Assessing Latin America’s Progress Toward Achieving Universal Health Coverage

Abstract

Two commonly used metrics for assessing progress toward universal health coverage involve assessing citizens' rights to health care and counting the number of people who are in a financial protection scheme that safeguards them from high health care payments. On these metrics most countries in Latin America have already "reached" universal health coverage. Neither metric indicates, however, whether a country has achieved universal health coverage in the now commonly accepted sense of the term: that everyone--irrespective of their ability to pay--gets the health services they need without suffering undue financial hardship. We operationalized a framework proposed by the World Bank and the World Health Organization to monitor progress under this definition and then constructed an overall index of universal health coverage achievement. We applied the approach using data from 112 household surveys from 1990 to 2013 for all twenty Latin American countries. No country has achieved a perfect universal health coverage score, but some countries (including those with more integrated health systems) fare better than others. All countries except one improved in overall universal health coverage over the time period analyzed.

Socioeconomic inequalities in women's access to health care: has Ecuadorian health reform succeeded?

“…A third indicator, skilled birth attendance, was selected to represent treatment coverage. These three outcomes have been previously used to indicate progress towards UHC and were available in the surveys [10,26,27].…”

“…An article by Wagstaff et al published the same year (2015) assessed the progress towards UHC using data from 112 household surveys from 1990 to 2013 for twenty Latin American countries. The overall conclusion was that all countries were progressing well in the right direction towards UHC, but still far from achieving full UHC [10]. Despite Wagstaff et al conclusion, several studies looking at the impact of the health care reforms on different aspects of the equity dimension in countries like Brazil, Mexico and Colombia have however suggested that the implemented reforms did not contribute to improve equity and fairness in the health system and therefore to achieve UHC due internal and external factors such as a huge fragmentation, poor delivery and unsustainable nancing of health system.…”

Summary indices for monitoring universal coverage in maternal and child health care

“…22 Monitoring universal health coverage is more complex than monitoring only coverage of reproductive, maternal, newborn and child health care; indicators also need to cover cardiovascular disease, mental health, injuries, cancer and several infectious diseases, as well as financial protection. 23,24 Given that universal health coverage tracer indicators tend to be age-specific, and in some cases sex-specific, it is unlikely that a cumulative index such as co-coverage will be useful as a single summary measure. Thus, the approach of using averages -as in the composite coverage index -is more appropriate for monitoring universal health coverage.…”

“…The universal health coverage measurement exercises mentioned above [22][23][24] all stress the lack of timely, populationbased and regular information for monitoring coverage. The availability of data on reproductive, maternal, newborn and child health is greater than for other age ranges, particularly due to the increase in DHS and MICS during the MDG era.…”

Challenges for Measuring Progress towards the Sustainable Development Goals

“…As different regions and, more critically, nations have different sensitivities about sexual and reproductive health concerns, care must be taken to maintain a holistic perspective 42,43 . As a cautionary example, the emerging global universal health care monitoring effort takes a broad perspective in the diverse areas of reproductive, maternal, neonatal, child and adolescent health 44,45 but care should be taken for family planning, being part of clinical practice, to feature among its set of health interventions as opposed to being grouped elsewhere due to its linkages with other social conditions 46 . National commitment to a common holistic approach will be essential for accountability and programmatic corrections.…”