Global threats loom over Universal Health Coverage, yet solutions are within reach
 
Universal Health Coverage (UHC) is encountering multiple global threats, as highlighted by experts during the panel discussion on UHC Day 2023. These threats range from demographic changes and the rise of non-communicable diseases to the impacts of climate change.

To address these challenges, measures such as strengthening primary care, promoting health prevention, improving the quality of care, and adopting health technology will be crucial.

This advice emerged during the panel discussion on "The Global Outlook on Health and Well-being: What's Next for Universal Health Coverage?" held at the Ministry of Foreign Affairs, Thailand on December 8.

The event was part of the pre-ceremony of the UHC Day, jointly organized by the Ministry of Foreign Affairs, Ministry of Public Health, Bangkok Metropolitan Administration, and National Health Security Office (NHSO).

UHC Day is observed annually on December 12, marking the adoption of the first unanimous United Nations resolution urging all nations to ensure affordable and quality healthcare for their citizens.

During the panel discussion, NHSO Secretary-General Dr Jadej Thammatacharee emphasized the need to address three global challenges impacting Thai UHC in the coming decade.

These challenges include health finance constraints resulting from a rising aging population, declining birth rates, economic recession, and technology that escalates healthcare costs.

Additionally, health inequality and disparity hinder marginalized communities' access to care, along with the looming threat of climate change, which will strain the health system.
  
Primary care is key



Dr Jadej underscored the urgent need to bolster primary healthcare, health prevention and promotion, and pandemic preparedness to combat emerging health challenges.

"We believe that UHC without primary healthcare can’t be sustained. However, we need to revamp our strategy and approach by making primary healthcare more proactive, participatory, and community-centric,” he stressed.

The NHSO has overseen the Universal Coverage Scheme, providing healthcare access to over 47 million beneficiaries.
 
Substantial efforts have been made to enhance coverage and benefit packages.
For instance, the NHSO plans to launch a telemedicine service this month, enabling Thai nationals living abroad to consult general doctors in Thailand without incurring additional costs.

The NHSO will also promote self-care, self-testing, and self-sample collection — an approach that has proven to speed up people’s health recovery and service access during the COVID-19 pandemic.

"Quality is the foundation of everything in particular when we see the quality of primary healthcare having an impact on accessibility and affordability of UHC," remarked Wei Han, Senior Economist, Health, Nutrition, and Population at the World Bank East Asia and Pacific.

She emphasized the necessity of tackling health inequality, underscoring that the COVID-19 pandemic revealed higher mortality rates within marginalized communities.

Another pressing issue requiring attention is antimicrobial resistance, which is directly responsible for over one million deaths annually and indirectly linked to six million deaths, according to Han. This phenomenon is expected to have a substantial impact on healthcare financing.
  
Addressing equity and eliminating discrimination

Sirirath Chunnasart, an adolescent development specialist at UNICEF Thailand, emphasized the necessity of including the voices of children and adolescents in ensuring health equity within UHC.

This demographic faces significant impacts from air pollution, causing respiratory diseases, impeding child development, and disrupting education.

In the mental health realm, UNICEF discovered that one in seven adolescents in Thailand has been identified with mental health disorders, potentially affecting UHC in the long term. Non-communicable diseases such as overweight and obesity are rapidly increasing among children and youth.

"To see change happen, we have to change the way we work. If we have never engaged any particular group of people like young people in UHC, this is the time we should take action and bring them in," stated Sirirath.

Dr Jakkrapatara Boonruang, a Research physician at the Institute of HIV Research and Innovation (IHRI), highlighted the room for improvement in HIV-relevant service access within UHC.

“Despite UHC providing access to care, including antiretroviral drugs for HIV patients, we continue to witness a rise in new HIV cases annually. This indicates a significant barrier preventing people from accessing necessary care.”

For instance, some government clinics only accept HIV cases two days a week, creating a gap for patients seeking prompt consultations and treatment covered by UHC.

Stigma and discrimination against HIV patients persist, with mandatory HIV testing for many job applicants and a lack of comprehensive sex education within the Thai education system to equip young people with knowledge about avoiding sexually transmitted diseases.

“We want to see the UHC tackle the needs of specific populations,” said Dr Jakkrapatara.
“If you want to know who we are tracking, we need them to voice out, Thailand has a lot of strong communities.

Why not ask them what they want for UHC? They can organize themselves. We need to believe in their power, and UHC must be ready to subsidize them.”
 


Leading with innovation

Dr Zin Ko Ko Lynn, Drugs and Health Officer at UNODC Regional Office for Southeast Asia and the Pacific, emphasized the importance of including drug and substance users in UHC health policies.

Drug dependency and substance use disorder are linked to health disparities. In 2021, approximately 400 million people globally used drugs, yet only one in five could access treatment for their condition.

Accessibility to treatment is even more challenging for women compared to men. Globally, only 27% of women who are drug users can access treatment, highlighting a significant gap in care between genders.

“We need to make harm reduction and treatment available. It’s not just about cure. It’s also about health promotion and prevention.

We must implement effective measures that can prevent the social consequences of drug use.” Dr Lynn said.

“To make that intervention available, we need an evidence-based approach that is one of the key success factors of Thai UHC.”

Supanan Janeteerawong, President of The Society of Medical Students of Thailand, echoed this sentiment, emphasizing the potential of technology to optimize resources and enhance healthcare accessibility.

Similarly, Sirinath from UNICEF sees digital health as a crucial channel for the tech-savvy younger generation to access healthcare, including young people, HIV patients, and drug users who may feel uncomfortable visiting hospitals.

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