Part 1: Global Health Under Pressure: Prioritizing Universal Health Coverage

Primary health services directly save lives, as Marwin Meier explains. He is a political advisor on health and migration at World Vision, with over 20 years of experience in health across various civil society organizations. Initially, he worked for ADRA (Adventist Development and Relief Agency) as country director in Togo and the Philippines. Later, he joined World Vision, focusing first on HIV/AIDS and then on maternal and child health. Through primary health services, mosquito nets are distributed to protect vulnerable populations from malaria. However, during the COVID-19 pandemic, lockdowns in many countries prevented the distribution of nets, and some health centers were closed, reports Marwin Meier. According to the WHO, malaria infections increased by 14 million in 2020, reaching a total of 241 million cases, with the number of deaths rising to 627,000. A reliable universal health coverage system is therefore essential.⁴ Reliable universal health coverage is therefore essential.

UHC: Where Do We Want to Be by 2030?

UHC is part of the Sustainable Development Goals (SDGs) set by the international community to be achieved by 2030, with UHC outlined in target 3.8. This includes financial protection, access to high-quality basic health services, and access to medications and vaccines that are effective, safe, and of high quality but still affordable.

Sexual and reproductive health and rights (SRHR) are also an integral part of universal health coverage. Dr. Magda Robalo, former Minister of Health of Guinea-Bissau, now co-chair of the UHC2030 Steering Committee, interim executive director of Women in Global Health, and president and co-founder of the Institute for Global Health and Development, has been working on improving access to basic health services and addressing the vulnerability of disadvantaged populations throughout her career. In an interview, she explains why gender-responsive UHC is necessary. Women form the foundation of health systems. Globally, 70% of all health personnel are women, and 90% of nurses are female.⁵ „Therefore, there is no way we can achieve UHC if the needs, the contributions and the leadership of women is not taken into account, in ways that benefits the population. If you don’t take into consideration the needs [and contributions] of women in health facilities in your health system […] you miss opportunities of learning, because [women] know best how to [care for] mothers, children and pregnant women. You miss in your leadership and management the knowledge, experience and the [caregiving skills] of people who constitute the majority of the global health [workforce],“ says Dr. Magda Robalo.

However, we are still far from achieving gender-responsive UHC. One reason is the lack of data. "Women are made invisible," criticizes Dr. Robalo. Indeed, health data is still not consistently disaggregated by sex. This means that data for men and women is not presented separately. During the COVID-19 pandemic, around 60% of countries worldwide reported that they did not disaggregate their data by biological sex. This has devastating consequences: For a long time, it was assumed that biological sex made no difference in physical health other than size and reproductive functions, and so the biologically male body was considered the norm in medicine.⁶ Due to the lack of studies, medications are still often dosed according to the biologically male norm – too high for biologically female bodies.

Another important indicator for achieving UHC is drastically reducing excessive household spending on health relative to income and total household expenditure. One possible strategy to make health services affordable for all is well-functioning health insurance systems. In an interview, Dr. Magda Robalo explains that the establishment and expansion of health insurance is a long-term task for states that requires careful planning. Regulations like the choice of service providers, the coverage of family members and the calculation of contributions are an essential prerequisite for reliable health insurance systems, but according to Dr. Robalo, many countries are struggling with this aspect. However, Indonesia is a positive example of implementing an effective health insurance system. Marwin Meier also names Brazil as a positive example of a well-functioning universal health insurance system. In Africa, Rwanda is a pioneer in universal health coverage.