8 Addressing the Global Health Crisis: Universal Health Protection Policies
3. The magnitude of the global crisis
3.1. Gaps in affordability, availability and financial protection for quality health care
The global deficit in access to health care services consists of multiple partly interrelated dimensions that contribute to the current health protection crisis: Gaps in legal
health coverage, availability, affordability and financial protection of quality services. Indicators that reflect best these aspects include the population coverage of legislation,
deficits in the density of health workers, health financing deficits and private expenditure in the form of OOP. Finally, maternal mortality rates can be used to show the overall
performance of the health system.
ILO uses relative thresholds to identify the related deficits in health workforce density and financing. In 2014, they amount to 41.1 health workers per 10,000 population
and to 239 USD public health expenditure per person and year. These thresholds are derived from population weighted median values of related data in countries that are
considered low vulnerable by ILO. They are characterised by enabling socio-economic environments for UHC - namely low levels of poverty, extent of informal economy and
fairness of financing in terms of risk pooling statistical details are presented in Annex II.
Figure 8: The global access deficit to health care
by level of country income 20122013
Source: ILO 2014c
90.3
82.5
92.6 47.8
37.5
20 40
60 80
100
Estimate of legal health coverage deficit as of pop.
Staff access deficit as of pop. threshold: median value of
health worker density in low vulnerability countries: 41.1 per
10,000 population
Financial deficit as of pop. threshold: median value of per
capita health spending in low vulnerability countries: 239 US
OOP expenditure as of total health expenditure
Maternal mortality ratio per 10,000 live births
Low-income economies Lower-middle-income economies
Upper-middle-income economies High-income economies
Addressing the Global Health Crisis: Universal Health Protection Policies 9
Figure 8 provides a comprehensive overview of the global access deficit to health care in countries grouped by income level. Concerning low income countries, it reveals
that •
more than 90 per cent of the population remains without any legal health coverage to provide access to the most essential health care;
• more than 80 per cent of the population lacks access to health care due to the
absence of health workers needed to provide such services; •
the current financial deficit exceeds 90 per cent of necessary expenditure to cover the costs of quality health care;
• with OOP accounting for more than 45 per cent of total health expenditure, the
affordability of health services and financial protection is a severe problem and financial hardship as a result of private health expenditure is assumed to be very
prevalent;
• the maternal mortality ratio is estimated to be as high as 37.5 deaths per 10,000
live births in low-income countries, and is often directly related to gaps in the availability of skilled health workers, particularly midwives.
In addition to these deficits in effective access to health care, it should be noted that in most countries certain groups, such as the rural population, women, the elderly,
minorities and people with special needs such as those affected by HIVAIDS, are even more likely to face barriers to access than the general population Scheil-Adlung and Kuhl,
2012.
Further, when comparing different groups of countries, or different schemes within countries, it is important to be aware that the scope of benefits provided by the various
systems and schemes may vary significantly. Depending on economic, financial, epidemiological and social conditions, the scope of benefits might range from providing a
limited number of public health and clinical interventions in primary care facilities to comprehensive benefit packages, limited by the exclusion of some services. Thus the
figure above does not reflect the wide disparities in effective access to care both within and across countries.
3.2. Rural areas: Globally most neglected
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