* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
All countries, no matter how rich or how poor, owe it to their citizens to progressively realize gender equality and their population’s right to health
Diane Gashumba, Minister of Health, Rwanda and Carin Jämtin, Director-General, Swedish International Development Cooperation Agency.
Today, on Universal Health Coverage Day, we stand together to advocate for the simple but radical idea that every person in the world has a right to health. Yet, on a global scale, women and children face a pressing and consistent gap in an area too often forgotten: sexual and reproductive health and rights (SRHR). Our ability to truly achieve health for all is impossible if we ignore these needs of women, girls and adolescents.
Improving the health of women, girls and adolescents – populations who are key to social and economic progress – can be a driver for health and sustainable development goals, which makes closing the gap in SRHR interventions especially urgent. This is especially true for marginalized and discriminated groups, for whom stigma can put services far out of reach. This lack of access is not only inequitable, it is dangerous. Women and girls around the world continue to face injury or death for largely preventable and mostly treatable conditions, devastating individuals and families and imposing a significant economic burden on women and girls, families, communities, and entire health systems.
The solution is not a complex one, but it is a purposeful one. The majority of SRHR interventions are health promotive, preventive, cost-effective and can be delivered at the primary health care level, making them highly feasible to incorporate into universal health coverage (UHC) programmes. We, as ministers of health and finance and as development cooperation partners, must make a resolute call for the prioritization and integration of services.
As countries embark on the pathway to universal health coverage, leaders across the health sector have a responsibility to integrate SRHR into their UHC agenda. This requires delivering services as close to the people as possible, and ensuring SRHR interventions are included at the primary health care and community level. It takes getting practical about how to make services acceptable to the people who need them, and how to ensure services are high-quality and stigma-free. It expects that governments bring the right people – including midwifes, nurses’ associations, psychosocial care professionals, and women’s rights organizations – and the best evidence to the table when deciding what services to provide. And it calls for an increase in funding, domestically and from global funding mechanisms and donors, to sustain interventions and their quality.
Rwanda, in prioritizing an equitable approach to health and reaching women and girls most in need, has shown us a way forward on UHC. A low-income country of approximately 12 million people, Rwanda has championed a people-centered, decentralized health care model, bringing services to households through a dedicated workforce of 58,298 community health workers who offer preventive and curative care at the primary health care level. Geographic accessibility to services has also been a strategic focus. Through the construction of 1,700 new health posts, peoples’ average walking distance to basic health care will be shortened from nearly an hour to only 25 minutes—bringing more Rwandans closer to the care they need. To make services more accessible for the most vulnerable people, Rwanda has instituted community-based health insurance, which provides access to the majority of essential SRHR interventions.
The results of this people-centered approach have been remarkable. Today, over 90% of the Rwandan population is covered by health insurance. 91% of pregnant women deliver with a skilled birth attendant – no small feat in a largely rural country. And because of these interventions and a rapid increase in the uptake of modern contraceptives, maternal mortality has dropped by 80% in the past 15 years.
Sweden has made a similar journey with a comprehensive approach, which includes one of the oldest midwifery programs in the world, strong investments in comprehensive sexuality education, and access to sexual and reproductive health services, including contraceptives, for adolescents and young people. Health services in Sweden are publicly financed, allowing coverage to be truly universal. Learnings from this approach are at the core of Sweden’s global commitment to equitable access to health, particularly SRHR. In 2017, the Swedish development cooperation for health was approximately $440 million USD and just over half of this was dedicated to SRHR.
All countries, no matter how rich or how poor, owe it to their citizens to progressively realize gender equality and their population’s right to health. Universal health coverage is not only an economically viable and life-saving solution, it is also a moral commitment. At least half of the global population still lacks full coverage of essential health services and health care itself is increasingly impoverishing, with 100 million people annually being pushed into extreme poverty because of out of pocket payments for health care. It will take dedicated and accelerated efforts from the global community and governments, like ours, to fulfill the promise of health for all. The upcoming High-Level Meeting on Universal Health Coverage at the United Nations General Assembly in September 2019 is an important opportunity for the international community to turn our commitments into action.
Fellow political leaders, fellow leaders of development cooperation agencies, and civil society stakeholders, join us in prioritizing women and girls in the call for universal health coverage. All people, no matter their background, have a right to the highest attainable standard of physical and mental health without discrimination. All states have a responsibility to provide high-quality, affordable health care for its citizens. On this UHC Day, let us make this rallying call a reality. Let us partner and stand together to ensure that no one – and particularly not one woman or one girl – is left behind.