Mobilizing the Financial Resources to Reach Universal Health Coverage

Since the adoption of the Millennium Declaration and the MDGs derived from it the international community has achieved substantial gains in reducing avoidable deaths and improving health outcomes. The multiplication of financial resources from both domestic funds and international cooperation - along with policies to reduce the prices of essential medicines - was instrumental for increasing the access to life-saving health services. In many developing countries life expectancy has improved significantly, while the decline seen in the regions most affected by the HIV epidemic was reversed. The positive results, however, are distributed very unevenly among countries and populations, as are the financial and political efforts to reach internationally agreed targets. Still, in 2012, more than 60 % of deaths registered in low-income countries occurred in people younger than 49 years old. Inhumane living conditions, extreme social inequality, persistently underfunded health systems and ongoing discrimination against vulnerable populations still cause unacceptable levels of mortality and morbidity - representing one of the most atrocious forms of injustice.

Securing a minimum of financial resources that permit to bring the full range of critical health services to all people constitutes a fundamental human right and an indispensable condition for human dignity. The model outlined here demonstrates that it is within our reach to close the financing gap even for the poorest countries by 2020 if all governments, from the privileged and underprivileged parts of the world alike, just fulfil the commitments and recommendations for financing human development and health that already were agreed many years ago.

On the one hand, the additional effort of developing countries to mobilize domestic resources combined with projected economic growth would reduce the worldwide gap between the own resources for health and the minimum financing need to roughly 49 billion US$ (in 2013 terms). On the other hand, the resources provided by the wealthiest countries for international cooperation in support of health systems in disadvantaged countries would rise to 53 billion US$ (at constant 2013 prices), if the recommendation is met to make available 0.1 % of the Gross National Income (GNI) for global health. When considering that exchange rates of countries in need of external support are often considerably lower than internal purchase power levels of national currencies and, thereby, making Health ODA amounts comparable to the volumes of domestic resources computed by a mixed calculation as described above the equivalent value of external resources would rise to 93 billion dollars. For the first time in history the development assistance for health would be commensurate with the volume of external cooperation needed to co-finance a minimum spending level for public health services in every part of the world.

In conclusion, the worth of resources made available through development cooperation for health would exceed the absolute need of external support in the most disadvantaged countries before the end of this decade. The projected surplus would constitute a necessary reserve for those unforeseeable cases, where exceptionally high resource needs or the failure to achieve the expected income and revenue growth lead to additional needs of international cooperation. Furthermore, the international community needs to confront the humanitarian need of supporting life-saving interventions in countries where the responsible government institutions fail to provide public services for the poor and discriminated populations.

Besides the basic guarantee of meeting the minimum need everywhere, we have to take into account that the proportional backlog of income levels in most developing countries compared to high-income countries is higher now than 30 years ago. At present, 55 % of developing countries fall in the bracket of having per capita income levels that do not even reach one tenth of the average seen in advanced economies, compared to a proportion of 49 % in 1980 (go to “Main Trends of Income per capita” for an overview and for country-specific data). Thus, the relative poverty of many disadvantaged countries did not improve but actually became worse over a generation, despite some more recent positive trends. This increasing income gap between countries means that the necessity of international resource transfers has increased if there is the aspiration that all people participate in the progress of mankind, especially in existential fields of human development such as health. Considering that health outcomes constitute a crucial yardstick for measuring the fulfilment of the basic principles of social justice and human solidarity we can argue that development assistance to secure the access of the world’s poor to essential health services should exceed the level recommended more than a decade ago.

It is time now to commit to and bring into reality a global compact to guarantee the universal access to crucial health services. This is the moment to overcome the fragmentary approaches depending on the generosity of the rich and develop a new financing model for global health based on binding rules in order to raise the resources required for developing truly operational, equitable and sustainable health systems.

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