People-centred Universal Health Coverage in the Asia-Pacific

Abstract

Universal health coverage (UHC), variedly construed, is not a new concept. In international politics, it emerged as a global health agenda in the 1920s, became marginalised by the 1950s, but re-emerged as BHealth for All^in the Declaration of Alma-Ata in 1978 (Gorsky and Sirrs 2018). The commitment then was to advance primary health care by linking health with community action, multilateral collaboration and social justice. Since then, health and health-related campaigns such as, for example, the Millennium Development Goals achieved some success, particularly in reducing the maternal mortality and under-five mortality ratios (Cha 2017). UHC remains a prominent goal in the United Nations' Sustainable Development Goals, and for good reasons. Still more needs to be done to improve the global state of primary health care, and its role in promoting the health and wellbeing of people and communities. Alarmingly, essential health services delivered through primary care are inaccessible to half of the world's population (Primary Health Care Performance Initiative 2018). In the Western Pacific Region of the World Health Organisation (WPRO), a large number of people are still Bleft behind^as inequities persist between urban and rural areas, and across subnational regions (World Health Organization 2017). How can bioethics as a field contribute to UHC? This may be a fair question to ask in the light of the remark by the Director-General of World Health Organisation, Dr Tedros Ghebreyesus (2017), that: B… universal coverage is an ethical issue^. Perhaps a response to this question may be closely linked to the Astana Declaration (World Health Organization 2018), which seeks to draw the political focus back to the commitment of the Alma-Ata Declaration (World Health Organization 1978) to develop a people-centred primary healthcare as a critical step to realise health for all. If this is correct, then bioethical inquiry into the goals and implications of UHC will need to be broadened beyond its health financing aspect and related concerns in equity.

Capacity Building: Continuity and Change

“…We welcomed the new year with an international research seminar that sought to consider the ethical implications of the Astana Declaration on endeavours directed at Universal Health Coverage (UHC) in a number of Asia-Pacific countries. Some of the works presented in this seminar have been published in the March instalment of the journal, which had people-centeredness in UHC as its central theme (Ho and Caals 2019). In the second instalment of the journal for the year, we published papers that not only reached back to earlier discussions on ethical deliberations around biodiversity (Lajaunie and Morand 2018) but also forward to ethical approaches in the evaluation of the Big Data phenomena in health research.…”

Understanding, being, and doing of bioethics; a state-level cross-sectional study of knowledge, attitude, and practice among healthcare professionals

“…Furthermore, the Pakistan study also added that 57% of the medical and dental residents did not know the code of ethics of the Pakistan Medical and Dental Council, and Studies conducted in India among physicians, medical residents, and nurses reported that the knowledge of ethics ranged from 34.8% to 59% [ 21 , 22 , 24 , 25 ]. These findings indicate the necessity of improved educational methods of medical ethics and warrant regulations to implement the practice of bioethics in the healthcare delivery system in India and other Asian countries [ 46 – 48 ] as well. The vast difference in the knowledge level between these studies with our study could be attributed firstly to the large sample size in this study, secondly, this study included a varied range of professionals unlike the other studies and the construct of the KAP questions varied as well.…”

Utilization of Free Maternity Services among Reproductive Age Women of Chepang Community in Nepal

“…Factors that prevent women from receiving or seeking health care during pregnancy and childbirth include inadequate services, poverty, distance, lack of information, and cultural practices [7] . Underutilization of health services is one factor contributing to high maternal mortality rates, for example, 81% of births take place at home, many without skilled health providers [8] .…”