Universal health coverage

Progressive realization of universal health coverage can contribute to the achievement of the right to health. Consideration of the positive value of financial risk protection is particularly relevant for NCD priority-setting, given the long-term cost implications for the patient and their household. The 2019 global monitoring report indicates that there has been no pronounced progress for the NCD component since 2000 and this situation will have to be addressed in all countries (48).

Those seeking to improve NCD service delivery through essential health benefit packages should consider the following principles. Essential benefit package design should be:

impartial, aiming for universality;
democratic and inclusive, with public involvement, including from disadvantaged populations;
based on national values and clearly defined criteria;
data driven and evidence-based, and should include revisions in light of new evidence;
respect the difference between data analysis, deliberative dialogue and decision;
linked to robust financing mechanisms;
include robust service delivery mechanisms that can promote quality care; and
open and transparent in all steps of the process, and decisions should be clearly communicated (49).

Sustainable financing is required for countries to support populationlevel interventions and reduce the unmet need for services and financial hardship arising from out-of-pocket payments. Countries should incrementally increase the allocation for health and, within that, for NCDs. This also involves improving the effectiveness of catalytic funding support. Out-of-pocket expenditure can be reduced only when NCDs are well covered under financial protection schemes in countries.

Meaningful involvement of the private sector, quality of care and outcome-based information collection are important elements that need to be addressed. Public–private partnership is one option, but approaches such as engaging private care to replicate the primary care centres as per national guidance and other such options can be considered.

Shifting public sector spending towards primary health care interventions, which form the backbone of universal health coverage, requires not only financial resources but strong political and logistical commitments. Achieving universal health coverage is not merely a financial, technical or rhetorical issue; successful national initiatives to provide genuine universal health coverage will require strong social movements and political leadership, among other factors (50).