Strategic Direction Two: Protect and Improve Universal Health Coverage

Health services are free, easy to access geographically and have high utilisation rates. However, quality, equity, outcomes and user experience and satisfaction are not adequately measured. This may imply certain population groups may be ‘left behind’, but not picked up by current routine monitoring – making a case for stronger measurement of these aspects of care. While public health sector services remain free of user charges, a series of NHA reports show increasing out-of-pocket spending on health, chiefly driven by increasing utilisation of private health services.

The two seminal global conferences on primary care (Alma-Ata, 1978, and Astana, 2018) have emphasised the importance of primary care as the key vessel to deliver quality health services to all, to improve everyone’s health and wellbeing. In recent years, UHC (defined in Box 1) has been the flagship approach of the WHO (and the wider United Nations) for improving health and wellbeing within the Sustainable Development Agenda 2030 framework48. A strong recent high-level political commitment to UHC was achieved, through a UN general assembly resolution49.
The principle aims to expand the range of health services provided, at high quality, to the whole population, with maximum financial protection. The ideals of achieving and improving UHC through strengthening primary care, are well aligned with both the global health goals (SDG 3) and the National Vision for Health.

Box 1 Definition of Universal Health Coverage (UHC)

“Universal health coverage means that all people have access to the health services they need, when and where they need them, without financial hardship on them. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care… high quality health services… through people-centred primary care.”

– Definition of Universal Health Coverage, World Health Organisation Primary care and the achievement of UHC are intricately linked to public health (aimed at prevention), health promotion (aimed at prevention and promotion), and health systems strengthening (provides the supports to improve the platform through which UHC services are delivered).

Seychelles has a relatively high UHC index of 7150. WHO criteria and targets are, however, generally not tailored for high-income contexts, and do not accurately reflect changes to UHC in the Seychelles context. As such, particularly in the context of an economic crisis, there is risk for erosion of past gains in UHC, which may go undetected in the annual standard UHC index measurements, hinting at a need for more tailored criteria and thresholds. There are also a need to measure equity and quality of health services.

SD2 Outstanding Issues

  • Urgent need to address priority diseases: NCDs (cancer, diabetes and cardiovascular disease outcomes) and communicable diseases (COVID-19, HIV, Viral Hepatitis).
  • Measurements and reporting are mortality-centric; non-fatal outcomes are not well measured.
  • Weak clinical governance mechanisms:
    • Lack of standardisation of care – great variation across health system.
    • Gaps in clinical care: inadequate guidelines, unclear care pathways, no clinical audit cycles, weak referral systems, no standards for care, inadequate measurement of quality and safety
      in services, lack of a quality policy, and no formal clinical audit.
    • Traditionally tertiary-care-centric role of clinical specialities – need for oversight and responsibility for improving care and services under the relevant speciality for the whole
      country, and not just the specific hospital unit.
    • Lack of a clear policy on process for overseas treatment, a major cost-driver.
  • Only a few innovations in care delivery; inadequate modernisation of services; outdated service delivery models.
  • Majority of health funding focused on curative care, much less on primary care, promotive and/or preventive health services.
  • Effectiveness, efficiency and cost-benefits of services are not measured.
  • Equity is not measured – possibly leaving behind certain groups.
  • Communication barriers – with public, and within health system.
  • Fragmentation of operations within health system; weak coordination mechanisms.

SD2 Priority Areas

  1. Use a combination of life-course (RMNCAH, men’s health, healthy ageing, etc.) and diseasespecific (cancer, CVDs, COVID-19, HIV, etc.) approaches to address health needs.
  2. Innovate and modernise care delivery – new service delivery models aimed at improving outcomes of prevention and care.
  3. Make quality a top priority in service delivery.
  4. Increase spending on preventive and primary healthcare services.
  5. Strengthen and promote a preventive care agenda.
  6. Ensure no one is left behind: Measure and improve equity in access to health services, and health outcomes.
  7. Improve health system resilience.

SD2 General Objective

To protect and improve Universal Health Coverage (UHC), through continued provision of quality preventive, promotive, curative and palliative health services to everyone in-need, without undue financial risks, and establish a system of continuous quality improvement. The key strategic domains to guide the direction are:

  • Improve health services across the life-course and address priority health conditions.
  • New direction for primary health care.
  • Improve secondary and tertiary care.
  • Innovate and modernise health programmes.
  • Champion quality improvement across the health system.
  • Implement a quality framework.
  • Develop and implement a clinical governance model.
  • Improve efficiency and effectiveness of services.
  • Improve collaboration with private health sector and health-related NGOs.
  • Partnership to provide services.
  • Mitigate risks and mainstream resilience across the health system.
  • Improve health and safety and staff wellbeing supports.
  • Climate change mitigation and adaptation in health sector.
  • Institutionalise COVID-19 response functions and build resilience.

SD2 Specific Objectives

View the Protect and Improve UHC: Specific Objectives

48 (accessed 24 Nov 2021).
49 UN 74th General Assembly Resolution 74.2 Political declaration of the high-level meeting on universal health coverage (10 October 2019).
50 World Health Statistics Report, WHO, 2021, p67.


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