UN Secretary-General António Guterres has urged governments to speed up and scale up their investment in universal health coverage (UHC) and stronger health systems, in order to tackle the COVID-19 pandemic and prepare for future crises. The policy brief also addresses the health impact of COVID-19 on refugees and internally displaced persons (IDPs).
In a video message to launch the brief titled, ‘COVID-19 and Universal Health Coverage,’ Guterres said the “world was not prepared” for the COVID-19 pandemic, and underinvestment in health care can have devastating impacts on societies and economies. He said the pandemic also revealed “yawning gaps in social protection and major structural inequalities within and between countries.” The brief argues that countries could more effectively and efficiently address the COVID-19 crisis through a UHC system, and underscores the critical linkages between public health and broader economic and societal resilience.
The policy brief cautions that the effects of the pandemic could “seriously impair or reverse progress towards the SDGs.” Each health-related SDG target is expected to go backwards. For instance, the brief states that reductions in maternal and child health interventions, such as immunization, could lead to over 250,000 additional child deaths and 12,000 maternal deaths in six months in 118 countries. If lockdowns continue for at least six months in 114 low- and middle-income countries, an additional 31 million cases of gender-based violence “can be expected to occur.” The brief also documents potential negative impacts on malaria deaths, AIDS-related illnesses, and noncommunicable diseases (NCDs).
In addition, the pandemic is affecting other SDGs. The global recession is expected to lead to the first rise in global extreme poverty since 1998, pushing 70 to 100 million people into extreme poverty and “wiping out progress made since 2017.” A large share of the new extreme poor will be in South Asia, and one-third is projected to be concentrated in Sub-Saharan Africa.
The brief presents five major recommendations:
- Urgently control COVID-19 transmission, including with stronger public health measures to reduce local transmission to zero, facilitate universal provision for COVID-19 testing, isolating, and contract tracing, and ensure access to care for COVID-19 patients to reduce deaths;
- Protect delivery of other essential services;
- Massively expand access to new rapid diagnostics and treatments, and ensure future COVID-19 vaccines are a global public good with equitable access for everyone, everywhere, including through fully funding the Access to COVID-19 Tools Accelerator (ACT-Accelerator) and urgently addressing the spread of misinformation about vaccine safety;
- Achieve UHC by investing in core health systems functions that are fundamental to protecting and promoting health and well-being, and suspending user fees for COVID-19 and other essential health care; and
- Strengthen national and global pandemic preparedness and aim for healthy societies.
The brief shares examples of good practice in addressing the health impact of COVID-19 on refugees and IDPs. Rwanda has included urban refugees in Kigali in its national health insurance scheme. Peru approved temporary health coverage for refugees and migrants suspected of or testing positive for COVID-19. In Argentina, Chile, and Peru, to address the socio-economic impact of COVID-19 on those who have been forcibly displaced, the governments have allowed foreign-trained refugee doctors, nurses, and others with medical training to work during the COVID-19 response. Ireland’s Medical Council announced that refugees and asylum-seekers with medical training can provide medical support, including as healthcare assistants. The Government of South Africa has provided financial support for foreign-owned businesses, including those owned by refugees.
The brief concludes that UHC can be a “powerful social equalizer” and a catalyst for economic growth. It underscores that systems that sustain progress towards UHC through a whole-population perspective are better positioned to respond to disease outbreaks like COVID-19.