BEIJING SYMPOSIUM: Challenging the wheels of inevitability on the road to universal health coverage
Over the last decade, the BRICS countries (Brazil, Russia, India, China and South Africa) have demonstrated rapid and remarkable economic development foreshadowing their increasing prominence and leadership in world affairs. It is perhaps appropriate therefore, that the first plenary session of the Second Global Symposium on Health Systems Research in Beijing invited these powerhouse countries to share more of their ‘challenges and lessons learned’, this time with regard to designing and implementing universal health coverage.
Despite their evident economic prosperity, the BRICS countries exhibit some of the most challenging health-related statistics in the world, be they related to HIV/AIDS, infant mortality, life expectancy or adequate access to healthcare. They are also coming to terms with the emergence of non-communicable diseases such as diabetes, the increase of which is expected to increase threefold in the next ten years in China alone, as Wang Longde of the Zheijiang University School of Public Health explained. Almost half of people in Brazilian capital cities are either overweight or obese, while some 40% of Russians still suffer from inadequate access to healthcare facilities.
For most of the panellists, this had led them to include the private sector (non-state actors) as a crucial part of the strategies they were now implementing to maximise coverage in the face of escalating demand. As Precious Matsoso, Director General of Health for South Africa explained, these public-private partnerships were at an embryonic stage, having only recently launched a number of preliminary studies to explore the range of services and fees charged by non-state actors that will help them understand how to engage with these providers most effectively. At the heart of their approach is a decentralisation of services based on district level primary healthcare that will leverage both public and private actors.
Brazil is slightly further along this road, having already partnered with the private sector on a range of interventions, including harnessing 25,000 private chemists nationwide to distribute free drugs for hypertension and diabetes to over 4 million people. It also has in place 34 public-private partnerships for product development alone, which according to Jailson De Barros Correia, Director of Science and Technology at the Brazilian Ministry of Health, has led to savings in state expenditure in this field of as much as 33%. With around 1 in every 10 Brazilians working in the health sector, and with health established as a human right in its 1988 Constitution, the ideological debate over whether the government should work with non-state health providers has been replaced by the recognition that the latter are an integral part of achieving and sustaining universal health coverage.
Srinath Reddy, President of the Public Health Foundation of India, echoed these sentiments in presenting the recently adopted vision for universal health coverage in India, in which the government becomes a guarantor and enabler – but not necessarily the provider – of health services, which will be contracted out to the private sector as appropriate. In reflecting on the limitations of the various government-run health insurance schemes currently in place, Srinath eloquently suggested that their vision for UHC represented a shift in government role from health insurance to health assurance, but warned that this would depend on understanding the most appropriate ways to leverage the private sector in order that the public system would not be weakened as a result.
Kiril Danishevskiy, Professor at the Russian Higher School of Economics, took a bolder stance altogether, warning that ‘when healthcare becomes big business, everyone benefits but the patients’. He asserted that ‘in free markets, the doctor becomes a businessman and takes control of a health system, making it very hard to reform.’ This can then have a negative, stultifying effect as he believes has been the case in the United States, where ‘the private interests of doctors with too much lobbying power’ was suggested as having been a key factor in the lack of progress towards the development of successful universal health coverage system. Of course, finding the right balance of public and private healthcare is a difficult and ever-changing challenge for every nation as it has been for the BRICS – perhaps the key message from this first plenary conference session was a call for governments to actively embrace the complexities of this challenge rather than persist with old and unsuccessful systems. As Srinath Reddy from India quoted from Martin Luther King, “change does not roll in on the wheels of inevitability, but comes from continuous struggle.”
This is the first of a series of daily blogs from the Second Global Symposium on Health Systems Research, and contributed by the HANSHEP Programme Manager with a view to generating further discussion and debate. For more information on the Global Symposium, visit www.hsr-symposium.org