Prioritize Refugee Health Needs for Universal Health Coverage by 2030
Universal health coverage (UHC) means that all people and communities receive the quality health services they need without suffering financial hardship. To reach this goal, the international community now recognizes Universal Health Coverage (UHC) Day on December 12, since the adoption of a resolution by the United Nations (UN) General Assembly in Tokyo in December 2017. At the same time, the UN adopted another resolution establishing UHC2030, a health system platform that promotes multi-stakeholder collaboration to advance global efforts towards achieving UHC by the year 2030.
Impact of Health Inequities on Vulnerable Communities
The publication of new data in the Tracking Universal Health Coverage: 2017 Global Monitoring Report revealed that at least half of the world’s population still lack access to essential health services and about 100 million people are pushed into extreme poverty each year because of their health expenditures. According to the report, although they may have access to some health services, more than half of the world’s 7.3 billion people do not receive all of the essential health services they need. Essential health services encompass everything from health promotion to prevention, treatment, rehabilitation, and palliative care throughout the course of a lifetime. These include neonatal, child, adolescent and maternal health, sexual and reproductive health, infectious diseases, non-communicable diseases, and more.
Additionally, over 800 million people spend at least 10 percent of their household budgets to pay for health care. What does this mean to a poor person in a rural community living below the global poverty line ($1.90 per day)? It means if one’s household annual budget is $1000, they spend at least $100 on health care. With this, one may not explicitly understand the adverse effects of huge health expenditures on one’s life. Now consider an unemployed person. The annual household income is usually very small to cover all their expenditures. What does this mean when it comes to paying for health services? It means that a person will spend more than they earn on healthcare services and thus resort to borrowing and potentially being pushed into extreme poverty.
To exacerbate the situation, such challenges fall hardest on vulnerable persons like refugees who leave all their businesses, income generating activities, and investments in their home countries. This makes it challenging for them to access healthcare, and in many cases whether refugees live or die is determined by who and where they are.
Refugees Influx in Uganda: Health Equity Crisis
With Uganda currently hosting over one million refugees from several unstable African countries, there is a need for stakeholder engagement for increased support for refugee health needs to achieve UHC by 2030. As part of the global effort to support refugees, Uganda hosted Solidarity Summit on refugees on June 21 and 22, 2017 and the world gathered in Uganda to stand in solidarity with the country as we hosted over one million refugees. The summit, hosted by the honorable President of Uganda Yoweri Museveni and the United Nations Secretary-General Mr. Antonio Guterres, raised over USD 350 million to support the refugee crisis and influx in Uganda. Of course, health services support for the refugees was among the many social aspects that could be addressed by this commitment. The summit was a great multi-stakeholder engagement towards supporting refugees globally.
Uganda’s integrated refugee response incorporating host communities has been named as the model for the Comprehensive Refugee Response Framework (CRRF), adopted at the September 2016 UN Summit for Refugees and Migrants in New York. This makes Uganda a front line state for this new approach. Along with the UN High Commissioner for Refugees, the government of Uganda and other humanitarian agencies have done a great job addressing the health needs of the persons of concern. However there is still a need to build more partnerships between private, national, regional and global agencies towards supporting refugee health needs as we strive to achieve UHC by 2030. This means that more partners across sectors need to invest in supporting refugee health needs through increasing community awareness of UHC and calling for stakeholder cooperation to support refugee health needs.
Partnerships Are Key for Improved Refugee Health
The 2018 theme for UHC Day was “Unite for Universal Health Coverage: Now is the time for collective action.” In Uganda, Rural Aid Foundation through Global Health Strategies was funded by UHC2030 to commemorate UHC Day and engage the refugee community and different stakeholders in a dialogue on UHC. The event was also held in partnership with Global Health Corps young leaders including Caroline Achola from Days For Girls and Dennis Ernest Ssesanga and Hana Hamdi from IntraHealth Uganda. Other partners included InterAid Uganda, the Ministry of Health, Public Health Ambassadors, and Rise up for Refugees. Over 250 refugees and stakeholders attended, creating strong momentum for advancing the global UHC 2030 strategy in Uganda with a specific focus on refugee health rights and government commitments and policies to protect and uphold those rights.
After the dialogue, various stakeholders committed to supporting refugee health needs and driving the UHC 2030 agenda by engaging other stakeholders at national, regional and global levels. They made a call to government and other stakeholders to prioritize refugee health needs for UHC.
Universal Health Coverage, SDGs, and UHC Advocacy Principles
- Leaving no one behind: a commitment to equity, non-discrimination, and a human rights-based approach
- Making health systems everybody’s business: engaging citizens, communities, civil society, and the private sector in achieving UHC
Expanding access to affordable, quality healthcare to refugees will require continued partnership at the community, national, regional, and global levels. To achieve UHC globally, states must prioritize and address the health challenges for the most vulnerable populations, including refugees, to ensure no one is left behind.
Frank Ategeka is a 2018–2019 Global Health Corps (GHC) fellow at the Center for Health, Human Rights & Development in Uganda.
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