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At the 67th WHA, Assistant Director General Marie-Paule Kieny unveiled WHO’s latest thinking with regard to the health goal in the post-2015 thinking – there is an overall goal of “Ensure healthy lives and universal health coverage at all ages” together with four sub-goals (click on image).
Overall, this appears to be shaping up well with some important entry points for those of us especially interested in the health of persons with disabilities, but with one, potentially hugely damaging, omission.
Some references in the initial targets and indicators outlined for the four sub-goals are very helpful – “80% coverage of NTD interventions”; “treatment of diabetes”; “non-use of tobacco”; “assistive devices for persons with disabilities” and others. However it is in the detail related to the monitoring of progress towards universal health coverage (UHC), published separately by the WHO and World Bank (Also available in multiple languages) that a serious omission is found. Table 1 on page 9 summarises the indicators and for the important equity measures, data is “stratified by wealth quintile, place of residence and gender” – but no mention of people with disabilities.
When challenged about this at the WHA, ADG Kieny’s response was that wealth, residence and gender were the “essential minimum” measures and that countries would be “encouraged” to collect more extensive data that included groups such as persons with disability.
This tepid response risks marginalising the 1 billion persons with disability from the otherwise largely commendable ideas contained within the draft health goal thinking. We all know that anything excluded from the data that must be collected in the final list of targets and indicators for post 2015 will simply not get measured by most countries and nor will it get the development attention required to improve people’s health.
Ironically less than 24 hours later the WHA adopted the excellent “WHO global disability action plan 2014 – 2021: Better health for all people with disability”. The Action Plan states that:
“…men and women with disabilities are twice as likely to find that health care facilities and providers’ skills are inadequate, three times more likely to be denied health care and four times more likely to be treated badly in the health care system. Half of persons with disabilities cannot afford required health care and they are 50% more likely than those without disability to suffer catastrophic health expenditures.”
WHO and the World Bank need to rethink – the equity indicators for UHC must be stratified to include persons with disability and other marginalised groups. Failure to do so undermines the fundamental principle of UHC.