WUNRN
UN World Health Organization
Research for Universal
Health Coverage: World Health Report 2013
______________________________________________________________________________________________________________________________________________________________________
April 3, 2014 - By Katrina Braxton
The
global maternal health agenda has been largely defined by the Millennium Development Goals (MDGs) for
the last decade and half, but what will happen after they expire in 2015? What
kind of framework is needed to continue the momentum towards eliminating
preventable maternal deaths and morbidities?
For
a panel of experts gathered at the
There
has been significant progress towards MDG 5
– reduce the global maternal mortality ratio by 75 percent between 1990 and
2015 and achieve universal access to reproductive health. But “we still have
challenges and the agenda is not finished,” said Jacqueline Mahon of the United Nations Population Fund.
There
is persistent inequality in access to maternal health services and
discrimination too, she said. The global maternal mortality rate has declined by 47 percent
since 1990, far below the MDG 5 goal, and an estimated 800 women still die every day from
preventable causes linked to pregnancy and childbirth, with 99 percent
of those deaths occur in developing countries. Only 58 percent
of women in developing countries give birth with a skilled attendant.
The
most vulnerable are “women living in conflict situations, or women who are part
of an ethnic minority, women living with disabilities,” said Dr. Ana Langer,
director of the Maternal Health Task Force. Poor women are
more vulnerable in general. According to a recent report from the
International Conference on Population and Development (ICPD),
150 million people each year suffer financial catastrophe and another 100
million fall under the poverty line as a result of out-of-pocket spending on
health care. At least a billion people, caught in “development traps of bad
governance, wasted natural resource wealth, lack of trading partners, or
conflict,” have been largely passed over by gains in health care.
These
problems suggest a critical need to develop a new framework to take the place
of the MDGs after 2015. There is some debate about how effective the MDGs were
in different development sectors, but Langer suggested the model has been very
helpful for maternal health. “The fact that we had that very, very measurable,
concrete goal, that it was embraced by the global community and also by
governments, and that it also included concrete mechanisms to track progress
and measure progress, it definitely helped to focus the global attention on
maternal mortality,” she said.
But
for those pockets of poor service and underserved women that remain, what needs
to change?
A
new PLOS Medicine essay, written by Langer alongside Dr.
Jonathan Quick, president and CEO of Management
Sciences for Health, and Jonathan Jay, senior writer at
Management Sciences for Health, makes the case for universal health coverage as
a means to prevent vulnerable and marginalized populations from slipping
through the cracks. “In terms of women’s health, it’s the only approach that
addresses all of women’s health needs,” said Quick.
Universal
health coverage makes it easier for families that otherwise couldn’t afford it
to get essential primary care. It also promotes service integration, creating
more pathways to the vital pre- and post-natal visits needed to ensure healthy
pregnancy, delivery, and childhood.
“The
key thing is to have a vision for universal health coverage and build your
system around that vision,” Quick said:
It’s
about mobilizing resources and focusing them from all sources, domestic and
international. It’s about using those financial resources to leverage health
system improvements; it’s about providing protection against poverty. A mother
shouldn’t go bankrupt because her child needs surgery but 100 million
households – families – go bankrupt a year because of health expenses. And
finally, it adapts to changing health needs.
According
to Langer and Quick, universal health coverage programs address five critical
factors: they provide an essential services package; give reliable, easy access
to services; eliminate financial barriers; diminish social barriers; and
provide performance indicators. “Whenever you’re starting a major global movement
on something, monitoring and the measuring is important,” said Quick. “What
gets measured is what gets done.”
Universal
health coverage programs have already shown positive impacts in several
low-resource countries.
Mexico’s
Seguro Popular
(“Popular Health Insurance”) was conceptualized after a study in the 1990s
revealed that more than 50 percent of health-related expenditures in the
country were paid for out of pocket, said Langer. The health package included
250 interventions covering expensive treatments for breast cancer, cervical
cancer, and HIV/AIDS, and was funded by a budget designed to increase by one
percent of the GDP a year. In addition, the government introduced a national
center for gender equity for reproductive health to address and monitor
pressing gender and access issues. Seguro Popular undergoes evaluations every
year, to assure accuracy in health coverage, access, and health outcomes
through extensive tracking mechanisms.
“We as a
community, have to be very smart to make sure that we don’t lose focus or
traction on what we’ve achieved in the last 15 years”
In
Afghanistan, Quick said a package of
essential primary care services implemented in 2003 by Dr. Suhaila Seddiqi, the
minister of public health at the time, embodies the principles of universal
health coverage. The package made a considerable difference in one of the worst places to be a mother (at
the time, 9 out of 10 women delivered without a skilled birth attendant),
providing training opportunities for hundreds of midwives and thousands of
community health workers. In less than 10 years, access to primary health care
increased from less than 10 percent to over 60 percent, Quick said, with
100,000 fewer infant deaths, double the prevalence of family planning, and a 50
percent reduction in maternal mortality.
As
the development community considers the post-2015 framework, universal health
coverage programs could be an important way to reach marginalized women around
the world, but it shouldn’t be the only health goal, said Langer. “We as a
community, have to be very smart to make sure that we don’t lose focus or
traction on what we’ve achieved in the last 15 years,” she said, pointing out
non-communicable diseases as an important emerging health issue that isn’t
necessarily addressed by universal coverage.
Quick
advocated for an integrated approach that uses universal health coverage to
help focus on healthy life expectancy. He proposed combining MDG 5 (maternal
health), MDG 4 (child health), and MDG 6 (HIV/AIDS and malaria) and introducing
better measures of accountability. “You can’t achieve the unfinished agendas
and deal with the chronic disease epidemic without an integrating platform that
maximizes the financial resources and uses them to improve the health system,”
he said.
As world leaders finalize the next global development framework, the maternal health agenda should maintain a top priority. Although maternal mortality rates have declined over the past two decades, the overwhelming need to create a framework that reduces persistent inequalities and improves life expectancy remains.
_______________________________________________________________________________________________________________________________________________