Uttam Maharjan

Universal Health Coverage (UHC) is a broad concept that ensures that all people, whether rich or poor, privileged or underprivileged, get access to the healthcare facilities they need without any discrimination and financial burden. UHC encompasses a broad array of services ranging from health promotion to prevention and treatment of disease to rehabilitation services and palliative care for patients.
UHC has three major dimensions: health services, financial management and population. It is a dynamic process that changes keeping abreast of the times so as to address the needs related to health services in terms of demographics, epidemiological and technological trends and people's expectations. Its hallmark is to ensure equal and fair access to health services, financial management for poor people and quality healthcare facilities. Health is wealth. Without healthy people, development cannot be conceived of. That is why health is accorded priority. In Nepal also, health has been prioritised through budgetary provisions.

Right to health
It is the duty of nations to provide health services for their citizens. Nepal has made provisions related to health in the Constitution of 2015 itself. As stipulated in the constitution, every citizen shall have the right to free basic health services from the state, and no one shall be deprived of emergency health services; every person shall have the right to get information about his or her medical treatment; every citizen shall have equal access to health services; and every citizen shall have the right of access to clean drinking water and sanitation. Thus, the constitution has treated health services as a fundamental right of the people.
The Sustainable Development Goals (SDGs) have also encapsulated provisions of promoting health in various countries. Under the SDGs, the UN has envisioned a world free from poverty, hunger and disease. The UN members are required to fulfill by 2030 the SDGs, including the health-related provision to the effect that healthy lives should be ensured and well-being for all people at all ages should be promoted. The SGDs have prioritised UHC as a health-related agenda.
UHC is aimed not only at promoting health by preventing and treating disease but also at contributing to improving the well-being of people, thus ameliorating the quality of life. The UHC component has been included in the SDGs related to health to overcome the financial burden of people during illness and to enhance the quality of health services across the world. This means UHC is aimed at providing financial protection for people, which will ultimately enable them to enjoy health services without discrimination. This will, in turn, improve the quality of life and increase their life expectancy.
In order to materialise the goals of UHC, countries should take the initiative in ensuring health services for all their citizens. The basic thrust of UHC is the provision of access to quality health services by producing skilled health workers and building sophisticated health infrastructure. Countries should make investments in the health sector on a priority basis. The policy related to health services should be integrated into the overall development plan.
There are gaping gaps between the haves and the have-nots in the world. While rich countries have managed sophisticated health services for their citizens through government-funded schemes like those for the elderly and poor citizens as well as various health schemes like insurance schemes, developing countries are lagging far behind them. That at least 50 per cent of the world population is deprived of the health services they require and about 100 million people get into the poverty trap every year owing mainly to financial constraints is a matter to be pondered over.
Around 44 million households or over 150 million people across the world are facing a dire healthcare burden. Out of these, about 25 million households with over 100 million people are being pushed into poverty owing to healthcare expenditures. Over two thirds of the world population is forced to avail themselves of healthcare facilities by going through a financial burden.
Since 1950, Nepal has taken measures to improve the health sector. From 1950 to 1990, the country was beset by a challenge of extending primary healthcare facilities. The 1990-2006 period witnessed the challenge of upgrading and integrating health services. Since 2006, there have been challenges of providing quality health services besides extending and integrating healthcare facilities.
Nepal adopted the Nepal Health Sector Strategy 2015-2020 under the National Health Policy 2014. The strategy was aimed at attaining UHC. It prioritised health system improvement, production of skilled human resources, public finance management, infrastructure, procurement and health governance. The strategy was aimed at ensuring equal access to healthcare facilities and making health services available through the introduction of various healthcare package schemes and safe delivery incentive schemes. The strategy was in line with the SDGs.

Investment
The health sector in Nepal leaves much to be desired despite the government's efforts to upgrade the health infrastructure. One of the basic approaches of UHC is to ensure fair access of marginalised people to healthcare facilities and to be on the qui vive for new disease or the re-emergence of disease. At present, COVID-19 is wreaking havoc with the world. The country has also been in the grip of the disease for one and a half years. When the pandemic emerged in the country in 2076 BS, it was caught off guard owing to its poor health infrastructure. At this juncture, the concept of UHC has been even more pronounced.
It follows that Nepal is marching towards attaining UHC. COVID-19 has shown how important investments in the health sector are. The budget of the country is focused on containing the coronavirus. All the provincial governments have also shown keen interest in stemming the disease at any cost. Investments in the health sector will pay. In health emergencies like the ongoing one, the government's efforts should be fully geared up towards not only containing the COVID-19 pandemic but also providing financial protection for the poor and marginalised people.

(Former banker, Maharjan has been regularly writing on contemporary issues for this daily since 2000. uttam.maharjan1964@gmail.com)