Universal Health Coverage

Focus on Jordan

International Health and Development

LJMU-7502-PUBUNI-63091

Ossama Ahmed Zaki Mohamed Zaki Ahmed Zaki

17191157 28/5/2024

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Introduction It is inherently wrong when millions have to choose between spending on

healthcare or basic needs such as food, housing, and their children's future. According to a press

report by World Bank and The World Health Organization (WHO, 2021), even before the

COVID-19 pandemic, 500 million people were being pushed into extreme poverty due to the

unacceptable fact that they had to use their savings to pay for healthcare services. These numbers

increased due to the pandemic (ibid.). This vicious cycle of poverty and poor health, where a

large number of poor people fall sick due to their harmful poor living conditions, get forced to

use their savings, sell their assets, or get into debt to pay for treatment, ultimately traps millions

with little hope of escape. There is a pressing need to protect people against unforeseen health

expenditures and to prevent them from falling victim to avoidable health and financial

complications. This essay sheds light on the concept of Universal Health Coverage (UHC) and

its adoption by the United Nations as a target in the 2030 Sustainable Development Goals

(SDG). Then it reviews the building blocks of healthcare systems and how strengthening them is

essential to achieving UHC. Lastly, it focuses on the challenges Jordan faces on the road to

UHC, critically examines national efforts to achieve it, and proposes evidence-based solutions

for the country to succeed

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Discussion WHO Director-General Margaret Chan referred to UHC "as the single most powerful

concept that public health has to offer."(theelders.org, 2017). It is defined as the ability of all

people

to access all the of-sufficient-quality healthcare services they need anytime, anywhere, and

without incurring a financial burden through out-of-pocket payments (WHO, n.d. b). Achieving

UHC was chosen as the SDG target 3.8 with two measuring indicators of progress in essential

health services' coverage (SDG indicator 3.8.1) and catastrophic health spending (SDG indicator

3.8.2,10% threshold) (ibid.). Owin to the utmost importance of health for development and

sustainability, achieving UHC is put at the heart of achieving many non- health SDGs, namely;

ending extreme poverty (SDG 1), improving educational outcomes (SDG 4), eliminating gender

disparity (SDG 5), promoting economic growth (SDG 8), and expanding societal inclusion (SDG

16). Research shows that achieving UHC can lead to a world of global health security that can be

sustainable and prosperous (Marie Paule Kieny et al., 2017).

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A system is a collection of interconnected parts that work together to achieve a purpose. A Health

System (HS) is defined as a system comprised of patients, families, communities, ministries of

health, health providers, and health financing bodies that mainly have 6 functions to improve,

restore, and sustain health. These functions are often referred to as the building blocks of the HS

(Kutzin and Sparkes, 2016). The WHO (n.d. a) defines those building blocks as :  Leadership

and governance  Health information systems  Service delivery  Health Workforce  Health

system financing  Medical products, vaccines, and technologies Health System Strengthening
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(HSS) is the means to realizing the UHC objectives (Digital, 2022). It goes beyond merely

feeding and investing more into the parts; it entails strong systematic thinking to improve the

interconnectedness between those parts, rethinking and reshaping the way they function, and

aligning those functions toward a strong health system that is resilient against health emergencies

(Gavi Alliance, 2013; unlimithealth.org, no date) . The WHO recommends strengthening a UHC

health system by strengthening each of its building blocks, based on the framework below.

According to Manyazewal (2017) leadership and governance are strengthened when the HS is

managed in a way that meets the needs of all people, based on political commitment and

accountability for the best use of resources and health workers' time. A way to achieve this is

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through leadership training programs to improve capacity for resource mobilization, using the

available health information system appropriately, and better monitoring the HS improvement

(imaworldhealth, no date). Strengthening Health information systems (HIS) means having a

system that is reliable, robust, and up-to-date that allows comprehensive data collection, analysis,

and dissemination (Gavi Alliance, 2013). This could be done through; collaboration between

health and other sectors, investing in health personnel capacities for using health statistics and

data, aligning stakeholders in support of HIS, leveraging the digital revolution to simplify data

collection, analysis, and reporting through eHealth strategies, strengthening the capacity for

systems and applications to be scalable and reusable, and using data to inform policy and

decision-making (WHO UHC Technical brief, 2017)

Gavi Alliance (2013) states that improving service delivery requires improving demographic and

geographic coverage and accessibility standards. Manyazewal (2017) expands that the way to

achieve this must be through eliminating all kinds of discrimination, treating all patients with

respect, and making it easier for patients to commute to healthcare facilities. WHO's approach to

health financing comprises three main functions: fundraising from all possible sources, pooling

of those prepaid funds to cover everyone, and strategic fund spending and allocation to effective

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health services to reduce wasting valuable resources (WHO, n.d. a). Raising funds could be done

through equitable taxes, obligatory health insurance, equitable out-of-pocket expenses (OOPE)

that get accumulated to protect everyone from catastrophic health spending (UHC2030, 2022).

Furthermore, private spending on health must be taxed where the tax funds are oriented into the

public health fund pool (ibid.). According to Cometto, Buchan and Dussault (2020) a health

workforce suitable for achieving UHC requires choosing personnel with certain characteristics,

such as good communication skills, cultural sensitivity, and the ability to work in teams. They

emphasize that their education and training should be shifted to one that is more adaptive to the

ever-changing disease patterns and the rise of non-communicable diseases (NCD). Furthermore,

they emphasize that the health worker needs to feel respected, valued, involved in decision-

making procedures, and be given flexibility and work-life balance (ibid.

To achieve UHC, medical products, vaccines, and medicines need to be of standard quality,

affordable, and available to all (Gavi Alliance, 2013). Additionally, proper use of these products

is a must. Excessive use of antibiotics could lead to the threat of antimicrobial resistance, while

the excessive use of opioids has caused addiction in several countries (WHO, n.d.). Medical

equipment and devices, particularly the diagnostic ones, need to be up

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