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UHC DAY 2019: A Call to Action to Governments, Providers & Civil Society

Today, we mark the 4th International Universal Health Coverage Day (UHCDay), a global commitment to healthcare for all, without financial burden to families and communities.

In the remote hills of Nepal, we continue to bear witness to a healthcare system that often struggles to meet the needs of the poor.

A car or farming accident can lead to upwards of $5,000 in hospital costs — sending many families to live below the extreme poverty line of less than $1.90 per person per day.

In Achham, over half of families suffered medical debt and one-third had spent greater than 10% of their monthly household income on medical care according to a survey conducted by our Community Health Workers among 2,500 households. This is forcing families to choose between food and healthcare.

A core component of Possible’s model, at both the community and hospital level, has always been to eliminate point-of-care fees. Our commitment and advocacy around primary health care includes essential inpatient and surgical care. We cannot have families go bankrupt, simply trying to access basic care.

But healthcare is not free. Healthcare needs to be financed through diversified mechanisms, the cornerstone of which is insurance.

Nepal at present has committed to reduce out-of-pocket expenditures from over 55% to less than 35% over the next 15 years. To achieve this reduction, providers, the municipal government and other stakeholders must align on standards of healthcare quality, and the expansion of and effective implementation of the nascent national health insurance scheme.

“Community Health Workers (CHWs) are a critical part of achieving UHC in Nepal. CHWs have helped create demand for healthcare in places where it’s needed the most. For remote communities, it is important to invest both in quality care in facilities and deploying paid, trained and supported CHWs, who are integrated in the public health system. We have witnessed the potential of this impact, and we know the challenge ahead of us,” says Aradhana Thapa, Director of Healthcare Design.

UHC day forces us to chart a viable, sustainable, ambitious path forward, at a time when more than half of the population continue to be left behind. Our call to action is to do more and demand more and to keep the promise to: 1) provide high quality care; 2) ensure that care is timely and accessible; and 3) costs at the point of care are minimized.

Today, we both celebrate the global movement that is rallying international, national and local players to step up. And we remember those patients and families who have been bankrupted in the process, as we anticipate what’s at stake.

Duncan Maru, MD, PhD, is co-founder and CEO. Aradhana Thapa is Director of Healthcare Design. Together they work with a team of 400+ individuals who are designing, building, and implementing health systems in underserved communities in Nepal.

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