Three tests for UHC

The data from Covid-19’s disproportionate impact on communities is sobering. It tells the story of a highly unequal world. Data from New York, Detroit, Houston in the US and other places across the world show that communities that were already struggling from inequity, discrimination and poor access to basic services were hit the hardest. The rate and number of deaths, overall morbidity and economic impact on poorer communities are staggering. The data from India has the same hallmarks as from the US, the UK and Brazil. Pakistan is likely to paint a similar picture. People who were already on the lower end of financial security are among the worst affected. Not only is this morally unacceptable, there are long-term economic and social consequences of this unequal impact. Never before, we have had such a strong reason to have universal health coverage (UHC) — a mechanism by which everyone regardless of where they live, how much they earn, ethnicity or faith — have access to good healthcare.

Last week, the Khyber-Pakhtunkhwa government did just that. It announced a bold new plan (which was already in the works before Covid) to create a UHC mechanism for nearly six million residents. It is an impressive step and while a lot more needs to be done (e.g. the population of the province is nearly six times as much, and the cost of healthcare is rising rapidly), it’s a step worth celebrating and one that the government should be rightly proud of. Rolled out effectively and with transparency, this can make a substantial long-term impact on the quality of life and overall economy. However, the real celebration should be reserved not for sustainability. In doing so, there are three basic criteria that any good UHC system needs to fulfil.

The first is quality. Having access to care is meaningless if it fails to be of high quality. Not having access to quality medicines, having to wait endlessly to get treated, or being forced to seek care in places that are incubators of disease due to neglect and poor hygiene is not going to do any good.

The second criteria is constant maintenance. There are ample examples of programmes in the country, launched with the best of intentions that deteriorate rapidly due to neglect, corruption and lack of financial commitment. While there is often lots of pomp associated with announcing of new schemes, delivering a quality outcome, with empathy and efficiency, requires leadership and commitment of resources. We have seen programmes in education and research that were launched with significant fanfare (think HEC and its various schemes) and that have now become a source of bickering, frustration and anxiety. We should not let this happen to the UHC initiative.

The third criteria is transparency and scale-up. The programme’s mission is to take care of people and provide them with quality care. This should be done through clarity (e.g. in the economic model and governance) and with the aim of scaling up to all parts of the country. While it is the right step — and six million beneficiaries in K-P is an impressive number — there is a need to expand this to a number significantly higher than six million. This is also an opportunity both for the ruling party and the opposition to work together and create a system that works for everyone, in every province.

If there is one lesson from Covid, it is that vulnerable people of all provinces, and with all political affiliations, are worse off than their affluent peers. A robust UHC system may be our best insurance against the next pandemic, and our best investment for an equitable and caring society.

Published in The Express Tribune, August 25^th, 2020.

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