international organizations should be maximized and channeled for universal health coverage, especially in assisting low-income countries as they build their universal health care systems [12];

- Universal health coverage will only be successful if all the six building blocks of a health system as described by WHO – governance, health human resources, medicines and devices, service delivery, health information systems, and health financing – are given equal attention and strengthened to produce positive and synergistic results [13].

The IFMSA also specifically calls on governments to: - Partner with other sectors – civil society groups, private sector, and

academia – in the design and implementation of universal health coverage, while

asserting its primacy as the major and leading actor in this endeavor;

- Enhance participation in joint learning exercises and other global collaborative work geared towards universal health care, since many countries today share this goal and produce new knowledge and tools that can be applied in various settings;

- Create spaces for community grassroots participation to allow ownership of universal health care by the people.

- Take into consideration all vulnerable groups – including indigenous populations, migrants, refugees, and internally displaced persons – in the design and implementation of universal health care.

The IFMSA applauds the efforts and calls on the following sectors to contribute to the

achievement of Universal Health Coverage:

- The World Health Organization to provide governments the technical advice and political push to continue with national efforts to achieve universal health coverage, and to create more spaces for global sharing of knowledge and best practices among governments;

-The global academic community to enhance the quality and quantity of research on universal health coverage and health systems strengthening, as governments look to them for up-to-date evidence and smart recommendations; -Medical schools and other training institutions to integrate health systems knowledge in the medical curriculum in order to produce future doctors with

capacity to work in universal health care systems and serve as change agents [14]; -The private sector to contribute resources, technical and financial, in order to fulfill national needs for the attainment of universal health coverage, and; -Civil society to remain aware and advocate for the people, to share knowledge and insights with governments and other partners, and to mobilize people to support reforms towards universal health coverage. Finally, the IFMSA also exhorts: - The leadership of IFMSA to build momentum for support for universal health coverage within the Federation by creating new initiatives and harnessing existing structures, and; - All members of IFMSA and all medical students across the globe to participate in education, research, and advocacy activities that are geared towards universal health coverage.

References

1. World Health Organization Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Geneva: World Health Organization, 2008. 2. World Health Organization. World Health Report: Health systems financing, the path to universal coverage. Geneva: World Health Organization, 2010. 3. Huang, Y. World Momentum Builds for Universal Health Coverage. Yale Global, 9 March 2012. 4. Joint Learning Network for Universal Health Coverage. http://www.jointlearningnetwork.org/ 5. Prince Mahidol Award Conference 2012 – Moving Towards Universal Health Coverage: Health Financing Matters.http://www.pmaconference.mahidol.ac.th. 6. World Health Organization and partners. The First Global Symposium on Health Systems Research (HSR) - Science to Accelerate Universal Health Coverage, Montreux, November 2010. Available: http://www.hsr-symposium.org/. 7. Resolution WHA58.33. Sustainable health financing, universal coverage and social health insurance. Geneva: World Health Organization, 2005. 8. World Health Organization, United Nations Children’s Fund. Declaration of Alma- Ata. Alma-Ata, USSR, 1978. Available from: http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf. 9. World Health Organization. World Health Report 2008: Primary Health Care – Now More Than Ever. Geneva: World Health Organization, 2008. 10. Zero draft of the outcome document for the UN Summit to adopt the Post-2015 Development Agenda, 2015 11. World Health Organization and World Bank. Tracking Universal Health Coverage: First Global Monitoring Report, 2015.

12. Ooms, G, Hammonds R, and Van Damme W. The International Political Economy of Global Universal Health Coverage. Background paper for the Global Symposium on Health Systems Research, November 16-19, 2010, Montreux, Switzerland. 13. World Health Organization. Everybody’s business: strengthening health systems to improve health outcomes – WHO’s framework for action. Geneva: World Health Organization, 2007. 14. Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010; 376: 1923–58