A plan for furthering the promise of equal access to healthcare

If you have access to healthcare, consider yourself fortunate. According to the World Health Organization’s (WHO) last survey on global health coverage, at least half of the world’s population cannot obtain essential health services.  

But even access can be a double-edged sword, bringing with it crippling financial burdens. An estimated 800 million people spend at least 10% of their household budgets on health expenses. Of that group, the cost of treating medical problems pushed 100 million into extreme poverty.  

The Covid-19 vaccine rollout was a clear illustration of the stark global inequalities that persist around health. As of July 2022, just 19% of Africans were fully vaccinated for the virus versus 61% of the global population. 

While many factors contribute to life expectancy, in higher-income countries, people live an average of 16 years longer than those from low-income nations. According to the WHO, uneven access to healthcare is a major driver of this gap.  

 Equal access to health goes beyond the contrasts between the global north and south. It exists between genders, particularly because women have the added complications that surround childbearing and menstruation. Within countries, it also exists for the disabled, various minority groups and those without sufficient wealth or insurance. In the US, for instance, medical costs create financial hardships for more than half of Americans, and a lack of health insurance was found to cause nearly 45,000 premature deaths per year. 

Access to affordable healthcare should not be a luxury. It is a human right and a global political commitment encompassed in the 2030 Sustainable Development Goals (SDGs). But according to WHO Director Dr. Tedros Adhanom Ghebreyesus, the world is still way off track on those goals, and the pandemic only made matters worse. 

A human-powered solution

 Susana Malcorra, Senior Advisor at IE University, proposes a pragmatic solution to boost access to health worldwide. As former director of the UN’s World Food Programme, Chief of Staff of the Secretary-General and Argentine Foreign Minister, she has profound experience tackling global crises. 

 “Having seen people in dire conditions throughout the world, I can attest that this basic right to health doesn’t exist for many,” she said. “But coordinating the first health mission for the Ebola outbreak taught me that countries can come together through the UN in a highly effective way.”  

During the 2013-2016 Ebola outbreak, initial Centers for Disease Control (CDC) models predicted that as many as 1.4 million people would be infected with the lethal virus. Thanks to a rapid and intense international response, fewer than 29,000 cases were reported before the epidemic faded away.   

“I think there is still so much inequality around access to health because governments don’t recognize it as a basic human right.” - Susana Malcorra, Senior Advisor at IE University

 Malcorra witnessed this success first-hand and believes the same could be done to secure universal access to healthcare. The solution, she says, isn’t rocket science—  it’s a matter of bringing healthcare professionals to the people.   

“For me, technology has been over-emphasized. I’m all for technology, but what’s needed is more healthcare actors within communities like family doctors and nurses. They can take a more holistic view and can pick up problems early. Of course, people with more complex cases should go to specialists or access sophisticated equipment, which may be further away,” explained Malcorra. 

She highlighted the success of Cuba’s system, which ensures that every single citizen has access to a nearby doctor. Despite economic and technological handicaps, the life expectancy in the island nation is more than a year longer than in the US.  

“A model built on close primary care is more cost-effective, but inaugurating a sophisticated hospital can sell better politically. I’m not against these hospitals, but they should be the last step in a long journey that starts in the community,” she said.  

Besides the strong economic case for a primary care-based model, it can also reduce the spread of communicable diseases such as Covid-19 or Ebola as it reduces the need to travel.  

As Public Health Specialist Mitra Feldman also pointed out in an interview with IE Insights, many of the people who get malaria each year live in remote rural areas and have limited access to adequate healthcare. One study found that access to primary health facilities could reduce the burden of malaria by as much as 66%. 

For this model to take root, Malcorra said financing and capacity building will be key, alongside the political will. “I think there is still so much inequality around access to health because governments don’t recognize it as a basic human right. Donor countries have extremely costly models that are unaffordable for the south. It's not only about donating money but also finding solutions that are manageable within each context.”