Expert panel discusses road to universal coverage in the Americas

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The road to universal health coverage, its definitions, and experiences in the Region were among the topics discussed this afternoon by a panel of experts who also analyzed how the Americas should proceed to become one of the first regions to achieve this goal.

The Director of the Pan American Health Organization (PAHO), Carissa F. Etienne, said that universal health coverage can be reached through a gradual process and encouraged countries to be ambitious in setting their goals related to universal coverage.

She defined universal health coverage as access to health services that are high quality, comprehensive, affordable, and take into account social determinants of health. She indicated this coverage should range from health promotion to palliative care and emphasized that a right-based approach to health is fundamental.

Dr. Etienne further noted that this process involves ensuring quality primary care, with health workers who are motivated and equitably distributed. She stressed that universal coverage requires financial coverage and a discussion of what services are covered and which should be prepaid. She added that the health sector needs to work with the private sector as well as governments to better understand how best to regulate and oversee activities related to this initiative.

For her part, the Minister of Health of El Salvador, María Isabel Rodríguez, recounted the experience of her country as it worked to achieve universal coverage. “Reform is a product of social movements, unions, the academic community, the general population, and the international community who joined us in this effort. This is not a recipe dictated from the outside. It is a cooperative effort,” she said.

Rodríguez explained that the reform seeks to guarantee the right to health to the entire Salvadoran population through an integrated health system. During this process, cost barriers, as well as those related to geographical access and equity, had to be faced. The Salvadoran system, she said, is based heavily on access that is free of charge and on ensuring that medical services are available to communities everywhere.

Currently, there are 517 community-based family health teams with specialists of all types to serve households in rural and urban areas. To date, this model has benefited 82% of municipalities, said the health minister. She added that medical consultations increased as the system improved its functions and reductions in maternal mortality are a direct result of this reform, which offers mothers care free of charge during childbirth.

Felicia Marie Knaul, of Harvard University’s Global Equity Initiative, presented the results of the PAHO consultative meeting, held on 12–13 September 2013, in which a group of experts explored ways to advance the universal health coverage agenda in the Americas. She explained that she interviewed more than 30 experts from 16 countries to determine the role that PAHO should have in the process of strengthening the advancement of universal coverage.

Among the findings that emerged was the idea that PAHO should focus on building consensus and partnerships; that it should disseminate successful experiences; and that it should establish the framework for these exchanges. In addition, the Organization should play a marginal role in the issue of funding, a responsibility more fully belonging to the Region’s governments, although PAHO is ideally suited to show the economic benefits of making these investments in improving health and also to develop strategy for liaisoning with the Region’s finance ministries.

Knaul added that the consultative group also agreed that PAHO should create a group responsible for implementing the strategy, promote universal coverage in Latin America and the Caribbean, and create an external technical group to advise the consultative group on these issues.

Craig Shapiro, Director for the Office of the Americas, Office of Global Health Affairs, Department of Health and Human Services of the United States, moderated the discussion and noted the importance of the panel topic “in a week that has been historic for the United States,” next in line to take steps toward universal health coverage.

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