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By Dr. Fuein Vera Kum (Download pdf version)

Universal Health Care Coverage and COVID-19


Healthcare is a fundamental human right. Health services, as well as the underlying determinants of health and universal health coverage, are critical tools for achieving health for all. Universal health coverage is defined as a situation where all individuals and communities receive the health services they need without undue financial hardship. However, at least half of the world’s population still does not have full coverage of essential health services, and over 800 million people spend at least 10% of their household budgets to pay for health (WHO, 2020).

Meanwhile, universal health coverage, by definition, includes access to the full spectrum of services, including health promotion, prevention, and treatment but all these, and also health security, are included in the tracking of universal health coverage progress under Sustainable Development Goal 3.8.1. In practice, the focus has largely been on treatment, with less or no attention to promotion and prevention.

During its outbreak, in the space of nine months, COVID-19 had spread to more than 190 countries, with over 30 million cases reported by the United Nations (2019) reference needed. Over one million lives were already lost. The pandemic laid long-ignored risks, including inadequate health systems, gaps in social protection, and structural inequalities. It also brought home the importance of basic public health and strengthening health systems and emergency preparedness, as well as the resilience of a population in the face of a pandemic, lending ever greater urgency to the quest for universal health coverage (UHC) (WHO, 2019).

In fact, in the longer term, pandemic preparedness and response can be seen as a global public good with commensurate investments at global and national levels. It requires a standardized outbreak alert system linked to concrete actions by national and local health authorities. As of now, only one-third of countries have put in place public health emergency management systems as required under the International Health Regulations of 2005 (World Bank,2020). The pandemic is costing the global economy $375 billion a month and 500 million jobs since the crisis erupted. The focus needs to remain on addressing the root cause of the economic crisis — which is COVID-19 (WHO, 2020).

The objective of this paper is to review the global adoption of Universal Health Coverage (UHC), discuss some effects of COVID-19 on Universal Health Coverage, and suggest some recommendations on how to handle this challenge of COVID-19 with respect to Universal Health Coverage.

Global Adoption of Universal Health Coverage

Globally, the move toward UHC has been associated with the intent of improving accessibility and affordability of healthcare, but UHC initiatives are often adopted in response to a social, economic, or political revamp. For example, Japan began its movement towards UHC before World War II to develop a healthy workforce through Citizens’ Health Insurance. France provided UHC to all its residents in 1999 through the establishment of the Universal Health Coverage Act (CMU), and it is the highest financial protection provider for healthcare-related expenses among countries in the Organization for Economic Co-operation and Development (OECD) (Reich et al., 2016).

In some countries, UHC was adopted to counter the financial crisis, such as Türkiye, Indonesia, and Thailand. To overcome health inequalities and financial risk, Türkiye had in 2003 introduced UHC through the Health Transformation Programme (Reich et al., 2020). Similarly, Thailand adopted UHC in 2002, which provided health coverage to all of its 66.3 million inhabitants (Naidoo et al., 2020).

By the mid of twentieth century, high-income countries such as New Zealand, Australia, and Canada had implemented the UHC in various formats (Tikkanen et al., 2020). Hence, COVID-19 is another push to stimulate the adoption of Universal Health Coverage, especially in developing countries.

The Implication of COVID-19 on Universal Health Coverage

Firstly, given the gross inequality in health status between males and females, rich and poor, developed and developing countries, it is estimated that about 150 million individuals worldwide face catastrophic healthcare expenditures, and out of these, more than 100 million are living in poverty (Xu et al., 2007). Thus, unlike any other crisis in recent history, COVID-19 has amplified the urgency to accelerate efforts to build strong and resilient health systems and to achieve progress toward UHC.

Strong health systems with adequate resources are key to successful crisis response and management. It has been demonstrated that the countries with a strong UHC, such as South Korea and Singapore, have outperformed during the COVID-19 pandemic.

In Japan, a COVID-19 response is coupled with effective public financing policies and universal health insurance with a uniform fee schedule. These policies have been effective in tackling COVID-19 and have provided an efficient mitigation response along with the restoration of essential health services amid the pandemic (Rabia Hussain and Sara Arif, 2021). Secondly, Amid COVID-19, the delivery of essential healthcare services is interrupted and inaccessible in almost all parts of the world.

Even high-income countries have struggled hard to provide adequate healthcare, medical commodities, diagnostic testing, and specialized Intensive Care Unit (ICU) equipment during the pandemic. The situation is far more challenging for countries with existing health inequities and developing healthcare systems. The pandemic has emphasized the importance of universal access to healthcare, proving that if the healthcare needs of a segment of the population are unattended or even a single individual is left unaddressed, the whole population is at risk

Conclusion and Recommendations

UHC is aimed at providing access to healthcare services to all populations in the world, regardless of geography, epidemiology, and technology. In the past, many countries adopted UHC, particularly during economically difficult circumstances, and so is the situation with many developing countries during COVID-19.

Although it will not be easy to fully achieve UHC all over the world, the government of each country and their respective partners need to work together to fully implement UHC in all parts of the world. Also, strong health systems based on primary health care are the foundation of an effective response to COVID-19, as well as universal health coverage.


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Dr Fuein Vera Kum is a Research Fellow at the Nkafu Policy Institute. She joined the institute as Economic Policy Analyst in 2017 with a focus on health economics and development policy. She holds a Ph.D in Economics from the University of Benin, Nigeria.