Countries who moved the most towards UHC display common patterns, apart from financial reform: high level leadership and commitment, investment in first line services accessible to the people by injecting additional money (China, Ethiopia, Thailand, Philippines, Rwanda) and/or improving efficiencies in the system (Moldovia).
To nobody’s surprise, the role of the private sector was fiercely debated. Is the private sector ‘a curse or a blessing’? See for example this participant: “The private sector is like bamboo: once you allow it, it quickly spreads and destroys the rest.” Some saw private provision as a blessing though, at least as far as efficiency is concerned. There are lots of good aspects about the private sector, but strong governance is needed. Let’s see how we can “make it work” instead of just playing the blame game.
There were plenty of strong messages, for example from Carissa Etienne (WHO) “Every individual has the right of access to services without fear of impoverishment”; “Is it utopia? Look into the eyes of the one billion who do not have access to health care and tell them it is utopia!”.
There were also striking quotes on development aid. “UHC cannot happen overnight. Development Assistance for Health can be used to help in the journey towards Universal Coverage” – Dr. Rifat Atun, Director of Strategy, Performance and Evaluation Cluster, Global Fund
“UHC is achievable, but it needs more money and political commitment”-Financial Controller, Ministry of Health and Medical Services, Solomon Island
“We do not like you because of the money, but because of your knowledge and experience. Money itself doesn’t change” –C/P of Eva Jarawan, Senior Health Specialist, World Bank
“The relationship between a recipient and a donor is like a marriage. You need to know what you want or what your partner wants because you live together”-Vice Minister of Health, Indonesia
Needless to say, the Thais did a fabulous job in organizing the conference, filling our stomachs and spicing up the debate, see for example Suwit Wibulpolpras: “we don’t talk about UHC, we do it”. Accommodation was perhaps a bit over the top, for some of the participants: splashing out on jacuzzi’s & thai massage and then discussing ‘health care for the poorest’ seems weird, to say the least. However, we marveled at the performance of the magician during the conference dinner. He entertained us and many others during the conference dinner using a magic wand. David Copperfield and even Harry Potter would have been impressed. It would be wonderful if something similar could be done to realize UHC. Or is that beyond the scope of today’s UHC magicians/gurus?
Finally, we were underwhelmed by the cheesy “We believe in UHC” performance at the end of the conference, but that’s just us, cynical Europeans. Our “can-do” American colleagues got much more into the groove. After all, theirs is the land that produced Michael Jackson’s “We are the world”…