Countries must increase spending on primary healthcare by at least 1% of their gross domestic product (GDP) if the world is to close glaring coverage gaps and meet health targets agreed in 2015, says a new report from the World Health Organization and partners on the eve of a UN General Assembly high-level meeting on Universal Health Coverage.
They must also intensify efforts to expand services countrywide.
The world will need to double health coverage between now and 2030, according to the Universal Health Coverage Monitoring Report. It warns that if current trends continue, up to 5 billion people will still be unable to access healthcare in 2030 – the deadline world leaders have set for achieving universal health coverage. Most of those people are poor and already disadvantaged.
Primary healthcare key to health for all
“If we are really serious about achieving universal health coverage and improving people’s lives, we must get serious about primary healthcare,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “That means providing essential health services like immunization, antenatal care, healthy lifestyle advice as close to home as possible – and making sure people do not have to pay for this care out of their own pockets.”
Investing an additional USD200 billion a year on scaling up primary healthcare across low and middle-income countries would potentially save 60 million lives, increase average life expectancy by 3.7 years by 2030, and contribute significantly to socio-economic development. It would represent about 3% increase on the USD7.5 trillion already spent on health globally each year.
Most of that funding would come from countries themselves. The report says that most countries can scale up primary healthcare using domestic resources – either by increasing public spending on health in general, or by reallocating spending towards primary healthcare – or by doing both. At present, most countries are underinvesting in primary healthcare.
But for the poorest countries, including many affected by conflict, this may not be feasible. These countries will continue to require assistance from outside. This funding must be carefully targeted to result in a lasting improvement to health systems and services – via a systematic strengthening of primary healthcare countrywide.
Accelerate scale-up of services
Countries must also renew efforts to scale up service coverage countrywide. Although coverage has increased steadily since 2000, progress has slowed down in recent years. Most increases have occurred in lower income countries, but these countries are still lagging behind. The biggest health service gaps are in the poorest countries and those affected by conflict.
“Too many women and children continue to die from easily preventable and treatable causes simply because they can’t get the care they need to survive,” said Henrietta Fore, UNICEF Executive Director. “By working with communities to provide primary healthcare to the poorest and the most vulnerable, we can reach the last mile and save millions of lives.”
Coverage is generally lower in rural areas than in towns. The report cites lack of health infrastructure, shortages of health workers, weak supply systems, and poor-quality care leading to low trust among communities as major obstacles to achieving UHC.
“Improving and expanding primary healthcare in all regions is key,” says Natalia Kanem, Executive Director of UNFPA. “It’s the best way to ensure people can obtain services to cover the majority of their health needs from pre-birth throughout their lives.”
Protecting against financial hardship
The report also highlights the need to protect people from financial hardship.
“The goal of universal health coverage will remain elusive unless countries take urgent steps to protect people from falling into poverty to pay for essential healthcare,” says Dr. Muhammad Pate, Global Director, Health, Nutrition, and Population at the World Bank. “Expanding access to quality primary healthcare services will save more lives and keep healthcare costs affordable.”
More people are suffering the consequences of paying for services out of their own pockets than 15 years ago. About 925 million people spend more than 10% of their household income on healthcare; 200 million people spend more than 25% of their income on health. And impoverishment due to paying for healthcare increased except among the extremely poor.
“It’s shocking to see a growing proportion of the population struggling to make ends meet because they are paying too much for their own health, even in advanced economies” adds OECD Secretary-General Angel Gurría. “The only places where this is not happening is in countries that invest more and more effectively in health.”
On 23 September, world leaders will discuss a far-reaching Declaration on Universal Health Coverage. The Declaration lists a number of steps to advance progress towards UHC. These include WHO’s recommendations relating to primary healthcare, including the allocation of an additional 1% GDP to primary healthcare through additional investments or reallocation.
Russia Among Global Top Ten Improvers for Progress Made in Health and Education
Russia is among the top ten countries globally for improvements to human capital development over the last decade, according to the latest update of the World Bank’s Human Capital Index (HCI).
The 2020 Human Capital Index includes health and education data for 174 countries covering 98 percent of the world’s population up to March 2020.
Russia’s improvements were largely in health, reflected in better child and adult survival rates and reduced stunting. Across the Europe and Central Asia region, Russia, along with Azerbaijan, Albania, Montenegro, and Poland, also made the largest gains in increasing expected years of schooling – mainly due to improvements in secondary school and pre-primary enrollments. The report also shows that over the last 10 years Russia has seen a reduction in adult mortality rates. However, absolute values of this indicator remain high in the country with this progress now at risk due to the global Covid-19 pandemic.
“Human capital contributes greatly to improving of economic growth in every country. Investments in knowledge and health that people accumulate during their lives are of paramount concern to governments around the world. Russia is among the top improvers globally in the Index. However, challenges persist and much needs to be done to improve the absolute values of Index indicators,” said Renaud Seligmann, the World Bank Country Director in Russia.
The HCI, first launched in 2018, looks at a child’s trajectory, from birth to age 18, on such critical metrics as child survival (birth to age 5); expected years of primary and secondary education adjusted for quality; child stunting; and adult survival rates. HCI 2020, based on data up to March of this year, provides a crucial pre-pandemic baseline that can help inform health and education policies and investments for the post-pandemic recovery.
Of the 48 countries in Europe and Central Asia included in the 2020 Human Capital Index (HCI), 33 are among the upper-third in the world, and almost all are in the top half. However, there are significant variations within the region.
In Russia, a child born today can expect to achieve 68 percent of the productivity of a fully educated adult in optimal health. It is at the average level for Europe and Central Asia countries and the third result globally among the countries of the same income group. There is a stark contrast between education and health subscales in Russia. While the education outcomes of the country are high and outperform many high-income peers, its health outcomes are below the global average.
Accelerating Mongolia’s Development Requires a Shift “from Mines to Minds”
A new report by the World Bank estimates that out of every dollar in mineral revenues Mongolia has generated over the past 20 years, only one cent has been saved for future generations. The report argues that to break this cycle, Mongolia should use its mineral wealth to invest in people and institutions, while gradually reducing its dependence on the sector.
This is particularly true as demand for key minerals is likely to tumble due to climate change concerns, a shift of investors’ preference toward sustainability, China’s ambitious goal to reduce coal consumption, and persistence of the COVID-19 shock, according to Mongolia’s Mines and Minds, the World Bank’s September 2020 Country Economic Memorandum for Mongolia.
Since the advent of large-scale mining in 2004, Mongolia’s economy has grown at an average rate of 7.2 percent per year, making it one of the fastest-growing economies in the world. Growth has translated to rapid decline – although at times partly reversed – in the incidence of poverty and improved quality of life. The report also notes that Mongolia enjoys relatively strong human capital, and its infrastructure capital has improved for the last few decades, though remains scarce given the size of the country and low population density. This performance has been made partly possible through a generous but inefficient social assistance system and a large public investment program supported by mineral revenues and external borrowing.
However, a number of enduring challenges have grown in the shadow of this success. Mongolia’s rapid growth has been obscured by its extreme macroeconomic volatility and frequent boom and bust cycles. Growth has almost entirely come through capital accumulation and the intensive use of natural capital rather than through sustained productivity growth. Meanwhile, the country has not only consumed almost all its mineral outputs, but has also borrowed heavily against them, bequeathing negative wealth to the next generation.
“Instead of maximizing the benefits of its mineral wealth for diversified and inclusive growth, Mongolia has increasingly become more addicted to it. At the same time, human capital has been underutilized and institutional capital has eroded.” said Andrei Mikhnev, World Bank Country Manager for Mongolia. “Such inability to capitalize on the country’s endowments has resulted in limited diversification of outputs and exports and has further amplified its vulnerability to the swings of the global commodity markets. Breaking this gridlock calls for a fundamental shift in approach that puts investing in minds on an equal footing with mines.”
The report recommends key policy actions to build the foundation of a diversified and sustainably growing economy. These include:
- Implement countercyclical fiscal and monetary policies – supported through transparent fiscal rules, an independent fiscal council, a market-driven exchange rate, and a well-functioning stabilization fund – to smooth consumption over the business cycle rather than maximize current consumption.
- Undertake bold investment climate reforms to enhance competition, secure investor rights, and create a more level playing field that enables productive firms to invest and grow.
- Move away from the mindset of diversifying products to expanding endowments, especially in terms of better utilization of Mongolia’s young and educated, especially female, labor force.
- Accelerate the implementation of fundamental governance reforms (especially on the government effectiveness and control of corruption) to reduce political interference, increase transparency, and improve regulatory quality throughout the economy.
“Fortunately, there are many encouraging signs of improved macroeconomic management in 2017-19, providing the new government an opportunity to advance its reform efforts,” said Jean-Pascal Nganou, World Bank Senior Country Economist and lead author of the report. “Some impressive fiscal outcomes were achieved not by introducing new reforms but by effectively implementing existing ones. They demonstrate that with the right political will and leadership, similar improvements are possible in other areas including monetary and exchange rate policy, the financial sector, the business environment, and the labor market. The new administration has, therefore, an opportunity to institutionalize these reforms and avoid policy regression in the future.”
Nearly 9 in 10 People Globally Want a More Sustainable and Equitable World Post COVID-19
In a new World Economic Forum-Ipsos survey of more than 21,000 adults from 28 countries nearly nine in ten say they are ready for their life and the world to change.
72% would like their own lives to change significantly and 86% want the world to become more sustainable and equitable, rather than going back to how it was before the COVID-19 crisis started. In all countries, those who share this view outnumber those who don’t by a very significant margin (more than 50 percentage points in every country except South Korea). Preference for the world to change in a more sustainable and equitable manner is most prevalent across the Latin America and Middle East-Africa regions as well as in Russia and Malaysia.
Next week’s World Economic Forum Sustainable Development Impact Summit will address the achievement of the sustainable development goals and the appetite for transformation which will drive the “decade of delivery”.
Clear majority ready for a more sustainable and equitable world
Globally, 86% of all adults surveyed agree that, “I want the world to change significantly and become more sustainable and equitable rather than returning to how it was before the COVID-19”. Of those, 46% strongly agree and 41% somewhat agree, while 14% disagree (10% somewhat and 4% strongly).
Russia and Colombia top the list of countries that strongly or somewhat agree with that statement at 94%. They are followed by Peru (93%) Mexico (93%) Chile (93%) Malaysia (92%), South Africa (91%) Argentina (90%) and Saudi Arabia (89%). The countries that are most change averse – disagreeing somewhat or strongly disagreeing with the statement – are South Korea (27%), Germany (22%), Netherlands (21%), US (21%) and Japan (18%).
Dominic Waughray, Managing Director, at the World Economic Forum said, “The Great Reset is the task of overhauling our global systems to become more equitable and sustainable, and it is more urgent than ever as COVID-19 has exposed the world’s critical vulnerabilities. But the technology to transform things tends to outpace the human will to change. In six months, the pandemic has systematically broken down this cultural barrier and we are now at a pivot point where we can use the social momentum of this crisis to avert the next one.”
Ready for significant personal change
Across all 28 countries, 72% want their lives to change significantly rather than returning to what it was like before the COVID-19 crisis (30% strongly and 41% somewhat) while the other 29% disagree (21% strongly and 8% somewhat).
Latin America stands out for its optimism, with Mexico, Colombia and Peru in the top five countries strongly or somewhat agreeing. Agreement is also high South Africa (86%), Saudi Arabia (86%, Malaysia (86%) and India (85%). By contrast, at least two out of five adults in the Netherlands, Germany, South Korea, Japan, Sweden, the US, UK and Canada long for their life to just return to how it was before the pandemic.
MethodologyThese are the results of a 28-country survey conducted by Ipsos on its Global Advisor online platform. Ipsos interviewed a total of 21,104 adults aged 18-74 in United States, Canada, Malaysia, South Africa, and Turkey, and 16-74 in 23 other countries between August 21 and September 4, 2020. Where results do not sum to 100 or the ‘difference’ appears to be +/-1 more/less than the actual, this may be due to rounding, multiple responses or the exclusion of don’t knows or not stated responses.
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