Ensuring no one is left behind on the path to universal health coverage

Sarah Collinson

Holo, a 70-year-old farmer from Tanzania, benefitted from Sightsavers’ Boresha Macho inclusive eye health project. ©Sightsavers/Michael Goima 

Sarah Collinson, Health Policy Adviser at Sightsavers

At the 2023 United Nations General Assembly in New York in September, member states adopted a new high-level political declaration with promises to accelerate progress to achieve universal health coverage (UHC) by 2030 and to scale up the global effort to build a healthier world for all, expanding their ambition for health and wellbeing in a post-Covid world.

This year’s International UHC Day on 12 December 2023 provides an opportunity for governments to ensure they are taking the action needed to truly achieve universal health coverage. The overall picture is not at all positive. In fact, midway to the deadline for achieving the Sustainable Development Goals (SDGs), the World Health Organization (WHO) reports that progress towards UHC is stagnant. Over half the world’s population still lacks access to essential health services, and 1 in 4 people are suffering financial hardship or can’t afford to access essential services.  

In listing the many gaps, inequalities and injustices still to be addressed, the new political declaration highlights the health inequities experienced by people with disabilities – including a 20-year gap in life expectancy – due to lack of knowledge, negative attitudes and discrimination within the health workforce, widespread social stigma, higher health costs and lack of equitable access to services. The declaration also notes that: 

• 1.65 billion people still require treatment and care for neglected tropical diseases (NTDs). 
• At least 1 billion people have a near or distance vision impairment which could have been prevented or hasn’t been addressed, and that 90% of those with unaddressed vision impairment or blindness live in low- and middle-income countries. 

UHC will only be achieved through concerted action to tackle these and other health inequities with increased investments in inclusive and rights-based health systems that are people-centred, community-based and founded upon primary health care and whole-of-society approaches – actions that benefit everyone. 

What Sightsavers is doing 

Sightsavers is working with a range of partners, governments and the WHO, to ensure that real progress is made so that effective, affordable and accessible health services are available for everyone, particularly women, people with disabilities and other marginalised groups. 

Our social inclusion strategy sets out our vision to ensure that all people with disabilities, particularly women and girls, have improved access to health care and good health outcomes, contributing to the development of more inclusive health systems and the achievement of universal health coverage. This includes working to make sure that governments take responsibility for the implementation of WHO’s new global report on health equity for persons with disabilities and its recommended priority actions. For example, in Cote d’Ivoire, we will be marking International UHC Day by convening a national workshop with the Ministry of Health and organisations of people with disabilities to identify concrete steps that can be taken there to implement the report’s recommendations. 

Sarah got involved in Sightsavers’ Boresha Macho inclusive eye health programme to improve accessibility for people with disabilities. ©Sightsavers/Michael Goima

As a priority area within our portfolio, we are promoting access to sexual and reproductive health and rights (SRHR) for all, tackling the barriers that women and girls with disabilities face in making informed choices, exercising their bodily autonomy and accessing the services they require. In Nigeria, with funding from UK Aid and the Inclusive Futures programme, we are implementing an inclusive family planning project in partnership with BBC Media Action, organisations of people with disabilities and local government partners. Through this initiative, we have already trained over 1,000 service providers on disability inclusive SRHR, conducted accessibility audits of health facilities, and have reached thousands of women and girls with disabilities about their rights. As part of the Women’s Integrated Sexual Health (WISH) programme, the UK Aid flagship SRHR programme, we are working with MSI Reproductive Choices and other partners to mainstream disability inclusion in SRHR interventions in West and Central Africa. 

We are also tackling NTDs which affect some of the world’s most marginalised communities. We collaborate with other organisations and undertake research to make sure that we reach everyone and that no one is excluded from our projects. In Cameroon, with funding from the Coalition for Operational Research on Neglected Tropical Diseases, we have trialled strategies to reach semi-nomadic groups with interventions targeting onchocerciasis, including utilising community knowledge, using satellite imagery and organising mobile outreach activities, demonstrating that these strategies considerably increased reach to nomadic camps. 

By embedding disability inclusion and the collection and use of inclusive data, improving outreach services, making clinics more accessible, training health workers and increasing take-up of services through inclusive communication, we not only ensure all of our eye health programmes reach everyone but we also promote inclusion in the wider eye health sector. In the UK Aid-funded Boresha Macho inclusive eye health programme in central Tanzania, for example, we piloted Sightsavers’ accessibility standards and audit toolkit, which gives guidance on how to improve inclusion in health care facilities in low and middle income settings. 

Sightsavers’ work is underpinned by the principle that everyone, including people with disabilities, should have a fair opportunity to realise their full health potential without disadvantage. To achieve truly universal health coverage, governments must fully embrace this principle by stepping up their efforts to accelerate progress towards UHC and ensuring that health equity is placed front and centre of every health-related investment, policy and action.