Week 12 - UHC and the Right to Health Study Guide With Practical Answers.

1) What are the major challenges of measuring progress toward and achievement of Universal Health Coverage (UHC)? What solutions might the global health community use to overcome these? - correct answer The major challenges that confront the achievement of UHC are in defining factors that constitute the initiative, making it equitable, and figuring out how to measure and mediate factors that are ambiguous. In fact, one of the most difficult aspects of UHC is that, by definition, it is ambiguous by nature. The UHC attempts to define what it denotes "core obligations." These obligations are those which ultimately determine and define the right to health. However, according to one report the statements regarding UHC, "does not sufficiently address the question of the resources necessary to meet core obligations." (Forman 28) In other words, it is firstly difficult to define core obligations, as they might vary in equity based upon the nation and its particular needs, but it is also difficult to then define the resources that will be necessary to accomplish such obligations. Not to mention, the act of collecting data is difficult in and of itself. That which can be measured, and is currently measured, still misses large portions of the population based on difficulties in accessibility, especially from those rural, secluded and/or indigenous communities. Even deeper, it is difficult to measure all of these factors of resources, actors, and any remaining factors; especially given that there is so much variance around the globe in people, basic health care needs, socioeconomic status, education, culture, etc. The same article goes on to suggest that the UHC committee has failed to develop a process to assess when a state has expended its maximum available resources and may need foreign intervention. More importantly, when this happens, there is no metric or criteria which defines how the burden will be divided among nations; i.e. who should take the blame for others to have free health care? This brings about yet another key 2) What is the role of the World Bank in implementing UHC? What are the major benefits and drawbacks of the involvement of this global actor in UHC policy? What should be the role of the World Bank in health systems strengthening? - correct answer Both historically and currently the World Bank has played an integral role in the implementation of Universal Health Care. Throughout its many developments, the World Bank seemingly started and has sustained its devotion to providing fundamental health care and health liberties on a global level. Throughout its existence, the World Bank has pivoted many times with respect to health care efforts. Originally devoting itself to population control with the intent of having positive implications on health of all peoples, then shifting to financing primary health care in the early 1980's, to health reform, and currently using a health system approach, democratizing health care and health equity has been a central focus of the World Bank. However, many of their efforts have further stratified systems of health equity and have counteracted benevolent efforts. As of present day, the World Bank serves to strengthen health systems through financing with project loans, trust funds, partnerships, etc. They are a partner with many forward-thinking health initiatives prompted by Primary Health Care Performance Initiative and International health Partnership. These initiatives, at the heart, work towards a sort of UHC with "primary", fundamental care across all nations, while institutionally-targeting efforts in health system reform for those countries with weaker health systems. While many of their efforts are very powerful, they, too, have drawbacks. The major benefits include the financial power and resources that the World Bank wields. On behalf of this, the World Bank can support UHC, according to a report on the World Bank and Financing Global Health. They can do so through its access to ministries which can promote coordinated, collective efforts. Moreover, it can drive metrics which ultimately support progress toward UHC. Addi 3) Consider the way in which Rwanda, Thailand and Brazil have each approached achieving Universal Health Coverage (UHC).a) Were there any shared approaches? Shared challenges? b) UHC has been cited by the World Health Organization to be a "practical expression of health equity and the right to health". Did you see this reflected in the videos? Was there any evidence of the critique sometimes lodged against UHC that it acts as a ceiling on the standard of care provided? - correct answer The shared approaches among Brazil, Thailand, and Rwanda seemed to be embedded in each country's individual belief that health is immeasurably valuable in the scheme of larger things. In Thailand, they believe that a healthy society is a productive society. In Brazil, they believe in the right to health as a fundamental human right. In Rwanda, they saw people in need of help and medicine, and thus took inspiration from the intended welfare of the health of its people. Each of these three countries also approached UHC autonomously, rather than waiting for outside donors and stakeholders to mobilize foreign resources. Thus, each of these "developing" countries were resourceful of their own people and their own coordination efforts. For instance, Rwanda and Brazil both took specifically to creating access to healthcare in more rural, isolated communities. Rwanda trained 45,000 health workers called "community health workers" whom had knowledge on how to treat a number of common diseases and educate local people on healthy practices. In Brazil, they created clinics all throughout the country with special focus on the favelas wherein doctors were encouraged to practice at 3x the normal rate. This incentivized better medicines and care to people who were previously unable to afford their right to health. They also focused a lot on vaccinations, ensuring that its people were guarded from those diseases which could be evaded. Thailand, meanwhile, focused a bit more on mobilizing and defragmenting efforts through policy and political will. While to an extent, each of these countries exercised this strategy, Thailand's coordinated efforts to effect change from bottom up to promote development from top to bottom was the pinnacle of their approach to a healthier society. The people of Thailand capitalized on the idea that health m Clarify what UHC means and encompasses - correct answer UHC is defined according to quality, affordable health care as the foundation for individuals to lead productive, fulfilling lives and for countries to have stronger economies Major challenges: measurement, compliance, health as a commodity, and not being able to ensure quality care Explore the World Bank Group's role in financing UHC - correct answer - focus on health system strengthening - exercises hard power in terms of financial means to push the agenda of UHC - use trust funds = ear-marked funds for a specific purpose often used to get countries out of debt from user core fees - take a utilitarian approach - 1968, involvement on behalf of aftermath of WW2, - first loans for disease, family planning, etc. (emphasis on poverty alleviation in social sector) ; , market based solutions and privatization of health care (user fees at point of care encouraged for LMIC); = focus on achieving MDGs through cooperation w stakeholders; 2010- now= works with govt to achieve UHC through financial instruments, trust funds to remove point-of-care fees, more focus on dealing with high profile health concerns, transition from lender for major development projects to a broker for private sector investment - UHC means all individuals and communities receive health services without suffering financial hardship including full spectrum of essential, quality health services from health promotion to prevention, treatment, rehabilitation, and palliative care Consider issues in the debate around UHC - correct answer - measurement is difficult to do (AAAQ relies heavily on quantitative values which are often not sufficiently measured) - question of what services are covered and for whom: promote primary health care, only most cost-effective interventions, most highly demanded?, most expensive which will neglect preventative care? and how to achieve the different facets that entitle everyone to every facet to healthcare - infrastructure/logistics: supplies, clinicians, referral systems/transportation and roadways, emergency response, management systems for revenue, purchasing, data collection, what about corruption? - social/cultural determinants - taking resources from some to give to others - critique of only focusing on health financing - requires more than just financial support - can people actually access the provision of services Explore the influence of the right to health on UHC - correct answer - min standard to which countries are held for right to health = core obligations. core obligations of a UHC - non-discriminator