What are the HRH dimensions of UHC?
Dr Catherine Kamuang doing her rounds at the Malnutrition ward at Tudikolela Hospital, Mbuji Mayi, DRC
Credit: Jodi Bieber/Save the Children
The World Health Organization defines Universal Health Coverage (UHC) as the goal that “all people obtain the health services they need, of good quality, without suffering financial hardship when paying for them.”
For countries to achieve and sustain UHC, they need to consider how they will address three dimensions of health coverage:
- Reducing direct, out-of-pocket payments and increasing the share of healthcare costs covered from pre-paid pooled funds;
- Increasing the share of the population covered;
- Increasing the number of services covered.
UHC is recognised as an issue for ALL countries, irrespective of their level of economic development. Within countries, those who are poorest and most excluded are not only the most vulnerable to ill-health and premature death, they are also the least likely to have access to good quality services or protection against financial risk. To address this injustice, equity must be at the centre of every country’s approach to UHC.
At the simplest level, without health workers, there can be no health services. Every country must therefore assess what kind of health workforce is required to attain, sustain or accelerate progress so that all people – rich and poor – can access, utilise and most importantly obtain the quality health services that they need.
Removing financial barriers to healthcare may stimulate demand for services that the existing stock of health workers is insufficiently prepared for. UHC policies that don’t take HRH considerations into account may result in reduced patient time with their health provider and lower the quality of care, patient satisfaction and potentially worse health outcomes.
Four critical dimensions of HRH are at the core of the concept of effective coverage and the right to health: availability, accessibility, acceptability and quality. All four dimensions are important but there is a logical sequence in addressing them:
Without sufficient availability , accessibility to health workers cannot be guaranteed; and even if availability and accessibility are adequate, without acceptability , the population may not use health services. Finally, when quality of health workers is inadequate, the effects on services in terms of improving health outcomes will be sub-optimal.