Universal Health Coverage and Human Rights

December 13, 2016


Last week, a few days before Universal Health Coverage Day (12 December), the Health and Human Rights Journal published a special section on Universal Health Coverage (UHC) and Human Rights. In the editorial, guest editor Audrey Chapman explains why UHC can be termed “a practical expression of the right to health” and why it is important to safeguard the inclusion of marginalized population groups. “Simply expanding health coverage, especially if it continues to exclude poor and vulnerable communities, is not sufficient from a human rights perspective,” she wrote. 

Further, Chapman lists the components of a human rights approach to UHC and expresses the need for a health system that incorporates the human rights principles of equality and non-discrimination, transparency, accountability, and participation.

User fees

In his foreword, Special Rapporteur on the Right to Health Dainias Puras raises awareness, among others, on the the need for financial risk protection. He argues that UHC consistent with the right to health requires establishing a financing system that is equitable and that pays special attention to the poor and others unable to pay for health care services, such as children and adolescents. “Still today, in many countries, out-of-pocket payments – such as user fees and co-payments, fees for treatment, and indirect fees related to the costs of seeking health care (transportation costs, informal charges, opportunity costs/loss of work, discrimination) – create major barriers to health care.” According to Puras, these costs are often significant and disproportionately affect the poor.

Poor people spend a considerably larger portion of their total income on health than richer ones. These fees may bar those without the means to pay from receiving needed care, as well as discourage people from seeking care in the first place. Puras: “Private, out-of-pocket payments account for around 50% of total health expenditures in countries where more than 50% of the population is living on less than US$2 a day. This means that it is the poorest and most in need who suffer from these payments.”

Private sector involvement

The seven articles in this special issue of Health and Human Rights address some urgent questions pertaining to UHC and human rights. They also offer evidence of the challenges and benefits of adopting a rights-based model of UHC. 

One of the articles is about private sector involvement in health care. It was written by IFHHRO Board Member Brigit Toebes and Antenor Hallo de Wolf, both working at the University of Groningen in The Netherlands. They emphasize that the obligation to protect the right to health requires that health services be available, accessible, acceptable, and of good quality, regardless of whether they are provided through the state or through private actors. They also propose the use of human rights impact assessments by governments to evaluate the consequences of privatization prior to its introduction. In addition, they identify the duty of governments to mitigate any financial problems related to out-of-pocket expenses charged by private actors. 


Three Case Studies in Making Fair Choices on the Path to Universal Health Coverage
Alex Voorhoeve, Tessa T.T. Edejer, Lydia Kapiriri, Ole F. Norheim, James Snowden, Olivier Basenya, Dorjsuren Bayarsaikhan, Ikram Chentaf, Nir Eyal, Amanda Folsom, Rozita Halina Tun Hussein, Cristian Morales, Florian Ostmann, Trygve Ottersen, Phusit Prakongsai, Carla Saenz, Karima Saleh, Angkana Sommanustweechai, Daniel Wikler, and Afisah Zakariah

What Do Core Obligations under the Right to Health Bring to Universal Health Coverage?
Lisa Forman, Claudia Beiersmann, Claire E. Brolan, Martin McKee, Rachel Hammonds, and Gorik Ooms

Using the Right to Health to Promote Universal Health Coverage: A Better Tool for Protecting Non-nationals’ Access to Affordable Health Care?
Claire Lougarre

Closing the Gap Between Formal and Material Health Care Coverage in Colombia
Everaldo Lamprea and Johnattan García

Human Rights and the Political Economy of Universal Health Care: Designing Equitable Financing
Anja Rudiger

Assessing Private Sector Involvement in Health Care and Universal Health Coverage in Light of the Right to Health
Antenor Hallo de Wolf and Brigit Toebes

Case Study of an Aboriginal Community-Controlled Health Service in Australia: Universal, Rights-Based, Publicly Funded Comprehensive Primary Health Care in Action
Toby Freeman, Fran Baum, Angela Lawless, Ronald Labonté, David Sanders, John Boffa, Tahnia Edwards, and Sara Javanparast

Access this special section on the Health and Human Rights Journal website