Universal health coverage (UHC) is a concept that refers to the notion of guaranteeing everyone has access to essential health services—such as health promotion, disease prevention, treatment, rehabilitation and palliative care—without experiencing financial hardship (World Health Organization (WHO), 2022). The implementation of the concept brings with it benefits and challenges.
For many countries around the globe, UHC is an important goal, as it has been shown to improve health outcomes and reduce poverty. However, achieving UHC requires the implementation of financial policies and accessible programmes that ensure indiviuals and families are able to obtain coverage in a sustainable way. There are a range of implementation models currently being used, each of which reflects the unique social, economic and political context of their host country.
Access to essential health services directly impacts on patient wellbeing, as those in need can receive a timely diagnosis, treatment and care. This may prevent illnesses from becoming more severe, reduce the risk of complications and help countries to address health inequalities. To realise the success of UHC, governments need to address the underlying social and economic determinants of health, such as poverty, lack of education and social exclusion, which can prevent people from accessing health services and negatively contribute to national health outcomes.
However, accomplishing these goals can be demanding. One of the main barriers is the cost of providing health services to everyone, a task that is particularly challenging in low- and middle-income countries, where resources are limited. This can be further compounded by context-specific political, cultural and social barriers, which can lead to resistance to change and, in some jurisdictions, concerns about the role of those providing care.
When developing an implementation strategy, the specific context of each country must be considered. Some of the key approaches that can aid developers and policymakers include the improvement of existing infrastructure, educating and training health workers, and ensuring that essential medicines and technologies are available. It is imperative that national and international organisations work with regional communities to understand their health needs, preferences and expectations, as well as involve them in the design and application of health programmes.
Advanced practice roles are ideally suited to the provision of UHC, particularly as part of a primary health care workforce strategy. Advanced practitioners (APs) can play an important role in managing patients with complex medical needs and long-term conditions, aid in the provision of patient education and counselling, help patients manage their condition and overall improve patients' quality of life. However, role-implementation barriers exist. These can range from confusion over role clarity, legislative limitations and regulation anomalies, to the inadequate provision of education, shortages of funding and physician resistance (perceived or real). Effective leadership is needed to align available APs with policy priorities and WHO aspirations. Close collaboration between policymakers and healthcare providers is more crucial than ever, as the issue of chronic disease prevention and management is one of rising importance in an increasingly connected and interdependent international system (WHO, 2023).
In the universal healthcare system, the role of the AP is essential. By working together, governments, communities, APs and other stakeholders can ensure that UHC can be implemented in a constructive and viable manner, and with the necessary components to safeguard its long-term viability.