The Need for Universal Health Coverage in Developing Countries


Researchers from the University of Miami and Harvard University recently addressed the current need for universal health coverage in low- and middle-income countries, focusing on solving one of the most important issues: the care of chronic illnesses.

Their suggestions focused on strengthening health care systems, including recommendations based on a “diagonal approach” for managing health care.

Study first author Felicia Marie Knaul, a breast cancer survivor and director of the College of Arts & Sciences’ Miami Institute for the Americas, said her personal experience with the disease has taught her much about the importance of accessing care at all stages of disease, including survivorship.

“Health systems around the world can and must be transformed to meet the challenge of chronic illness and respond to the needs of patients from prevention to palliation to achieve effective universal health coverage,” Dr. Knaul said in a press release.

Chronic illnesses are costly to treat and require proper management involving consideration of each stage of the chronic disease continuum: prevention, early detection, treatment, survivorship, rehabilitation, palliative, and end-of-life care.

Advances in medicine have transformed many previously terminal illnesses into chronic conditions. Moreover, rapidly aging populations impose an increasing burden on already weak systems of health care in low- and middle-income countries.

Health care systems in low- and middle-income countries are designed to treat acute episodes of illnesses and injuries. They are not designed to effectively treat the rise in chronic diseases. The paper suggests that there be a focus on effective universal health care coverage to redesign health care systems for care across the lifespan of a person.

Three requirements need to be met in order for universal health care coverage to be established. First, legislation and affiliation to ensure coverage of all people needs to be addressed.

Provision of access to cost-effective health services is also a requirement for universal health care coverage. Finally, the creation of a means of financial protection is required. Effective universal health coverage adds an additional component: integration of services at each stage of the care continuum and health systems function.

Traditional practices in low- and middle-income countries’ health care systems are ill-prepared to handle the increasing instance of chronic illnesses. The approach is either vertical or horizontal, with vertical approaches targeting particular diseases and horizontal approaches targeting health care systems, investing in one disease or stage of care at the cost of neglecting another.

Authors of the study propose a diagonal approach that leverages the elements of both vertical and horizontal approaches, making for a more effective response to chronic illness.

“A diagonal approach to health care is an efficient strategy for achieving better results with limited resources,” said Julio Frenk, president of the University of Miami and co-author of the study. “It changes the fragmented view of health systems, which focuses on its constituent elements — like human resources, financing, facilities, and technologies – individually, in a sort of ‘laundry list’ conception, to a new system based on the interrelations among the various components. This concept can help move forward universal health coverage in all countries.”

The report presents a case study on the management and treatment of breast cancer as a tracer illness for assessing effective universal health coverage within the context of the 2003 health care reform in Mexico. The case study underscores the failures of the reform in considering stages of the care continuum beyond treatment, such as early detection and palliative care.

The report concludes with recommendations for how to implement diagonal strategies in health care systems in low- and middle-income countries, by integrating services and strengthening existing platforms to provide care to individuals, which takes into consideration the needs and potential needs of the person throughout their lifetime and across different stages of disease.

Future research efforts will focus on a more detailed analysis of effective universal health coverage for each stage of breast cancer, beyond early detection and palliation, within the context of health care reform in Mexico. Other low- and middle-income countries will be evaluated as well in the hopes of utilizing this type of health systems analysis as a model for other chronic conditions.

“Along with my co-authors, I plan to continue research around health systems strengthening and chronic disease management, particularly to promote means for improved priority-setting around chronic diseases and to reduce health inequities,” said Afsan Bhadelia, visiting scientist at the Harvard T.H. Chan School of Public Health and co-author of the study, who was a research associate at the Harvard Global Equity Initiative at the time the study was conducted.

The work will be continued in collaboration with the Miller School of Medicine, Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, and the Miami Institute for the Americas.

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