The Global Goals and Universal Health Care

BLOG POST April 4, 2016

Vicky Ramirez

Communications Associate, USAID ASSIST Project/URC

A few months ago, the United Nations unveiled their strategy to end poverty, combat climate change and fight injustice and inequality by 2030. Delineated in 17 metric-driven goals, the Global Goals for Sustainable Development seek to do just that. Under Goal 3: Good Health & Well-Being, lies an ambitious agenda—achieving universal health coverage (UHC).

But what purpose does universal health coverage serve if the quality of care is inadequate?

According to Tamar Chitashvili, “This would be just an irrational use of limited resources. Poor quality would mean less population covered with quality services and the need for additional resources from payers, and would not reach the ultimate goal of UHC, which is improved health outcomes.”

That’s true. According to the World Health Organization (WHO), quality is a fundamental precondition for universal health coverage. It is therefore not just about expanding coverage, but delivering quality care that will achieve good health and wellbeing and avoid causing a financial burden on patients and families.

How can we achieve this?

Addressing this topic at multiple conferences, Dr. Chitashvili says, “In order to reach universal health coverage, countries need to focus their efforts on (1) expanding service coverage; (2) reducing cost-sharing and fees, including out-of-pocket expenses; and (3) extending coverage to those who are not covered. Universal health coverage is not an aim in and of itself, but should rather serve as a tool for better health outcomes.”

As seen in the graphic above, reaching UHC means stretching the three pre-conditions. But with limited resources, that can seem unrealistic and unachievable. That’s where quality improvement comes in.

Dr. Chitashvili explains, “Quality improvement not only allows health systems to expand and effectively utilize their health spending, but also offers the opportunities to maximize their impact.ASSIST’s strategy focuses on targeting high-burden conditions with high-impact, cost-effective interventions. This approach allows for improving coverage with existing resources and expanding access to wider population groups.”

Want to see this in action? Here’s a mini-case study from Georgia, where Dr. Chitashvili was Chief of Party, which demonstrates that there are effective and efficient strategies to improve care.

• To improve prevention and care of non-communicable diseases (NCDs) and pediatric respiratory tract infections (RTIs), ASSIST supported a collaborative improvement intervention in 17 ambulatory clinics and village practices and 3 hospitals in Imereti Region of Georgia from June 2012 through January 2015.
• Quality improvement (QI) teams focused on improving integrated prevention and management of cardiovascular disease (CVD), hospital management of Acute Coronary Syndrome (ACS),  Chronic Obstructive Pulmonary Disease (COPD), and asthma and their cross-cutting risk factors in adult patients and on care of RTIs and asthma in children.
• After just 34 months of project interventions, results showed that average compliance with evidence-based bundles of best practices in each priority clinical area improved between 55-80 percentage points, reaching compliance of over 89% by January 2015.

Universal health coverage is achievable in low-resource settings. In fact, the strategies used in Georgia to improve integrated care are aptly scalable, adaptable, and relevant across different settings.  These results show that scale-up and institutionalization of proven QI methods/tools can lead to measurable improvement in prevention of high-burden diseases, their complications, and associated cost-saving for payers and society.