David Hercot

To build on a CGD post  about ‘what’s hot and what’s not’ in global development for 2012, after  attending the PMAC conference in Bangkok, I think it’s fair to say that as far as global health is concerned,  UHC is on the rise. That is, if the global health big shots and Ban Ki Moons of this world indeed put their heart (and money) where their mouth is. So UHC is definitely in vogue. Conversely, keeping in mind the new direction taken by the Global Fund, Health systems strengthening is probably going to fade out, at least as a buzzword.

What is good about the new UHC momentum is that it focuses more on ‘people’ than HSS. Perhaps not as much as the 1978 Alma Ata declaration of “health for all” did, but this is still a move in the right direction. Of course health systems will need to be strengthened but as a means to an end, not as an end in itself.

Putting too much emphasis on reaching UHC might be dangerous, though. UHC is a moving target that no country on earth has ever reached. Declaring that a country reached UHC is therefore a blatant though understandable lie. This doesn’t preclude strong country commitments and/or important progress, but offering all-comprehensive health care to all citizens at an affordable price is quite utopic. Rationing is part of the game, so we’d better talk about it. Unfortunately, this reality was omitted from all discourse on UHC at PMAC. I believe we better face it.

Defining measurable UHC targets to accommodate them into future MDG+ or SDG frameworks might bring us some self-serving measurement of progress as well as fiery political declarations, yet, they will never reflect the complexity or the neverending quest of moving towards UHC. UHC is a spirit, not an indicator for me. (but granted, many ohers reckon that we need some sort of ideal composite index to rank countries according to their UHC progress.)

Having said that, I firmly agree with the final Bangkok statement on UHC. It’s great to be part of this global drive towards UHC!


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