You Can’t Have Universal Health Coverage Without the Community

UHC is the acronym du jour – everyone is talking about how to achieve universal health coverage. But, it’s no surprise that there’s no simple solution. Like any other initiative in history that has successfully created radical change, UHC will require political will, the right people to be allocated sufficient resources, and scaling relatively low-cost, yet effective, interventions.

I urge you to think about what delivering universal health coverage to the poorest, most remote communities in the world really means. Despite the UHC agenda being dominated by issues of health insurance and financing, it is not a national health insurance schemes that will deliver UHC, but well-resourced and efficient primary health care systems. I would even go one step further and suggest that the face of UHC should be community health workers (CHWs), the individuals physically reaching the last mile to provide basic healthcare to their communities; at a substantially lower cost than facility-based care when it comes to delivering basic services and preventative medicine.

The WHO has recognized the importance of CHWs in delivering UHC and is developing guidelines to assist national governments in the design and implementation of CHW programs. It is great to finally see community health being prioritized and governments being given clear guidance to facilitate and develop their own community health efforts. That said it remains a daunting task, especially when considering that national CHW programs require managing the performance and demonstrating the impact of a workforce often several times larger than those on the current payroll, based in disparate locations and with minimal education.

This is where technology can help. mHealth solutions can support governments to improve the quantity and quality of the data collected, improve the consistency and accuracy of diagnosis and treatments, and enable managers to monitor the performance of CHWs and their supervisors on a daily basis. This type of data highlights the direct impact of community health programs and enable more innovative financing methods such as results-based financing.

However, a smartphone in the hands of a CHW – even one that comes with a well-supported mHealth solution – is not a silver bullet. If governments are serious about UHC, they need to design CHW programs that are integrated into the broader healthcare system. This requires them to:

  • Strengthen supply chains, so that CHWs are properly equipped with lifesaving drugs;
  • Have dedicated supervisors able to provide supportive supervision in the field; and
  • Establish effective data collection and reporting mechanisms to provide visibility and accountability at the community level.

At Living Goods, we have shown that a well supervised, well equipped and properly motivated CHW can dramatically reduce child mortality (our randomized control trial showed a 27% reduction in under-5 mortality against our control households), and this can be done for less than $2 per person served a year. After a decade of experience, we are keen to translate what we’ve learned about high impact community healthcare and enable governments to adopt new models to manage their own CHW programs and ensure sustainability.

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