May 21, 2024
Financing universal health coverage | Political Economy
Financing universal health coverage | Political Economy

n the realm of healthcare, priorities are paramount. All allocations of funds must be guided by a clear understanding of the population’s needs and the most cost-effective interventions.

The recent controversy regarding the procurement of robotic surgical systems raised the question of ‘misplaced priorities.’ There is no denying the urgent need for a systematic approach to prioritising sustainable financing for universal health coverage.

According to the World Health Organisation, UHC means ensuring that the people have access to the entire range of quality health services they need, when they and where they need them, without facing financial hardship.

The debate over the allocation of funds for the acquisition of robotic surgical systems raised a fundamental question: What should be the priorities in a public healthcare system in Pakistan given the scarcity of resources?

Realising UHC requires a health system that prioritises cost-effectiveness. Given the unmet primary health needs of millions of people and the rapid population growth, every rupee spent on healthcare must yield maximum benefits for the population.

The government decision to halt the procurement of robotic surgical systems shows that the government is aware of the importance of prioritising essential health services over high-cost, specialised interventions.

What constitutes essential healthcare? The third edition of the disease control priorities (DCP3) defines essential healthcare services as those which address the most important health problems globally, delivered to the entire population in an equitable manner.

These services are meant to be both effective and cost-effective. DCP3 identifies 218 essential health services, 70 percent of those at the primary healthcare level and up to 90 percent, once first-level hospitals are included. The specific list may vary depending on the context and local priorities.

The DCP3 was an extensive project spanning over five years. It engaged prominent global medical experts and resulted in the creation of nine volumes comprising 172 chapters. Each volume focuses on specific aspects of health services, covering essential surgery; reproductive, maternal, newborn and child health; cancer; mental, neurological and substance abuse disorders; cardiovascular, respiratory and related disorders; major infectious diseases; injury prevention and environmental health; child and adolescent health and development; and disease control priorities aimed at improving health and reducing poverty.

The corpus of work aims to streamline healthcare delivery by identifying a set of interventions that address most of the health needs while remaining cost-effective.

The development of a National Essential Package of Health Services in 2020 represented a step towards achieving UHC. The EPHS was customised by the provinces by prioritising interventions and calibrating the costs according to contextual realities.

By systematically identifying and delivering a prioritised package of essential health services, policymakers can ensure that all citizens have access to quality healthcare, regardless of their ability to pay for it. The implementation phase can be more challenging and needs to be pursued with great vigour.

The cost of implementing the EPHS – $13 per capita annually according to 2019 estimates – is modest compared to the potential benefits.

The EPHS, developed in consultation with healthcare specialists and stakeholders from across the country, provides a roadmap for strengthening primary healthcare and addressing the most pressing healthcare needs of the population.

The EPHS aims to deliver comprehensive care at all levels. The roadmap needs to be operationalised through a well-thought-out implementation plan.

Crucially, the EPHS emphasises the importance of prioritising interventions that can be delivered at the primary healthcare level, where resources can have the greatest impact. By investing in primary healthcare and community-based services, Pakistan can address the root causes of illness and reduce the burden on secondary and tertiary care facilities.

The cost of implementing the EPHS – $13 per capita annually according to 2019 estimates – is modest compared to the potential benefits. The impact of investing in essential health services is far-reaching. It can improve health outcomes, reduce disparities and contribute to progress towards UHC.

Pakistan must prioritise the effective implementation of the EPHS. This means that the benefits reach those who need them most, that resources are utilised effectively to achieve desired outcomes and that the interventions are designed to address immediate health challenges and the investments continue to ensure long-term impact.

Strong political commitment, strategic implementation planning, robust financing, and stakeholder engagement are essential. By regularly consulting stakeholders, interventions can be prioritised to create a practical and replicable implementation plan that fits local contexts.

Governments need to prioritise inclusion based on socioeconomic status, geographic location and vulnerability. Implementing the package should be the strategic imperative of the governments to generate evidence for recalibrating the interventions and informing its geographical expansion.

Let us not lose sight of the ultimate goal: to ensure that every Pakistani has access to the quality healthcare they need. By investing in essential health services and prioritising the well-being of our citizens, we can build a healthier, more equitable future for all.

Financing universal health coverage isn’t just a moral imperative; it’s also a strategic investment in future prosperity. Healthy populations are more productive, better educated and more resilient in the face of economic and social challenges. By prioritising essential health services and strengthening primary healthcare systems, Pakistan can lay the foundation for sustainable development and inclusive growth.

As we confront the daunting task of financing universal health coverage, let us draw inspiration from the tireless efforts of healthcare workers, policymakers and advocates across the country. Together, we can build a healthcare system that leaves no one behind, that uplifts the most vulnerable and that reflects the values of compassion, equity and justice.

In the words of Nelson Mandela, “Health cannot be a question of income; it is a fundamental human right.” Let us seize this moment to reaffirm our commitment to realising that right for all Pakistanis, today and for generations to come.


The writer is a Fulbright scholar with a master’s degree in international development studies and a technical adviser for an international organisation working on health financing. He can be reached at [email protected]

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