Universal health coverage (UHC) is built on the principle that all people should have access to the health services they need, without financial hardship. This includes the availability of and access to a full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.
In this plenary session, Elizabeth Iro, the Chief Nursing Officer for the World Health Organization (WHO), opened the session by talking about the vital and multifaceted role of nurses in universal health coverage.
As the largest health profession in the global health workforce, nurses are intrinsically linked and well placed to play a key role in achieving UHC and the Sustainable Development Goals. Iro emphasised the vital role nurses play in an effective healthcare system, saying that in 2020 nurses and other health care workers have mounted an effective response to COVID-19, bringing their skills, experience and knowledge. Doing this they demonstrate the fundamental importance of a skilled and agile national healthcare work force in preventing and managing communicable diseases.
The WHO has designated 2020 as the Year of the Nurse and the Midwife, reflecting that the global healthcare response depends on the leadership and contributions of the nursing workforce. Iro said “the contribution of nurses cannot be overstated”.
Working across the life course and in all settings, nurses are often the first and only point of care in their communities. They work to uphold human rights, fight to reduce inequalities and empower people and communities.
Iro highlighted the “landmark” State of the World’s Nursing Report released by the WHO this year, which makes clear the huge global benefits seen when there is investment in nursing, as this is shown to drive improvements in patient health.
“Without nurses and healthcare workers we cannot achieve health for all or end diseases like tuberculosis (TB)”, Iro continued, closing by saying “the WHO is calling for your support to ensure that the nursing and midwifery workforces are strong enough to ensure that everyone gets the healthcare they need.”
Exploring the journey to UHC from a practical perspective, Erika Mohr-Holland, Rifampicin-resistant Tuberculosis Epidemiology Activity Manager for Médecins Sans Frontières, spoke about tackling the gaps in the healthcare pathway for people with TB.
Mohr-Holland gave the tragic example of a person living in Khayelitsha, a township in South Africa. This man had a cough and was tested for COVID-19, but there were no resources to test him for TB. His COVID result was negative and he was sent home. By the time his DR-TB was diagnosed, he was too unwell and died.
“The system failed this man,” said Mohr-Holland. “How many times does the system have to keep failing people, in order for there to be real systemic changes?
“We need to do better.”
Mohr-Holland went on to highlight the specific gaps in the cascade of care, from case-finding, the lack of health promotion and information, barriers to access to care; the need for better tests and screening processes, and the need for rapid point-of-care tests to bridge the gap.
To achieve UHC, said Mohr-Holland, communities must be educated, not stigmatised or denied access to services. She stressed the urgent need to act, ending “The time to act is now.”
Community voices should have a critical leadership role in decision making and accountability for UHC. Prachi Kathuria was diagnosed in early adulthood with chronic bronchitis and asthma and she spoke about what it feels like to live with a respiratory condition. Shining a light on her varied experiences as a patient, Kathuria spoke of the frustration that her diagnosis took five years of tests and fighting to get care, as a result of failings within the health system. However, after diagnosis the nurses, healthcare workers and the community were a vital and positive support network.
This experience shows the need for patient voices at the centre of this conversation. Kathuria called for UHC through strengthening healthcare workers, prioritising prevention, early diagnosis, and maintaining a continuous supply of essential medicines.
Her strongest message was the call of civil society and patients the world over: “nothing about me, without me”. She called for those listening to put patients at the heart of everything they do, and at the centre in the move towards UHC, saying, “Let’s put people first.”