Beyond clinical skills: key capacities needed for universal health coverage.

Editorials 801 Global commitment to achieving universal health coverage (UHC) has grown stronger in recent years. 1 With this commitment has come the realization that, for UHC to be attained, the health workforce must possess clinical and non-clinical skills and competencies that respond to actual population needs. 2 The workforce is vital to well-functioning health-care delivery systems and equitable access to health services, but it is not enough to produce more health workers and place them where they are needed: we must also transform their education. 3 Several capacities beyond clinical skills that are key to attaining UHC are uncommon in the health sectors of low-and middle-income countries. Experiences in China, 4 Mexico 5 and Thailand, 6 and in other countries rapidly progressing towards UHC, have demonstrated the need for capacity in two broad areas: policy formulation and policy implementation. In countries pursuing UHC, the health sector needs not only professionals who are clinically competent, but also people with the capacity to generate country-specific evidence on the feasibility, sustainability and equity of different financing sources – e.g. taxes, health insurance premiums, out-of-pocket payments and donor contributions. It also needs professionals able to generate evidence on purchasing modalities and on the cost-effectiveness of new health technologies for the design of benefit packages. Another essential capacity is that of translating evidence into policy. This is a nonlinear process: analysing evidence for decision-making takes skill and long-term institutional capacity , which can be developed through mechanisms such as independent policy " think tanks ". The process of informing policies must be country-led and executed through national institutions, not foreign experts. The capacity to design UHC systems is also critically important. All sorts of choices must be made, including how to pay providers, and each has implications for financial risk protection, access to care, health system accountability and responsiveness, cost containment and system efficiency. 9 For example, certain measures introduced in countries of the Organisation for Economic Cooperation and Development, including closed-end payments, have resulted in improved microeconomic incentives for health-care providers. 10 Also indispensable is the capacity to monitor progress towards UHC, including the level and distribution of service utilization and financial risk protection. Health sector professionals need to know how to track and analyse the evidence needed to monitor equity. They must also be adept at designing and adapting survey instruments and other means of collecting the evidence. 11 Finally, several longer-term, …