Is universal health coverage an opportunity to end AIDS and TB?

Bobby Ramakant
At the United Nations General Assembly in September 2019, a special United Nations High Level Meeting (UNHLM) will be held on Universal Health Coverage (UHC). 193 countries have promised to deliver on UHC by 2030 by committing to Sustainable Development Goals (SDGs).
But will push on UHC alone deliver on the promise of health for all where ‘no one is left behind’? And will UHC complement the efforts to eliminate tuberculosis (TB), AIDS, malaria and improve outcomes of other disease-specific programmes?
Dr Suvanand Sahu, Deputy Executive Director of Stop TB Partnership, said at the 10th IAS Conference on HIV Science (IAS 2019): “We believe that Universal Health Coverage (UHC) is needed to end TB epidemic. Four million people who have TB, are missing from care every year. UHC is the way where these missing people with TB, can be diagnosed and put on treatment. We also believe that UHC is a mechanism to find everybody who needs care in a timely manner and getting all the resources to do it in a way that it will not lead to catastrophic out of pocket expenditure.”
Dr Sahu shared example of Japan which was a co-facilitator of UNHLM on TB last year. “Japan has made a strong case for UHC, by linking TB and UHC together. When Japan brought down rates of TB it was very much due to the approach of UHC. We must also see how TB is seen as a pathfinder for UHC in some other countries.”
“In some ways ending TB and AIDS and achieving Universal Health Coverage are essentially the same thing. After 20 years of unprecedented investment, attention, and commitment to tackling AIDS, TB and malaria, one thing is clear: we have probably achieved what we can achieve by using the current approaches. More business as usual is unlikely to take us further towards ending these epidemics. We need to clearly do something differently to move the dial in any meaningful way” said Dr Tim France, global health thought leader and Managing Director of Inis Communication. Dr France was speaking (via video) at the 10th IAS Conference on HIV Science (IAS 2019) in Mexico.
“I would argue that there are three things that we need to do differently to achieve that. Firstly, we need to approach health through a much more holistic model and thinking even beyond universal health coverage and not just individual diseases.
 In my view the best model we have currently available to us is one which is being put forward by the World Health Organization (WHO) as part of their next five-year plan” reflected Dr Tim France.
WHO’s new ‘Three Billion’ plan is to ensure that in next five years, one billion more people benefit from universal health coverage (UHC); one billion more people are better protected from health emergencies; and one billion more people enjoy better health and well-being.
Dr Tim France says that UHC specifically is a limited opportunity on its own, so in order to have any real chance of success against the most pressing health issues countries, communities and individuals face, including TB and AIDS, we, need to approach health in a much broader way. “In much the same way as the ‘WHO Three Billion plan’ does, it should be a plan for global health I think and not just for WHO” said Dr France.
“I am drawn to this 3 part model of health because it reflects the realities that affects people’s health and it is about how people see their own health, not as one disease or health issue but as a complex web of factors that affect their health, well-being and vulnerability” said Dr France. First part of “WHO Three Billion plan” refers to UHC, aiming for minimum package of services and health technologies and support the people’s need when they are accessing the health system. Second part of the WHO plan talks about health emergencies and protecting vulnerable people who are particularly vulnerable at certain times, such as, “the current Ebola outbreak in Democratic Republic of Congo or unstable post-conflict or post-disaster situations. To be contd