Universal Health Coverage: Filling the Gaps through International Partnership

To Achieve ‘Health For All,’ Everyone Needs a Seat at the Table

Achieving universal health coverage is target 3.8 of United Nations’ Sustainable Development Goal 3—to “ensure healthy lives and promote well-being for all at all ages.” More than this, providing universal health coverage, which includes access to high quality, affordable health services and essential medicines, is necessary to achieve all 17 of the Sustainable Development Goals. Societies overwhelmed with the burden of disease cannot combat other sources of inequality and injustice. Investing in the local health workforce is a necessary step to reducing the social and economic impacts of injury and illness, and ultimately to achieving universal health coverage.

Societies overwhelmed with the burden of disease cannot combat other sources of inequality and injustice.

To that end, Health Volunteers Overseas (HVO) partners with collaborating institutions—including hospitals and universities—to design and implement training programs for health workers in resource-scarce countries. At present, HVO partners with more than 80 institutions worldwide to facilitate short-term volunteer assignments for health professionals to provide education, support, and mentorship to their colleagues in low-income countries. The local partners help establish reasonable, mutually beneficial project goals, and adapt them to meet the changing needs of the project site and the local community over the course of the project life-cycle. This collaborative and flexible approach has enabled HVO to expand health coverage around the world through partnership for more than three decades.

Bhutanese students and staff working with an HVO volunteer. Image courtesy of Jean Baumgartel, OT, CHT.

Local Partners Are Needed to Address Disparities
A recent report by the World Health Organization (WHO) and the World Bank indicates that there has been progress toward achieving universal health coverage over the last two decades. The authors of the report estimate that global coverage of essential health services increased 20 percent between 2000 and 2015. However, with at least half of the world’s population still lacking complete coverage of all essential health services, there is much work needed to close the gap.

To achieve universal health coverage, governments, nonprofits, and international aid organizations must ensure access to all essential health services. Access to maternal care that brings a child safely into the world must be accompanied by access to pediatric care that will enable that child to grow and thrive. Access to life-saving surgical interventions must coincide with access to rehabilitation services that will allow the patient to regain his or her quality of life. Moreover, essential treatments and life-saving medications must be accessible and affordable for all, regardless of geographic location or economic status.

In countries where some but not all essential health services are available, local institutions are needed to guide targeted interventions focused on improving access to neglected areas of care. International partnerships with collaborating institutions enable HVO to identify pressing needs at each project site, and to ensure these needs are addressed when crafting project goals and objectives. Ongoing monitoring and evaluation processes promote the continued growth and evolution of projects to meet the changing needs of partner institutions and the communities they serve.

International partnerships also enable nonprofit organizations like HVO to recognize and address disparities in access to care. As the authors of the WHO/World Bank report note, “Unless health interventions are designed to promote equity, efforts to attain [universal health coverage] may lead to improvements in the national average of service coverage while inequalities worsen at the same time.” Too often, rural communities and impoverished urban areas are left out of the economic and social developments seen at a national level. This includes lagging behind in the availability, quality, and affordability of health services. By partnering with local health institutions, HVO has been able to focus its efforts toward reducing inequities in access to care in a number of countries, including in Bhutan, where the physical therapy program has significantly increased the number of providers serving in district hospitals throughout the country over the last two decades.

Improving Care for the Mobility-Impaired in Bhutan
The mountainous terrain of Bhutan is stunning, but it is also exceptionally difficult for individuals with impaired mobility to move about. When HVO launched the physical therapy project in partnership with the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu, Bhutan in 1999, a small number of physical therapists, all located in the capital city, were the only providers available to serve the entire population. For mobility-impaired individuals living in rural areas, a commute of many hours or even days separated them from the physical therapy services they needed. Consequently, many did not receive these services, which would have increased their mobility and improved their quality of life.

Physiotherapy student practices his skills. Image courtesy of Kathryn Clark, PT, MS, MPT.

Together with JDWNRH staff, including members of the country’s existing physical therapy workforce, HVO volunteers have worked to develop and revise the curriculum for a physiotherapy training program, and have trained over 60 physical therapy technicians over the last two decades. Upon completion of the training program, technicians are assigned to district hospitals. Physical therapy services are now available to individuals throughout Bhutan, including those living in rural communities.

In a 2016 trip report, three-time volunteer Kathryn Clark, PT, MS, MPT, described the changes she observed since her first assignment in 2002. “Over the years, I have witnessed tremendous growth and development of the profession of physiotherapy and growth in the numbers of physiotherapy technicians working in country,” she wrote, adding that she also noted a “healthy growth in their clinical skills.”

The Voices of All Stakeholders Must Be Heard

Hands-on training in Bhutan. Image courtesy of Mary Pritchard, LPT.

International partnership is essential to the success of the physical therapy training project in Bhutan. Insight from Bhutanese providers and leaders in the healthcare sector helped shape the project goals and objectives to target the imbalance in coverage experienced by the rural population. As a result, the training provided by HVO volunteers has benefited individuals throughout the country, not just those living in Thimphu. Health Volunteers Overseas will continue to promote international partnership as a key component of strategic interventions aimed at achieving universal health coverage. The participation of local leaders, institutions, and health workers who are on the front lines delivering patient care and filling coverage gaps is needed to transform universal health coverage from a goal into a reality.

Feature image courtesy of Leon Petrosyan.

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