Measuring UHC

This page is about the way GNHE conceptualises universal health coverage (UHC).

It also provides practical tips on how countries can measure their progress towards UHC.

GNHE Consensus Statement on Universal Health Coverage

The GNHE Consensus Statement was submitted at the end of 2012 as part of the WHO/ILO consultation process regarding the Post-2015 Development Goals in Health. GHNE’s conviction is that Universal Health Coverage is an end in itself and should as be promoted as a new global commitment.

Assessing Progress to UHC – The GNHE Perspective (Health Service Use)

A key element of UHC is access to needed health services for all. Due to the complexity of measuring access directly, GNHE proposes measuring the actual use of services. Instead of focusing on a few services (such as antenatal care and immunisations), GNHE proposes assessing the adequacy and equity of overall service utilisation.

We recommend a minimum average utilisation rate of 4 outpatient visits per person per year; utilisation rates below this threshold suggest that a country is unlikely to have adequate access to services.

For inpatient services, a minimum threshold of 100 inpatient discharges per 1,000 population per year is recommended.

To assess equity, these minimum thresholds should be achieved in all socio-economic groups and as a minimum, utilisation rates should be at least equal across socio-economic groups.

Assessing Progress to UHC – The GNHE Perspective (Financial Risk Protection)

A key element of Universal Health Coverage (UHC) is financial risk protection (FRP) for all.  Equitable financial protection means that everyone, irrespective of their level of income, is free from financial hardship caused by using needed health services. FRP must be measured alongside, and in addition to, the other dimension of UHC, which is access to needed health services: this is because UHC can only be achieved when both dimensions are addressed.

Assessment of FRP should go beyond the conventional measures of financial catastrophe and impoverishment from out-of-pocket spending, because these under-estimate the level of financial risk. Measurement should seek to be inclusive and comprehensive, covering the whole population (both those who use health services and those who are unable to afford the use of health services when needed). If the traditional measures are used, they should be interpreted accordingly – as simply the proportion of the population who use health services and are consequently impoverished or face financial catastrophe.