Through the looking glass of invited participants at the 2012 Prince Mahidol Award Conference (PMAC), experiencing Thailand for the first time, it seems like Universal Health Coverage (UHC) is a mantra here in Thailand. There were statements like “seize the dragon year for UHC as it is the time to make things happen”. The commitment of the Thai people and government to Universal Health Coverage is so contagious that it makes the conference stand out as the peoples’ conference. This indeed may be the unique contribution of the PMAC conference to the international community: getting hands on experience live from those who did it and convincing other countries that have not, that good health is achievable at low cost. The world does not lack money but the right priority setting to achieve UHC.
Political will and continuity of policy and governance stand out as factors essential for achieving UHC, but equally important are the commitment and participation of the people and civil society in ensuring that a country keeps health care top on the agenda. Civil society has to go beyond just being a voice to become a movement with public commitment, responsibility and accountability towards society. There is hardly anything new about these, but what is unique about PMAC is that people are talking about global responsibility and local/community responsibility at the same time, not one or the other. Indeed, to achieve UHC, portability of financial risk protection must be addressed, not only within countries but across borders.
Evidence was presented over and over again showing that solutions will always be context specific. Talking about UHC in vacuum does not add much; putting the context in perspective is imperative. There is UHC for people in Guantanamo Bay, but that piece of information says not much about the quality of life they have. UHC must not be a goal in itself, but a means towards achieving the right to health for all. There is always a lot to learn from different countries, and like one panelist observed, “’National Health Insurance in Taiwan is like a car, the parts are made all over the world but all is domestically assembled in Taiwan according to the needs.”
The repeated call for evidence before action remains a lame excuse. Ruth Bishop, a 2011 Prince Mahidol Award Laureate gave the first keynote speech telling the story of the development of rotavirus vaccine. Rotavirus is the single most important cause of severe diarrhoea in infants worldwide, with 500 000 deaths from rotavirus every year, 85% of which occur in sub-Saharan Africa and South East Asia. The use of the rotavirus vaccines has led to a 90% reduction in hospital admission for severe diarrhoea in the US, but they are expensive, hence hardly available in the parts of the world where they are most needed. Here is another magic bullet in our hands, similar, if not more important than the smallpox, measles and polio vaccines. Yet, no one mentioned the rotavirus vaccine again after the keynote speech. We applauded, rose up and pretended that nothing happened! Here is evidence, now what do we do with it?
The keynote speech was supposed to be a wakeup call, but it seems we need a louder bell to rouse us from our collective complacency.
Amal Shafik and Seye Abimbola
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