In 2014, the Ebola epidemic forced the world to recognize the urgent need to invest in public health. But this latest crisis is by no means new. For decades, since the era of structural adjustment in the 1980s, orthodox fiscal policies have kept public health severely underfunded. As a result, many national health systems could not properly develop in middle and low-income countries. Efforts to palliate the situation with quick fixes like small vertical programmes (e.g. immunization) have been insufficient to meet the health needs of populations. In many countries, health services were commercialized, and high private health expenditures and out-of-pocket payments became main causes of impoverishment and ultimately a lack of access to health care. Countries need investments in universal public health systems.
For the Universal Health Coverage Day next 12 December, we have released a new report: Addressing the Global Health Crisis: Universal Health Protection Policies
This policy paper: (i) examines the dimensions of the global health crisis based on severe deficits in health protection and limited access to health care; (ii) presents the extent of the health crisis at global, regional and national level as well as rural/urban divergences within countries and their root causes; (iii) suggests policy options to address the health protection crisis using the framework of national social protection floors by focusing on inclusive legislation, adequate financing as well as making quality services available and providing financial protection; (iv) concludes that progressing towards universal health protection is possible by developing a three step approach that yields highest rates of returns in terms of sustainability, economic growth and equity. The Annexes present global data on total health expenditure, health coverage and skilled health workers for 171 countries.
Below a more descriptive summary, the press release:
Global health protection crisis leaves almost 40 per cent of the world’s population without any coverage New ILO study reveals large health coverage gaps, including in West African countries, where 80 per cent have no coverage.
GENEVA (ILO News) – An ILO study shows that 80 per cent of the population across 44 countries are without any health protection and are therefore deprived of the right to health. These countries include Burkina Faso, Cameroon, Guinea and Sierra Leone. Globally, some 40 per cent of the population is excluded from social protection in health.
The study “Addressing the Global Health Crisis: Universal Health Protection Policies ” says that similar major gaps also exist in Asia. In India, for example, more than 80 per cent of people lack health protection coverage. Other countries showing substantial coverage gaps include Azerbaijan, Bangladesh, Haiti, Honduras, and Nepal.
The report was issued to coincide with the Universal Health Coverage Day, which is observed on 12 December.
“Universal health protection is key to fighting poverty, reducing inequity and nurturing economic growth. Sustainable development with decent jobs for all requires investment in health protection – these linkages cannot be ignored in policy development,” said ILO Director-General Guy Ryder ahead of the universal day.
Barriers to health coverage
The ILO study points to high impoverishment due to private health spending as a barrier for accessing health care. In many countries, such as Sierra Leone, 75 per cent of total health expenditure comes from private resources in the form of out-of-pocket payments, which has led to deep impoverishment.
The extent of impoverishing out-of-pocket payments in a country increases with the level of the population living below the poverty line. “Thus, it is the poorest with the highest needs who suffer the most from having to pay out-of-pocket healthcare expenses,” explained Xenia Scheil-Adlung, Health Policy Coordinator at the ILO.
Another major factor leading to the global health crisis concerns the shortage of health workers, who are often poorly paid. Globally, the ILO estimates that 10.3 million additional health workers are needed to close the current gaps and ensure the delivery of universal health care. In countries such as Haiti, Niger, Senegal and Sierra Leone, as many as 10,000 people have to rely on services provided by five or fewer health workers, whereas in a high-income country like Finland there are 269 health workers available for 10,000 people.
Rural areas most neglected
The study shows that 56 per cent of the global population living in rural areas do not have health protection coverage, compared to 22 per cent of the urban population.
“For decades, public health systems were underfunded and could not properly develop in middle and low income countries. Quick fixes like small vertical programmes – for example, immunization -- are insufficient. Countries need investments in universal health systems,” said Isabel Ortiz, Director of the ILO Social Protection Department.
The highest inequities and disparities in coverage between rural and urban areas were found in Africa, Asia and the Pacific.
Rural populations are also most affected by the lack of health workers. Seven million out of the total 10.3 million health workers who are missing globally are needed in these areas.
Overcoming the crisis
Since 2010, fiscal consolidation policies have stalled or even reversed steps towards universal health coverage by increasing the financial burden on private households, cutting back health services and cutting/capping wages of the health workforce.
The study explains that overcoming the current global health crisis requires a policy shift towards universal health protection and points to ILO Recommendation 202 concerning national floors of social protection as a useful tool for achieving that goal.
Investment in health systems leads to sustained economic growth, increased productivity and wellbeing for populations, a reason why countries like Benin, Gabon, China, the Philippines or the United States have expanded health coverage in recent years. In Thailand, the introduction of universal health protection has led to economic gains of as much as 1.2 times the original investment.
The ILO study shows that irrespective of a country’s level of income, it is possible to move towards universal health protection. A precondition for such a move is that countries are committed to fully implementing rights to health, minimizing impoverishing out-of-pocket payments and ensuring sufficient numbers of skilled, decently paid health workers.
Director Social Protection
International Labour Organization (ILO)
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