COVID-19 has highlighted the lack of universal health care globally and its negative impact on world health. The lessons learned support the need for universal health care and should be used as guides to ensure that everyone has access to equitable, affordable and safe healthcare, irrespective of ability to pay, poverty, race, gender and level of education. Only then, will the world be better prepared for the next pandemic.
The COVID-19 pandemic has infected more than 6 million people, with over 3 million recoveries and 388,000 deaths. Although both cases and deaths are disproportionately higher in high-income countries, low- and middle-income countries are not spared. Treatment of those infected is overwhelming health systems due to the specialised care required.
For a long time, the global health community has advocated for universal access to care: yet forty-two years after the Alma Ata Declaration on health for all, universal access has not been achieved. COVID-19 has shown the dangers of this omission. Universal Health Coverage (UHC) means that everyone has access to affordable, equitable and quality healthcare without suffering financial hardship. It means no one should be denied healthcare because of an inability to pay, or because of poverty, race, level of education or gender.
The lack of UHC can push people into poverty
I know firsthand what it means to live in a country without UHC and to suffer catastrophic health expenditure as a result. In 2009, our first daughter, Yagazie, was born. Yagazie is the Igbo word for “it is well.” However, within weeks of her birth, my wife and I realized that all was not well with Yagazie. She was diagnosed with four different kinds of congenital heart defects. The most serious of the defects is called transposition of the great arteries, meaning the two major arteries leaving her heart are reversed. This is a life-threatening condition. We were scared and wondered how we could provide the healthcare our daughter needed. The only way was for my wife and I to borrow money from our employers and travel thousands of miles to India for Yagazie to have open-heart surgery. My family was pushed into poverty because it took many years for my wife and I to repay the loans.
Too many Nigerians have similar experiences, despite living in Africa’s wealthiest and most populous nation. In Nigeria, the lack of UHC leads to unacceptably high out-of-pocket expenditure for healthcare. About 75% of Nigeria’s $10 billion annual total health expenditure is out-of-pocket. This is a whopping $7.7 billion and is seven times the total international donor support to the country. In an earlier opinion piece, I argued for channeling this high out-of-pocket expenditure towards health insurance that would help Nigeria achieve UHC.
A joint report by the World Bank and World Health Organisation showed that 100 million people per year are pushed into extreme poverty (living on less than $1.90 per day) because of catastrophic health expenditure. A publicly funded health insurance scheme is a way to reduce out-of-pocket expenditure and prevent individuals from falling into poverty because of healthcare costs.
Globally, COVID-19 is highlighting the world’s failure to guarantee healthcare for all people. In India, COVID-19 testing is free in government facilities but can be as expensive as $60 in private laboratories. The poverty level in India means many poor people are priced-out of COVID-19 testing, making it harder to contain the pandemic. In the U.S., people must pay for tests, and one woman’s bill was a shocking $34,927.43 for COVID-19 testing and treatment. In Europe, COVID-19 testing and treatment is free. In Nigeria, testing is free in both public and private laboratories coordinated by the Nigeria Centre for Disease Control.
COVID-19 has persuaded many people that no one should have to pay for testing and treatment when they need healthcare. A recent survey of 2,000 Americans by OnePoll reveals that 74% of self-identified Republicans and 84% of self-identified Democrats agree that the COVID-19 pandemic is a sign that the U.S. should move towards a universal health care system.
Lessons learned from COVID-19 can help drive transition to UHC
Although COVID-19 has highlighted the lack of UHC globally, there are three lessons we learn from responding to this pandemic that can help drive the transition to UHC.
First, investments in epidemic preparedness should be part of the overall plans for UHC. COVID-19 has shown that pandemics require an equitable and affordable healthcare system that meets the healthcare needs of all citizens. In 2018, during his visit to Nigeria, Dr. Tedros, the Director-General of the World Health organization, identified global health security and universal health coverage as two sides of the same coin. This means it is impossible to have a world free of infectious diseases without UHC. Due to the world’s interconnectedness, countries without UHC will act as weak links in achieving global health security. Infectious diseases do not respect borders, so countries must share data and experiences regarding infectious diseases. Delay in doing so can be deadly.
Second, UHC must include a full spectrum of essential quality services that covers prevention, promotion, treatment, rehabilitation and palliation health services. UHC is not linear and must be carefully planned so that no component of the spectrum is lacking. For instance, COVID-19 prevention includes hand washing, physical distancing, and wearing masks. In the event that people still contract COVID-19, they should receive testing and treatment without having to pay at the point of need. They should also receive help for any long-term complications, such as organ damage affecting the lungs and heart. The health system must also provide care that helps patients and their families deal with life-threatening illnesses via early assessment and management of pain and other associated problems. Terminally ill patients with pre-existing conditions are known to have severe forms of COVID-19. The involvement of their families in their care is necessary to help them to die with dignity.
Third, there must be a focus on equity rather than equality. In different countries there are distinct marginalized and underserved communities. Focusing on equity ensures that people get the healthcare they need to meet their particular circumstances. For instance, in the U.S., institutionalized racism is keeping Black Americans sick with non-communicable diseases such as hypertension, stroke and diabetes, and also predisposes them to obesity. These diseases worsen COVID-19 and are known to increase the likelihood of death. Similarly, as the search for a COVID-19 vaccine intensifies, the global community must ensure its distribution is done in an equitable manner. Poor countries and communities should not be the last to receive the vaccine. The current push by global leaders for a “people’s vaccine” has amplified the importance of providing COVID-19 vaccines, diagnostic tests and treatments free of charge to everyone, everywhere.
COVID-19 will not be the last pandemic. Governments, international donors and other partners should prioritise instituting the full spectrum of UHC now. Only then will the world be better prepared for the next pandemic.
Ifeanyi Nsofor
