Achieving universal health coverage

Perspectives There is global consensus on the goals of universal health coverage (UHC), which has been defined as " all people receiving quality health services that meet their needs without exposing them to financial hardship in paying for them. " 1 Yet despite this consensus, it remains unclear how the global health community can achieve universal coverage. The obvious answer is to ensure that health services reach those who need them. The complicated real-world challenge, however, is actually delivering services to reach those most in need and more specifically to those who are hardest to reach. Without a focus on reach, resources will be wasted and the number of preventable deaths and treatable illnesses will remain high. Until now, the main constraint in achieving UHC has been understood in terms of lack of ability to pay for health services. The barrier to universal health, many argue, is the un-affordability of health services for the world's very poor. 1 Hence, conventional wisdom prescribes the reduction of financial barriers – such as the removal of user fees – to achieve UHC. 2 This is not the wrong prescription ; it is an important one and without a reduction of such financial barriers, UHC is impossible. But it is a prescription that only addresses one obstacle. As the global health community moves beyond the financial model of health access, it has begun to consider and address additional barriers to health care, such as geographical distance, cultural differences, gender norms, citizenship, social determinants and so on. 1 Innovative methods are needed so that health services reach beyond and around these barriers. After all, a very poor villager in the rural hinterland of India is more likely to be unhealthy not just because she cannot afford health care, but also because many health services do not reach her. But to be reached requires one to be visible in the first place. If the goal of UHC is to reach vulnerable populations who are otherwise left out, then all people need to be visible. Many people in high-income countries take visibility for granted. Most pay taxes; have an official identification; a registered birth; a street address. They can be reached by health services because they are visible. This is not the reality for many people in low-and middle-income countries, particularly those who are very poor or marginalized. For instance, how is it possible to deliver an …