Financing a Healthier Future for All
By Yanira Garcia, Global Health Analyst, ACTION
A new era of health equity is upon us. Serious efforts from governments, civil society and multilaterals to “leave no one behind”, are underway to meet the broader social needs of people. If constructed with attention to the needs of diverse populations and country contexts, it will undoubtedly go a long way to address disparities and foster equity.
Over recent decades, immunization has contributed to the dramatic reduction in child deaths. The number of children dying before the age of five has reached a new low — 5.6 million in 2016, compared to nearly 9.9 million in 2000. Routine immunization services are a cornerstone of primary health care and drive an equitable approach to health service delivery on the path to UHC. With their broad reach (their current coverage rate is 86%) they serve as a foundation for delivery of other vital services integral to reaching UHC. These include malaria prevention, nutritional supplements, neonatal and maternal health care and sexual and reproductive health and education. Tackling preventable diseases in an integrated way lessens the burden on health systems by decreasing the cases of critical childhood diseases.
Gavi, the Vaccine Alliance, through its efforts to shape the vaccine market, ensuring the provision of quality vaccines at sustainable prices to low and middle-income countries, has dramatically increased the number of vaccines available to children in the last 15 years. However, coverage remains too low with one in ten children unable to access any vaccines. Immunization saves 2 million lives every year, but with higher coverage, it could save up to twice as many. Continued investment in immunization is needed, both by governments and donors and could be critical to achieving UHC.
With less than 12 years to go before reaching the target date for the Sustainable Development Goals (SDGs) of 2030, we still have a long way to go to achieve our objectives. Today, at least half of the world’s 7.3 billion people still do not have full coverage of quality, essential health services.
While we are seeing increasing investments through both governments and donors alike, more attention should be placed in expanding domestic investments in health and reallocating funds in low- and middle-income countries, in addition to continued commitment from high-income country governments and multilateral institutions to see their investments through. Public investments are too low and donor financing is changing. This is especially the case as financing from the Global Polio Eradication Initiative (GPEI) and Gavi is reducing: both have had considerable impacts on countries immunization and health systems, but when they leave, there is a big risk that services will not be funded domestically and no longer be provided. For example, Nigeria, a middle-income country facing financial reductions from both GPEI and Gavi, has a weak health system, and a current immunization rate of 33% — declining to as low as 2% in some areas. Low immunization levels compromise gains in all other areas of health for mothers and children. The poorest, most vulnerable children who need immunization the most, continue to be the least likely to get it.
As Ministers of Finance gather at the World Bank Spring meetings, as donors are evaluating their continuing support for health, and as multilaterals are changing their guiding policies to how they will reduce country support, it’s the time to ask — how will we finance UHC? How are we building and financing sustainable health systems that can address the vast existing inequities in accessing health services? Especially for those people who out of pocket expenditures prevent them from accessing the services core to UHC, particularly immunization. It’s a critical moment to call on world leaders to commit concrete steps to support financing for primary health care and stronger routine immunization systems, both at the heart of UHC.
