The article highlights Dr. Martin Luther King Jr.'s perspective on health, stating that "Of all the forms of inequality, injustice in health is the most shocking and inhuman." This view serves as inspiration for advocates of universal health coverage.
The Advocacy for Primary Healthcare
Achieving health justice in low- and middle-income countries is proposed to involve strengthening primary health care, mobilizing local resources for financing, and applying behavioral science to healthcare delivery. The 1978 Alma-Ata Declaration, supported by 134 countries, established primary health care as foundational for "Health for All," advocating for essential health services that are universally accessible, equitable, and community-driven. Although many governments have diverged from these principles, countries like Rwanda demonstrate successful implementation.
Rwanda's Community Health Worker Program
Rwanda has developed an extensive network of over 50,000 community health workers (CHWs). These CHWs are selected by their communities and typically receive training in maternal and child health, focusing on conditions such as malaria, pneumonia, diarrhea, and nutrition. Their responsibilities include early assessment and intervention, such as providing oral amoxicillin for pneumonia according to WHO guidelines before guiding children to district hospitals, which is critical in areas with limited access to immediate medical facilities. This model has enhanced access to basic services, improved health outcomes, and reduced health disparities.
Strategies for Healthcare Financing
The changing landscape of global aid, with the U.S. reorienting its strategy to prioritize national governments and U.S. interests, underscores the necessity for low- and middle-income countries to develop domestic funding mechanisms. Suggested methods for local resource mobilization include:
- Encouraging diaspora communities to allocate a percentage (e.g., 1%) of their remittances toward health insurance.
- Collaborating with citizens to redirect out-of-pocket health expenditures towards health insurance schemes.
- Addressing illicit financial flows, which are estimated to cost Africa between $88 billion and $90 billion annually, funds that could otherwise be invested in health systems.
The Impact of Behavioral Science
Behavioral science is identified as a critical component of effective health interventions. Many social interventions primarily focus on knowledge transfer, often neglecting the importance of motivating behavioral change. A project in Nigeria, which utilized social media and community pharmacists to increase HPV vaccine uptake among girls aged 9–14, observed that caregiver engagement, support from family and friends, clear information, and convenient vaccine access contributed to higher vaccination rates.
Call for Leadership and Action
Leaders are called upon to fulfill their responsibility in eliminating health injustices and ensuring a dignified life for all, echoing Dr. King's enduring question: "Life's most persistent and urgent question is: 'What are you doing for others?'" This perspective emphasizes that health equity is a fundamental aspect of justice.