UN High-Level Meeting: Affordable healthcare, but not for the most vulnerable

Universal healthcare coverage – the commitment that by 2030, adequate healthcare must be available for everyone without causing financial distress – is one of the key health topics for the 78^th UN General Assembly, held in New York this week. Doctors Without Borders (MSF) is worried that the current plans for Universal Healthcare Coverage are leaving behind the very people who are now most excluded from access to healthcare. An MSF report highlights the access barriers to affordable and timely care that people face in some 20 countries.

A High-Level Meeting will discuss Universal Healthcare Coverage (UHC) as an important instrument to achieve the third Sustainable Development Goal, ‘Good health and well-being’. But the ways countries are developing and implementing plans for UHC often fail to consider the health needs of some of the most vulnerable groups: those forced to forego care because it’s unaffordable, migrants and refugees, and people living in crisis situations. To make serious progress in UHC, the current approaches need to be adapted, with a clear choice towards tangible results for people now excluded from access to care.

It is very wry that the people who need it most are often not considered in UHC plans. The out-of-pocket expenses or patient fees for healthcare make them delay or forego care altogether. This foregone care is a blind spot in the monitoring of UHC, ignoring the health consequences of unaffordable services. MSF teams see how patients are asked to pay for essential medicines & services in public services, even in places with policies declaring care free of charge. Existing fee exemption initiatives such as for women and children, patients with tuberculosis, HIV, chronic diseases, or malaria – key to progress in access to care and improvements in the burden of disease and death – are undermined by shortfalls in funding and lack of independent verification. When medical supplies are lacking in public services, patients are forced to seek drugs from private outlets at higher costs, or to go without those medicines entirely. Patients unable to pay their hospital bills are withheld care, or even detained.

Another group whose health needs are all too often ignored, are migrants, including refugees and undocumented people. One in eight people today is a migrant or is forcibly displaced. These people often have poorer health outcomes, and health systems need to be adapted to provide adequate healthcare. Yet MSF’s experiences in countries such as Belgium, Italy, Poland, Greece, Lebanon, and South Africa show that migrants face significant barriers to accessing even essential and urgent services, in some cases even when the policy environment explicitly provides for this. Complex procedures and administrative hurdles block access to affordable and timely care. Country plans to implement UHC must include explicit measures to eradicate the various barriers to access healthcare for these people.

Thirdly, UHC plans often fail to foresee adaptations during crisis situations, such as conflicts, disease outbreaks, and natural disasters. During such crises, pre-existing vulnerability and health service gaps often worsen and health care barriers for vulnerable groups are disproportionally worsened. Continuity of treatment is a specific challenge in times of crisis, in particular for people on treatment for HIV, tuberculosis, and chronic diseases. Measures to protect people in such crises are lacking in many places; timely measures to ensure access to essential care, for existing and new health needs, are missing from UHC country plans.

MSF’s experiences show the barriers that some of the most excluded, most vulnerable and most discriminated people face in accessing healthcare. However, the current UHC-agenda and most UHC country plans fall short of the ‘Leave no one behind’ principle. There is not enough attention for people foregoing care, migrants and refugees, and people in critical crisis situations. Real change and tangible results in access to care – including and foremost for the most vulnerable people- are urgent to prioritise. As long as these vulnerable people are missing from the UHC-targets, progress towards real UHC will fail.

Medium shot of patients in the waiting area outside the mobile clinic in the Closed Control Access Centre in Zervou, Samos. MSF provides primary -including sexual and reproductive health care services by deploying a mobile clinic and team into the closed camp three times per week. A health promotion team is also visiting the camp to discuss and implement hygiene practices and ensure that people in the camp are aware of the support MSF can provide to its patients as a medical humanitarian organisation. Photographer: Evgenia Chorou/MSF| Location: Zervou, Samos, Greece | Date: 29/09/2022Medium shot of a patient’s hands waiting outside MSF’s mobile clinic in the Closed Control Access Centre in Zervou, Samos. Since April 2022, MSF has started to provide primary healthcare services (including sexual and reproductive health care) inside the closed access and control center of Zervou. An MSF health promoters team makes sure that people in the camp are aware of the kind of support MSF can provide. Photographer: Evgenia Chorou/MSF| Location: Zervou, Samos, Greece | Date: 29/09/2022

A general view of MSF's waiting area in our pediatric clinic outside the camp of Moria in Greece where MSF sees an average of 100 children and pregnant women every day. Photographer: Anna Pantelia/MSF | Location: Moria Camp (Lesbos) | Date: 24/09/2018BEFORE THE APRIL 15, 2023, ESCALATION. In 2020 MSF upgraded the so-called rural hospital to a secondary healthcare facility in Rokero town. We manage the inpatient department (IPD), the emergency room (ER), the ITFC, the maternity and delivery and paediatric wards and the observation room. We build new ER, maternity, paediatric wards, observation room and ITFC. It is the only secondary healthcare facility in the locality in north Jebel Marra, patients were moved there in late March early April 2023. Photographer: Francois Dumont/MSF| Location: Central Darfur | Date: 09/04/2022

Seipati Moloi

Head of Media and Digital Relations, Doctors Without Borders (MSF)

• Seipati.Moloi@joburg.msf.org
• +27 (0) 76 752 5594

• msf.org.za
• MSFsouthafrica
• @MSF_southafrica

About Doctors Without Borders (MSF)

Doctors Without Borders (MSF) is a global network of principled medical and other professionals who specialise in medical humanitarian work, driven by our common humanity and guided by medical ethics. We strive to bring emergency medical care to people caught in conflicts, crises, and disasters in more than 70 countries worldwide.

In South Africa, the organisation is recognised as one of the pioneers of providing Antiretroviral Treatment (ART) in the public sector and started the first HIV programmes in South Africa in 1999. Until today, the focus of MSF’s interventions in the country has primarily been on developing new testing and treatment strategies for HIV/AIDS and TB in Eshowe (Kwa-Zulu Natal) and Khayelitsha (Western Cape).

In Tshwane, we run a migration project, and we offer medical and psychosocial care to migrants, refugees, and asylum seekers, who struggle to access public health services under South Africa’s increasingly restrictive.

Previously we offered free, high-quality, confidential medical care to survivors of SGBV in Rustenburg.

To learn more about our work in South Africa, please visit this page on our website (www.msf.org.za). To support MSF’s work: