Universal health coverage is out of reach unless we eliminate discrimination

Zero discrimination is more than a slogan. It is essential for achieving universal health coverage (UHC).

March 1, 2018

According to WHO and the World Bank, half the world still lacks access to essential health services. Non-discriminatory health services can help people feel safe and comfortable in seeking health care. Unfortunately in far too many parts of the world and for far too many people, discrimination is a major barrier to accessing health services. For instance, people living with disabilities are four times more likely to report being treated badly by health-care staff and nearly three times more likely to be denied health care. Ageism and age discrimination also occur at all levels. Older women and men frequently report that they are refused treatment or treated with disrespect because of their age. And these are just a few examples.

UHC is about dignity of the person and equity and it is deeply rooted in the right to health.  Countries have an obligation to respect the right to health by preventing discrimination in access to health services, eradicating stigma and increasing social protection for marginalized and vulnerable groups. Ending discrimination requires an intersectional approach. Imagine if the world’s efforts to achieve UHC were driven by the power of human rights. What would this look like? Here are three key elements:

1. Political leadership

World leaders have committed to the Sustainable Development Goal target of reaching UHC by 2030, and leaving no-one behind. Simply expanding health services is insufficient. Health systems must meet the needs of the people they serve and be designed to explicitly address equity. This requires a rights-based approach that focuses on improving the affordability, accessibility, availability and quality of health services, including investments in sensitising health workers to provide non-discriminatory health services.  For example, Brazil integrated ageing into the national family health strategy to facilitate better care for the elderly. Health professionals were trained in caring for older people and ageing considerations were integrated into a range of clinical-care procedures.  

2. Community engagement

While HIV-related discrimination is still too pervasive, the AIDS response has shown us that participation matters. The meaningful involvement of community based organizations and networks of people living with HIV can drive greater access to, and uptake of, treatment and prevention services. In Nigeria, for example, for each community-based organization created, the likelihood of treatment access was shown to increase 64 per cent per 100 000 people, while the likelihood of accessing HIV prevention doubled. Marginalized and vulnerable groups must be involved in the development, implementation and monitoring of non-discriminatory health services; they can assist in monitoring stigma and discrimination in health-care settings and encourage people to access services and improve service delivery.

3. Enabling legal and policy frameworks

The removal of punitive laws, policies and practices, and the promotion of protective legal and policy environments also play a critical role in making people feel they can safely access health services. UNDP is working in partnership with governments, civil society, UNAIDS Cosponsors,  the UNAIDS Secretariat and other partners in 88 countries to implement the recommendations of the Global Commission on HIV and the Law by expanding human rights programmes which can remove barriers to accessing services.

These are just a few of the concrete measures that can help the world deliver on the promise of universal health coverage. It is time to link the human rights and UHC movements. Discrimination and the goal of ‘health and well-being for all’ are diametrically opposed. Discrimination is immoral and must be eliminated if the right to health, and ultimately universal health coverage and the pledge to leave no one behind, is to be realized by 2030.

About the author
Mandeep Dhaliwal
is the Director of the HIV, Health and Development Group in the Bureau of Policy and Programme Support at UNDP. Follow her on Twitter: 

This article was originally pubished in Devex.