Research for Universal Health Coverage

By Chan, Margaret | World Health Report, Annual 2013 | Go to article overview

Research for Universal Health Coverage


Chan, Margaret, World Health Report


Message from the Director-General

As we approach the 2015 deadline for meeting the United Nations Millennium Development Goals (MDGs), it is time to take stock of the progress that has been made since 2000. It is also time to reflect on how we made progress, and on how we could do better.

All eight of the MDGs have consequences for health, but three put health at front and centre--they concern child health (MDG 4), maternal health (MDG 5), and the control of HIV/AIDS, malaria, tuberculosis and other major communicable diseases (MDG 6). To highlight just one of these, MDG 4 calls for a reduction in the number of child deaths from 12 million in 1990 to fewer than 4 million by 2015. Although great strides have been taken since the turn of the millennium, especially in reducing deaths after the neonatal period, the best measurements indicate that nearly 7 million children under five years of age died in 2011. From experience in high-income countries, we know that almost all of these deaths can be prevented. But how can that be done everywhere?

One idea is to make greater use of community-based interventions. But do they work? Experiments in the form of randomized controlled trials provide the most persuasive evidence for action in public health. By 2010, 18 such trials in Africa, Asia and Europe had shown that the participation of outreach workers, lay health workers, community midwives, community and village health workers, and trained birth attendants collectively reduced neonatal deaths by an average of 24%, stillbirths by 16% and perinatal mortality by 20%. Maternal illness was also reduced by a quarter (1). These trials clearly do not give all the answers--for instance, the benefits of these interventions in reducing maternal mortality, as distinct from morbidity, are still unclear--but they are a powerful argument for involving community health workers in the care of mothers and newborn children.

These rigorous investigations have the potential to benefit millions around the world. They confront the challenge presented by just one of the MDGs, but they capture the general spirit of this report--to promote investigations in which creativity is harnessed by the highest-quality science in order to deliver affordable, quality health services and better health for everyone. More than that, the process of discovery is a source of inspiration and motivation, stirring ambitions to defeat the biggest problems in public health. This is the purpose of Research for universal health coverage.

This report is for everyone concerned with understanding how to reach the goal of universal health coverage--those who fund the necessary research, those who do research and who would like to do research, and those who use the evidence from research. It shows how research for health in general underpins research for universal health coverage in particular.

Understanding how to make progress towards achieving the MDGs is central to this report. But its scope is wider. As the 2015 deadline draws closer, we are looking for ways to improve all aspects of health, working within and beyond the MDG framework. And we are investigating how better health can contribute to the larger goal of human development. In this broad context, I invite you to read Research for universal health coverage. I invite you to assess the report's arguments, review its evidence, and help support the research that will bring us closer to the goal of universal health coverage.

(1.) Lassi ZS, Haider BA, Bhutta ZA. Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes. Cochrane Database of Systematic Reviews (Online), 2010,11:CD007754. PMID:21069697

Dr Margaret Chan

Director-General

World Health Organization

Contents

Message from the Director-General

Executive summary

1. The role of research for universal health coverage
   Developing the concept of universal health coverage
   Investigating financial risk protection
   Investigating the coverage of health services
   Equity and universal health coverage
   Coverage of health services: quality as well as quantity
   Conclusions: research needed for universal health coverage

2. … 

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