Universal Health Coverage (UHC) is defined as ensuring that all people can use the promotive, preventative, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while ensuring that the use of these services does not expose the user to financial hardship.
The report highlights how palliative care is not often available and accessible to those who need it and in accessing palliative care households can be driven into financial hardship.
Around the world, households are facing serious financial hardship through the reduction of household income because people are unable to work due to their life limiting illness, or because household earners are caring for their family members.
In addition, hospice and palliative care services are often sparsely available, meaning that people have to travel great distances to get the palliative care – or pain treatment – that they need, at great financial, emotional and physical cost.
Often palliative care – or aspects of palliative care such as oral morphine and home care services – are not included within universal coverage schemes including insurance or national health financing protection schemes.
This means that even if the services are available nearby, people who need them may not be able to access them as they are not covered.
The report looks at some of the barriers that may have prevented the greater inclusion of palliative care in Universal Health Coverage policies and schemes and looks at case studies in England, Mexico, Singapore, South Africa and the Republic of Ireland, highlighting the extent to which palliative care is included within universal coverage schemes.
It also provides recommendations on how palliative care needs to be addressed in policy, service delivery, education, financing, monitoring and advocacy relating to UHC in order to make this vital care available and accessible to those who need it, without causing financial hardship.
Equity is one of the fundamental components of Universal Health Coverage and it is vital not only that the poorest and most marginalised have access to the palliative care and pain treatment that they need, but also that they are not driven further into poverty by getting it.
Unfortunately, challenges with routine and comparable data collection on palliative care, as well as the disaggregation of data make this debate difficult.
However, despite these challenges, the report notes that as a core component of the continuum of health care services, palliative care must be included in global and national monitoring frameworks of UHC.
This is because, as WHO states, measures of coverage should comprise the full spectrum of essential health interventions, which includes palliation.
The report recommends that the indicator: ‘Morphine equivalent consumption (excluding methadone) per capita’ should be demographically adjusted and utilised as a tracer indicator while further work is done on improving global and national palliative care monitoring and data collection.
Palliative care is often noted as one of the most neglected aspects of health care. Those who need it can therefore be described as one of the most neglected groups of people in the health care system.
As the incredible drive and momentum towards Universal Health Coverage grows at the national and global level, we cannot allow those who are facing life limiting illness and the end-of-life to be left behind.
The implementation of UHC could have a major influence on improving access and availability of palliative care services for those who need them, as well as making sure people do not face financial hardship as a result.
Hospice and palliative care advocates around the world are supporting the first-ever Universal Health Coverage Day with a resounding call to action of: ‘health for all’. And that means too that no-one must be left behind, including those who are suffering and need palliative care.
You can access more information on the Universal Health Coverage Day website.
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