Just a few short months ago, the United Nations General Assembly formally adopted an ambitious 15-year global agenda for sustainable development. Among its targets for eliminating poverty and protecting our planet is universal health coverage (UHC).
This major achievement marks the culmination of years of effort by national leaders, international organizations, civil society groups, and many others who believe that achieving universal health coverage is both the right thing to do for people and the prudent thing to do for economic development. The Rockefeller Foundation was proud to join in leading this global campaign.
The prospect of achieving health for all by 2030 may seem daunting on a planet with more than seven billion people, but we have already celebrated several milestones on the path toward UHC, not least of which is the inspirational example of Thailand's own universal coverage scheme. Such triumphs spring from the groundbreaking UHC movement's accelerating momentum over the past decade. Today, countries on every continent have taken first steps toward quality health services that are accessible, affordable, and equitable in their delivery.
One of the keys to success in achieving UHC—and sustaining it—is the ability of countries to set smart priorities. Otherwise, UHC becomes unaffordable for most nations. For example, although economies in Asia and Africa are poised for growth, national budgets for health are unlikely to increase quickly enough to match the exponential economic upswing. Instead, patients in these regions are more likely to see a rise in their out-of-pocket spending, a phenomenon that invariably impacts the poor, further exacerbating inequities in health.
Smart priority setting means that national governments must make difficult decisions. They must look toward evidence from national burdens of disease, health technology assessments, and cost-effectiveness, as well as inclusively incorporate cultural and societal needs for health. They must take up the challenge to prioritize which interventions and services are essential and should be subsidized and which ones should not.
Building long-term capacity within the national system to support priority setting for UHC is important to keep the momentum going. To achieve this capacity, national governments will have to strengthen laws and policies that establish national bodies and technical committees entrusted with handling these transformations. Many countries, such as Brazil, Chile, Colombia, Uruguay, and Thailand, have already done so, successfully adopting well-defined priority-setting processes to guide their allocation of resources to promote health equity and efficiency.
Priority setting for UHC requires long-term, strategic, and integrated approaches. Done properly, its processes force leaders to examine the whole health system, not just its constituent parts, and to be aware of its strengths and its weaknesses at different points in time. It is not a one-time fix. National priorities must constantly be adjusted to meet the changing health needs of the population and the evolving availability of resources. In this way, priority setting must become an integral part of the ongoing management of a nation's health system if it is to achieve and sustain its commitment to UHC.
At The Rockefeller Foundation, we recognize that effective priority-setting mechanisms can carry a positive social dividend that extends beyond a national system's health sector. A successful health system with an explicit priority-setting process also keeps citizens informed of the benefits to which they are entitled, ensures greater accountability from health care providers, and promotes increased transparency in the decisions it makes. That is why our Transforming Health Systems initiative has partnered with expert technical organizations such as England's National Institute for Health and Care Excellence and Thailand's Health Intervention and Technology Assessment Program to elevate the importance of priority setting—by creating manuals and tools for practitioners, building capacity in Asia and Africa, and encouraging the use of data and evidence for improved decision making.
Priority setting can contribute to the overall resilience of a nation's health system, thereby increasing its effectiveness in both good times and bad. Over time, a clearly defined priority-setting process will help create a public health system that can withstand adversity while simultaneously providing long-term benefits to people, communities, and countries.
DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST
No potential conflicts of interest were disclosed.