Exclusive Commentary: Universal and Sustainable Health Coverage

By Krycia Cowling

Thank you for your coverage of Jeffrey Sachs’s talk last Thursday in Global Health NOW. I also attended the lecture. While I welcome his call for universal health coverage, I was disappointed that he made no mention of many of the most important underlying causes of weak health systems in low- and middle-income countries and that he did not adequately discuss how to make providing universal health coverage (UHC) sustainable.

In my opinion, his emphasis promotes an aid-dependent model of funding primary health care globally, as opposed to working towards a future wherein each country can fund its own public primary health care system. Aid funding can contribute substantially to this goal, but a longer-term vision must include other components. To discuss UHC without mentioning access to education and the inequities of the global economic system fails to address the critical economic development needed in order for each country to eventually fund its own UHC—ultimately the most sustainable model. The BRICs countries provide examples of emerging economies that are now working towards UHC.

In addition, he made no mention of curbing the health worker brain drain, which is fundamental to ensuring sufficient capacity exists in all countries to provide primary health care services for each person. Meaningful action to reduce the movement of health workers will almost inevitably require policy reforms in high-income countries, in order to reduce our extraction of workers from lower income settings.

I agree with Professor Sachs that UHC is an important goal, but I would like to see calls to achieve it include consideration of the most fundamental problems that currently make this difficult, and a vision for ultimately achieving UHC in a more sustainable way.

Krycia Cowling, MPH, is a PhD student in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health.

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