African youth raises their voice for Universal Health Coverage

On Monday, December, 12th, over 800 organizations and many more individuals raised their voices to establish universal health coverage (UHC) for all. InciSioN (The International Student Surgical Network), one of the partners of the UHC Coalition, encouraged its national small working groups to organize local events for Universal Health Coverage Day with a special focus on Global Surgery. (1)

<Zineb Bentounsi>

Four national small working groups (being Egypt, Morocco, Rwanda and Tanzania) organized local events, being countries where “health for all” is an urgent need, and not just a concept.

In Egypt, Morocco and Tanzania, medical students gathered and brainstormed trying to answer the questions “how can we achieve UHC in our country?” and “how do we avoid that anybody is pushed (further) into poverty for needing surgical care?”. At the end of their meeting, each group wrote a statement with their suggestions. Each group had different suggestions based on their own context, but some suggestions were common.

These three groups urged their government to increase the budget allocated to health and Tanzanian students further highlighted that “there must be a well-defined amount of money” dedicated only to surgical care. Another cornerstone was taxes, with Moroccans and Egyptians both suggesting to lower taxes on medications and health care equipments (especially surgical equipment) and push their governments to start manufacturing that equipment locally, instead of importing them (thus investing in technology and engineering as well).

Egypt and Tanzania also believe that everyone should have access to emergency surgeries regardless of their ability to pay. To achieve this goal, Egypt suggested to establish a fund (financed by taxes proportionally deducted from incomes) to cover those surgeries, while Tanzania thinks that missionaries should focus on settling in low-income areas, providing emergency surgeries to those populations.

Furthermore, some suggestions were adapted to the country’s context. For Moroccan medical students, a health insurance policy to cover every Moroccan should be a priority [Note: there are several public and private health insurance policies in Morocco depending on income, but no standard registration]. For Tanzania, it seems important to include basic surgical care in primary health care in order to “lower the workload” in referral hospitals. Lastly, Egypt mentions the health workforce in their declaration, asking for improvement of the status of healthcare professionals.

On the other hand, the students from Rwanda did something completely different, by choosing to tell the story of a patient who needs surgery because of a road accident, yet can’t afford to pay for it. Reading the story gives you an insight into Rwanda’s health care system and its efforts to reach UHC. To read the story, please find the link as follows: https://m.facebook.com/story.php?story_fbid=1808107899404362&substory_index=0&id=1737737036441449

InciSioN would like to thank each group for organizing and sharing their activity. Special thanks to Nermin Badwi from Egypt, Godfrey Sama and Faith V. from Tanzania, François Xavier Rutayisire, Theogene Sengarambe and Iraguha Bandora Yves from Rwanda, the executive boards of Medec’IN-Casa in Morocco and ZMSSA in Egypt. (2,3)

Further reading:

1. http://universalhealthcoverageday.org/welcome/
2. https://www.facebook.com/MedecIN.Casa.official/?fref=ts
3. https://www.facebook.com/ZMSSA/?ref=ts&fref=ts

Universal Health Coverage Day

Imagine the following situation. You’re walking home from work on a day like any other, until you suddenly become part of a road traffic accident. Urgently needing transportation to the nearest emergency care center to receive life-saving surgery, your nation’s health care system requires you to pay out-of-pocket, ultimately leading to catastrophic expenditure and the loss of the few assets you possessed. Your life has been saved, yet you are left without life as you knew it.
<Dominique Vervoort>

Depending on where you come from and what your experiences are, the story above may seem either doubtfully unlikely or the sad truth. Even today, during times of relative global wealth, technological advances and medical heights, such situations continue to happen, both in high- (HICs) and lower- and middle-income countries (LMICs).  

Many countries already provide(d) some sort of health coverage for their population, yet often unequally, with some people receiving deeper coverage than others, regardless of their actual needs. Inequity not only exists between regions and countries, but also within, with many countries providing (more and better) care only for those able to pay, thus negatively affecting the people who need it most, being the poorest part of a population.

Health coverage should not only be extended to those “uncovered”, but also in a way (how deep and what should be covered) that prevents the creation or sustainment of health system gaps. It is therefore important to consider Universal Health Coverage (UHC) as a concept that provides everyone -rich and poor- with the health services they need (i.e., correct and adequate care), and makes sure that nobody suffers undue financial hardship as a result of getting the care they need.

The Case for UHC & Access to Surgery

Health financing mechanisms that offer financial risk protection are needed to protect people from impoverishing and catastrophic expenditure due to out-of-pocket payments. In many countries, these costs are often high, especially when access to surgical care is needed. LMICs have to move away from out-of-pocket user fees to indirect financing methods, including general taxation or insurance models. The latter could then lead to UHC packages, aiming to promote equity and equality, hand-in-hand with financial risk protection within national health systems. These packages should cover, at minimum, a basic package of essential surgical, anaesthesia and obstetric care, based on the needs of the respective country.

One could say that some nations don’t have the needed funds to allocate to investments in their health care systems, yet the WHO published their WHO Health Systems Financing Report in 2010, which indicates that every country is able to mobilize the funds to move toward UHC. (1)

In 2013, the Lancet Commission on Investing in Health found that better health status drove 24% of full-income growth over a decade, with every $1 invested able to return 9-20 times the benefits. (2) Thus, UHC has proven to be cost-effective, resulting in social and economic dividends for nations as a whole, and as a result, the question that arises is not “if”, but “when” more governments will start investing in UHC. Nevertheless, today, still far too many governments fail to invest enough in their health care systems.

UHC Day

December, 12th 2016 will mark the 3rd consecutive UHC Day, a day on which several hundreds of organizations from over 100 countries across the globe join forces as part of the UHC Coalition to spread awareness and organize activities regarding UHC. Even today, hundreds of millions of people’s lives and finances are jeopardized by the existence of health system gaps.

Even though there is still a long way to go, many steps forward have been taken in 2015 and 2016, partially due to the success of the first two UHC Days. In June 2015, a few months after the costly Ebola crisis -which would have cost less to prevent- the first UHC Global Monitoring Report was published by the WHO and World Bank Group. It was the first report measuring health coverage and financial protections in countries, in order to assess their progress towards UHC. The report showed that 400 million people do not have access to one or more essential health services, 17% of people are impoverished by health costs and 6% of people in LMICs are tipped or pushed further into extreme poverty. (3) As a result, in September 2015, the goal of achieving UHC became part of the Sustainable Development Goals (SDG 3.8). (4)

After the G7 endorsed UHC in May 2016, African leaders united in August 2016 to launch a framework to work towards UHC, driven by the investment of $24 billion by the World Bank and Global Fund. One month later, WHO Director-General Dr. Margaret Chan announced the International Health Partnership for UHC 2030. (5)

“African countries can become more competitive in the global economy by making several strategic investments, including investing more in their people, their most prized resource. A critical part of this commitment is to accelerate progress on universal health coverage—ensuring that everyone, everywhere has the opportunity to live a healthy and productive life.” - Jim Yong Kim, President of the World Bank Group

This year, the UHC Coalition aims to “act with ambition”, saying that:

• Countries making the greatest strides toward UHC put the poorest and most marginalized populations first, not last;
• Leaders can and must invest in policies and health systems that reach every person and community based on need, not ability to pay, with services that are free at the point of use;
• People have diverse health needs over a lifetime and valid concerns about cost and quality of care. Health care systems should ensure high-performing primary care in every community, supported by well-trained, well-paid health care workers;
• Proactively safeguarding everyone, everywhere, will prevent the next pandemic, expand economic opportunities and promote shared prosperity;
• Data should measure what matters, i.e., whether systems, services and medicines are accessible, high-quality and affordable for all.

Establishing universal health coverage in nations is imperative for reaching the health-related Sustainable Development Goals by 2030. International and nations’ leaders should be held accountable for current health system gaps, in order to promote more and smarter investments in health systems. To achieve these goals, we can all help by spreading awareness and further pushing UHC on the global health agenda as, after all, everyone, everywhere should inherently be safeguarded from health expenditure.

References

1. World Health Organization. Health Systems Financing: The Path To Universal Coverage. Geneva: World Health Organization; 2010.
2. Jamison DT, Summers LH, Alleyne G, Arrow KJ, Berkley S, Binagwaho A, et al. Global health 2035: a world converging within a generation. Lancet. 2013;382:1898–955. doi: 10.1016/S0140-6736(13)62105-4.
3. World Health Organization, World Bank Group. Tracking Universal Health Coverage: First Global Monitoring Report. Geneva: World Health Organization; 2015.
4. United Nations. Transforming Our World: The 2030 Agenda For Sustainable Development. United Nations; 2015.
5. World Bank. Partners Launch Framework To Accelerate Universal Health Coverage In Africa; World Bank And Global Fund Commit $24 Billion.; 2016.

InciSioN Global Surgery Workshop at the 65th IFMSA General Assembly, August 2016

With almost a third of the global burden of disease attributable to conditions that could be managed or treated with surgery, the field of Global Surgery (GS) is being increasingly recognised across the world as a crucial part of public and global health. In this context, it seemed like the perfect time for the InciSioN group to host a Global Surgery Workshop at the 65th IFMSA General Assembly in Puebla, Mexico this year to gauge students' interest in this area and speak about the work that InciSioN is planning on doing over the next year.

Sixteen students attended our workshop from around the world, with representatives from countries as diverse as Switzerland, Taiwan, Guatemala, South Africa, and Lebanon. While none of the students had had much experience with global surgery before, we had a fantastic and interactive discussion over the hour and a half session about the key issues in the area.

While the first part of the workshop focussed on an introduction to global surgery, highlighting some key statistics and myths about surgery and the role of surgery in global health, we also talked briefly about our aims with InciSioN as a group, particularly in relation to our plans for our Advocacy and Education sub-committees.

However, the real fun of the workshop was in the various role-play and team exercises that we had planned. These included an exercise looking at barriers to surgical care in Low- and Middle-Income Countries (LMICs), by getting students to work through a case of a woman presenting with a vaginal fistula from an indigenous LMIC community, and a brainstorming session to look at solutions to global surgery issues with participants divided into groups representing High-Income Countries (HICs), LMICs, international organisations, and rural clinics.

Although the session unfortunately had to be relatively limited (an hour and a half was definitely not long enough, as the participants declared) we were really impressed by the passion and enthusiasm that all of the students brought as they participated. In the future, we hope to present more global surgery workshops in partnership with IFMSA NMOs, to allow us to educate even more students on the importance of global surgery in modern healthcare.

Our team would like to thank Dominique Vervoort for facilitating the workshop and Josephine de Costa for writing this entry.

Welcome to our new InciSioN Blog!

InciSioN is the International Student Surgical Network, and used to be formally known as the IFMSA's Global Surgery Working Group.

We are a collaboration of medical students from all over the world who have come together to discuss about, educate on, advocate for and perform research in Global Surgery.

We will be providing regular content from our student members around the world, linking to new research and advocacy campaigns as well as providing a space for comments and discussions.

Interested in hearing more? Feel free to email us on incision.students@gmail.com