A Japan Overseas Cooperation Volunteer who is a public health nurse talks about breastfeeding and children's meals as part of a health workshop in Bolivia
In Japan, most people usually have access to the health services they need, without much financial hardship. This can be attributed to financial protection systems and quality health services that can be said to achieve Universal Health Coverage (UHC). However, this is not universal at this moment in a global context.
The first Global Monitoring Report, issued by the World Health Organization and the World Bank, revealed that 400 million people cannot access essential health services*1, and every year 100 million people are pushed into poverty because of out-of-pocket expenditures on health services*2.
It is essential to ensure that all people can use the health services they need, while also ensuring that the use of these services does not expose the user to financial hardship. The government of Japan and JICA, together with WHO, the World Bank, UNICEF and UHC 2030, will hold the Universal Health Coverage Forum 2017, an international conference to accelerate achievement of UHC, in December in Tokyo. Ahead of the forum, the JICA website will share JICA's activities on the ground and thoughts aimed at realizing health for all.
UHC means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.
Global initiatives have had major effects, including halving the number of under-5 deaths, from 12.6 million in 1990 to 5.6 million in 2016. However, there are still too many people in the world who cannot access health services. Inequality is seen both among and within countries, and fragile people cannot access essential health services.
In addition to health-care services being readily available nearby and the expense not presenting an obstacle the patient, UHC aims to improve the following three kinds of access:
1. Physical access: Access to medical facilities, supplies and equipment, as well as doctors and nurses, in one's neighborhood
2. Economic access: Medical expenses and transportation costs to see a doctor are affordable, and incomes of the patient and family members are not reduced because of the illness.
3. Social access: The importance and necessity of the services is understood. Family's don't withhold permission. There is no language barrier. No bribes are demanded.
In addition, every year 100 million people are pushed into poverty because of out-of-pocket expenditures, and some people refrain from using health services because they cannot afford to, including transportation expenses. Based on the principle of affordable contributions and sufficient benefits, financial protection where the entire society bears and shares the expenses is critical.
Without medical security, more and more people fall into poverty
• The patient's income declines because he can't work
• The patient or her family pays the medical expenses
• Transportation and medicine also cost money
A pregnant Vietnamese woman who received a maternal and child health handbook. The predecessor of Japan's maternal and child health handbook was the expectant and nursing mothers' handbook that began to be distributed in 1942, and it was created concurrently with the launch of the world's first pregnant woman registration system
JICA has been making a contribution in the health sector for many years. It has emphasized improving health services, including maternal and child health and infectious disease control. It also has carried out capacity development for human resources so countries could maintain and strengthen their own health systems.
In the 1960s and '70s, JICA's cooperation was centered on human resource development, research and improving medical technology, all based in hospitals and university medical faculties. From the 1980s, there was an increase in cooperation for community health, in the 1990s for maternal and child health and the control of such infectious diseases as HIV/AIDS, and in the 2000s for health systems strengthening and community-based cooperation and improving health systems. For achievement of UHC, financial protection has been a focus of JICA's cooperation in recent years.
Japan achieved UHC in the early stages of its economic growth by introducing a health insurance system for all citizens in 1961, among other measures. Japan's social security system, including health insurance, is said to have contributed to equitable economic development and social stability*2. As a result, Japan maintains a high level of health compared to other developed countries at a comparatively low cost. This experience in Japan could be applied in many countries.
A resolution on UHC was adopted at the 2005 World Health Assembly. The principal of UHC is consistent with the concept of human security, which focuses on each individual. Japan has taken leadership in advancing UHC, and it is notable that Japan has made a significant contribution to including UHC as one of the targets in Goal No. 3 of the Sustainable Development Goals adopted in 2015: "Ensure healthy lives and promote well-being for all at all ages."
More than 300 government personnel and health care experts will gather in Tokyo on Dec. 12-15 for the UHC Forum 2017 to discuss further promotion of UHC. The JICA website will feature a series of articles on our efforts to achieve UHC as the forum approaches.
*1 WHO/World Bank. (2015). Tracking universal health coverage: first global monitoring report
*2 Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T. Protecting households from catastrophic health spending. Health Affairs. 2007;26(4):972-83.