Today, more than 4.6 million confirmed cases of COVID-19, including more than 310 thousand deaths were reported to WHO globally. Unfortunately, these numbers are not estimates, behind each number, there is a real person. The impact of COVID-19 goes beyond health. It is much more than a health crisis affecting both lives and livelihood. Dr Tedros Adhanom Ghebreyesus, WHO Director General and Kristalina Georgieva, IMF Managing Director acknowledged that COVID-19 is a crisis like no other. The later said that the IMF never had witnessed such hard time in its history. Now, the world is in an economic recession which is worse than the previous global financial crisis of 2008.
The crisis hits all countries whether rich or poor and puts them under massive difficulties to cope with health protection, unemployment, income loss and poverty. Emerging markets and developing economies with less resources are at highest risk. Similarly, as the virus hits the most vulnerable people, the economic crisis hits the vulnerable economies hardest. National efforts to save people’s lives and livelihoods are exacerbated when there are relatively weak health systems and limited social safety nets specially for the poor, low income and vulnerable households.
The fight against COVID-19 requires solidarity at national and global levels. Recognizing both, all organizations need to come together to protect the health of people, save their live and livelihood. A partnership is one of the fundamentals to build and exercise the national and global level solidarity to protect people. It could mean to establish or strengthen and use existing collaborative platforms and relationships among government stakeholders, development partners and international institutions to work together towards protecting the people affected by COVID-19. The P4H Network, known as a global network facilitating collaboration in the area of health financing and social health protection (SHP) for universal health coverage (UHC) is one of them. It creates opportunities and promotes partnership by connecting different stakeholders across health, finance, social and other relevant sectors at all levels.
Depending on the situation, protecting people could be interpreted differently. Here, the focus is to strengthen the partnership on financial protection. In other words, partnership to save lives and protect livelihood of the people relative to health, income, and social safety nets. In some situations, national policy reforms and actions to attain UHC may need extra efforts and additional resources to ensure that their health systems maintain and expand their coverage with regards to population, health service benefits and cost of using these health services. It will provide much needed protection for low income households or people without health insurance coverage and prevent them from falling into poverty. Another important feature of protection is income security and protection against the costs of accessing health services. Therefore, protecting people during the COVID 19 needs comprehensive, integrated synergetic actions and leverages under UHC and SHP.
Universalism in population, health service and cost coverage and financial protection is an intrinsic element of UHC and SHP. Financial protection or ensuring that the use of these services does not expose the user to financial hardship is well embedded in WHO’s definition of UHC. The ILO recognizes that SHP is central to reaching UHC which underlines the importance of financial protection. Technically, SHP presents a series of public or publicly organized and mandated private measures to achieve effective access to health care without hardship and income security to compensate the loss of earnings in case of sickness.
In many health systems, financial protection primarily deals with financial hardship associated with out of pocket payment (OOP). High levels of OOP make health financing systems regressive, inequitable and inefficient. OOPs are the main determinant of household catastrophic health expenditure and impoverishment.
Among experts and policy makers, financial hardship is discussed in terms of catastrophic health expenditure and impoverishment. Currently, a substantial number of people both in developed and developing countries experience financial hardship due to OOP. A recent study on the financial protection commissioned by the WHO South-East Asian Region revealed that the key driver of OOP is spending on medicines. This is true in other regions and countries despite their efforts to improve health financing policies and reforms aimed at UHC. Most likely, the situation will worsen since COVID-19 is putting hard pressures on limited health budgets and public revenues at large.
Assessing the COVID-19 situation around the globe, WHO’s health financing team advises to ensure sufficient funding for the Common Goods for Health, strengthen the foundations of health systems and remove financial barriers to health services. If people delay or forego because they can’t afford health care, they not only harm themselves, but make the pandemic harder to control, and put society at risk. Suspending user fees and providing free testing regardless of citizenship and insurance coverage or residence status is critically important in these days. User fee removal should be supported with measures to compensate health care providers for their loss of revenues.
On the other side, covering cost of accessing to health services refers to people’s spending on non-medical, indirect costs items such as transport and food. In some cases, indirect costs to reach and obtain health services create substantial financial barriers and burdens on households. In these days, this would also include the cost of in-country and inter-country transportation and isolation of COVID-19 suspected cases and contacts. Practically, protecting household income and preventing from income loss and falling into poverty will have profound effects on removing financial hardship and financial barriers. A study suggests that economic costs (lost income) during illness can be much larger than all other medical and non-medical costs. In emergency situations like COVID-19, cash transfers (including vouchers) are frequently used as part of government social assistance programs, as well as humanitarian assistance. This form of support temporarily helps individuals who are in desperate need for securing income and spending on essential or minimum livelihood necessities including health. Vouchers can be considered and effectively used for the poor, vulnerable, migrants and refugees to incentivize and obtain COVID-19 related test, diagnosis and treatments as feasible. Today, the need and demand for such emergency support and humanitarian assistance is becoming critical. WHO is calling for national and global solidarity to combat with this epidemic by saving lives and protecting livelihoods which is a multi-sectoral and multidimensional issue. Therefore, the whole-of-government approach and partnerships across different sectors and levels is needed to combine all efforts to protect the economy and mitigate adverse socioeconomic impacts of COVID-19 during these darkest hours.
The author wishes to thank Claude Meyer, P4H Coordinator for his support and comments