September 2019 A collection published by The Harvard Global Health Institute and The BMJ Universal health coverage UNIVERSAL HEALTH COVERAGE EDITORIAL 1 Delivering on the promise of universal health coverage Ashish Jha, Fiona Godlee, Kamran Abbasi ANALYSIS 2 Rethinking assumptions about delivery of healthcare: implications for universal health coverage September 2019 EDITORIAL OFFICES Jishnu Das, Liana Woskie, Ruma Rajbhandari, Kamran Abbasi, Ashish Jha The Editor, The BMJ BMA House, Tavistock Square 7 Climate change threatens the achievement of effective universal healthcare London, UK, WC1H 9JR Email: [email protected] Renee N Salas, Ashish K Jha Tel: + 44 (0) 20 7387 4410 Fax: + 44 (0) 20 7383 6418 BMJ - Beijing 13 Achieving universal health coverage for mental disorders A1203 Tian Yuan Gang Center Vikram Patel, Shekhar Saxena East 3rd Ring North Road Chaoyang District 16 Motivating provision of high quality care: it is not all about the money Beijing 100027 China Mylène Lagarde, Luis Huicho, Irene Papanicolas Telephone: +86 (10) 5722 7209 BMJ - Hoboken BMJ Publishing Inc 21 Overcoming distrust to deliver universal health coverage: lessons from Ebola Two Hudson Place Liana R Woskie, Mosoka P Fallah Hoboken, NJ 07030 Tel: 1- 855-458-0579 email [email protected] 26 Global health security and universal health coverage: from a marriage of convenience BMJ - Mumbai 102, Navkar Chamber, A Wing to a strategic, effective partnership Marol, Andheri - Kurla Road Andheri (East) Mumbai 400059 Clare Wenham, Rebecca Katz, Charles Birungi, Lisa Boden, Mark Eccleston-Turner, Lawrence Gostin, Tel: +91 22-40260312/13/14 Renzo Guinto, Mark Hellowell, Kristine Husøy Onarheim, Joshua Hutton, Anuj Kapilashrami, Email: [email protected] Emily Mendenhall, Alexandra Phelan, Marlee Tichenor, Devi Sridhar BMJ - Noida Mindmill Corporate Tower 6th Floor, 24 A, Film City Sector 16 A ESSAY Noida 201301 Telephone: + 91 120 4345733 - 38 Email: [email protected] 32 How moves towards universal health coverage could encourage poor quality drugs BMJ - Singapore Suntec Tower Two Elizabeth Pisani 9 Temasek Boulevard, #29-01 Singapore 038989 Tel: +65 3157 1399 Email: [email protected] OPINION BMJ - Sydney Australia 35 Universal quality health coverage—committing to a healthier and more productive Telephone: +61 (0)2 8041 7646 Email: [email protected] society Twitter: Follow the editor, Fiona Godlee @fgodlee and The BMJ at twitter.com/bmj_latest Jeremy Veillard, Edward Kelley, Sepideh Bagheri Nejad, Francesca Colombo, Tim Evans, Niek Klazinga BMA Members’ Enquiries Email: [email protected],uk 37 Non-communicable diseases must be part of universal health coverage Tel: + 44 (0) 20 7383 6955 Advertising Sania Nishtar Email: [email protected] Tel: + 44 (0) 20 3655 5611 39 Building more effective health coverage in Argentina Reprints Email: [email protected] Adolfo Rubinstein Tel: + 44 (0) 7866 262 344 Subscriptions 41 Investing in community health workers accelerates universal health coverage Email: [email protected] Tel: + 44 (0) 20 7111 1105 Wilhelmina Jallah, Francis Kateh, Raj Panjabi Other resources Other contacts: http://www.bmj.com/about-bmj 43 Will artificial intelligence help universalise healthcare? 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UNIVERSAL HEALTH COVERAGEFEATURE Delivering on the promise of universal health coverage A new initiative to focus on improving healthcare delivery systems niversal health coverage—the course, how is it possible to ensure that the know little about how best to deliver what is notion that people should coverage that is created is worth having? known to work. But that doesn’t mean that be able to access healthcare As Teerawattananon and colleagues have there aren’t generalisable principles, and services regardless of their pointed out, setting priorities early helps our hope is that The BMJ can be a vehicle for ability to pay, and do so with nations make better decisions about how best furthering our knowledge about how to do Ufinancial protection—is a major focus for G7 to achieve these goals, especially when faced universal health coverage well. policy makers and others around the globe. It with scarce resources.2 We are at a critical juncture in global health. is an important component of the sustainable Herein lies one of the largest challenges of The world has increasingly come to realise development goals, leading many countries to universal health coverage. The safety, quality, that we are interdependent and that a poor increase their use of scarce public resources and efficiency of most healthcare delivery performing health system in one place is a to ensure their citizens are covered. The systems (across high, middle, and low income threat to us all. We must pull together to help motivation, of course, is compelling. People countries) are far from the best they could nations develop their own healthcare systems should not develop or die from preventable be. In many countries, especially those with and achieve effective universal coverage in or treatable conditions because they are poor, scarce resources, the quality of the underlying ways that are consonant with their history, and treatment should not lead to financial healthcare delivery system is so poor that it is culture, and values. We can all learn from bankruptcy. unclear whether increasing access to services each other, and learn we must, because good Simply prioritising universal health will do more good or more harm. Conservative intentions are a start but they are insufficient. coverage, however, will not be enough to estimates put unsafe medical care as one Competing interests: We have read and understood achieve its main goals. Even if nations are of the top 10 causes of human harm, with BMJ policy on declaration of interests and have no able to identify the necessary resources, adverse medical events affecting 8-15% of relevant interests to declare. fundamental questions about achieving hospital inpatients in high income countries Provenance and peer review: Commissioned; not effective universal coverage remain and even more in low and middle income externally peer reviewed. 3 unanswered. Without these answers, simply countries. In some places, patients who visit Ashish Jha, director1 pushing for universal coverage may waste physicians are more likely to get the wrong Fiona Godlee, editor in chief2 precious resources without achieving the diagnosis and harmful treatment than they Kamran Abbasi, executive editor2 4 5 important goals of improved health and are to get the right ones. 1Harvard Global Health Institute, Cambridge, MA wellbeing of citizens in a way that is efficient While we strongly support the idea of 02138, USA for people and countries. universal health coverage, we do not know 2The BMJ, London, UK Although the primary focus is coverage how to ensure we get the most for our Correspondence to: A Jha (financing healthcare services, ensuring investments. We do know, however, that given [email protected] adequate staff, etc), success depends on the millions of deaths that occur from poor the underlying healthcare delivery system. quality care, one way to improve the value of It also requires clarity about the trade-offs. that investment is to improve the quality of the 1 Massachusetts Budget and Policy Center. Governments have limited resources but underlying delivery system. Massachusetts state budget. 2016. http://massbudget. many important priorities. What will not To this end, the Harvard Global Health org/browser/index.php.