Vaccines are free. Why not all health services?

This year, everyone in global health is talking about universal health coverage– whether they want to or not. UHC is the principle that governments should ensure everyone can access essential health services, not only those people with cash to pay for them. Next week, there is an important consultation meeting that will help decide what the UN High-Level Meeting on UHC in September will achieve.

In the 15 years that the Sustainable Development Goals have to run, the High-Level Meeting is a unique moment  to actually make progress towards UHC. But many people will be there calling for attention for a specific disease or service. There’ll be people funded by the Global Fund to Fight AIDS, TB & Malaria arguing for another replenishment later this year. There will also be advocates for sexual & reproductive health and rights (with the US and others governments opposing this), for mental health, for palliative care and many, many other topics.

The beauty is that, if there were actually progress towards UHC, it would benefit all these topics. The danger is that everyone is too busy arguing for their priorities that they don’t argue for the changes that would actually make progress towards UHC. Ask not what UHC can do for your topic, but what you can do for UHC!

There will also be advocates for immunisation, particularly because in 2020 there will be a replenishment (hosted by the UK) for Gavi, the Vaccines Alliance. Immunisation shows that health services can get close to universal if there is genuine political will. While donor money buys some vaccines for some low-income countries, much of the staff, infrastructure and delivery costs are paid for by governments from people’s taxes.

Crucially, I have never heard anyone argue that service users should be asked to pay cash to get their child vaccinated. Vaccination is always free at the point of use. It is a preventative health service, not a service sought when people are sick or in pain. It has benefits for the whole of society, not just the person who receives it.

So why this is not the same for all health services? We need people to access health services at the right time, not wait until pain or suffering forces them to borrow money or sell assets, and the condition has become too serious. We want societies to benefit from healthier populations, not allow high levels of ill-health and early mortality to undermine development. If we are serious about UHC, all services should be free at the point of use and paid for by compulsory and fair contributions, such as tax.

Whichever services we care about, we all need to get behind common goals that can build UHC. We all need to push that governments tax people fairly and spend at least 5% of GDP on health. We need to make sure that donor money increases and helps the poorest countries, where 5% of GDP will still not be enough. Donor money should support vaccines and other health priorities but, more importantly, it should also support countries to build comprehensive universal health services.