How 24 Developing Countries are Implementing UHC Reforms From the Bottom Up

The World Bank Group has published a new book, titled “Going Universal: How 24 Developing Countries are Implementing UHC Reforms From the Bottom Up”. The foreword describes UHC as a “triple win: It improves people’s health, reduces poverty, and fuels economic growth”.

The World Health Organisation describes the goal of universal health coverage (UHC) to “ensure that all people obtain the health services they need without suffering financial hardship when paying for them. This requires:

• a strong, efficient, well-run health system;
• a system for financing health services;
• access to essential medicines and technologies;
• a sufficient capacity of well-trained, motivated health workers.”

The book has collected data from 26 UHC programmes across 24 countries (which covers a third of the world’s population) and focuses on their progress towards providing universal health coverage and expanding access the poor have to those health services.

The reported aims to enrich the global knowledge regarding UHC through providing an opinion over which aspects of UHC to prioritise and aims to provide practical insights to policy makers and others who seek to accelerate progress toward UHC worldwide.

At least a billion people suffer each year because they cannot obtain the health services they need and about 150 million of the people who do use health services are subjected to financial catastrophe annually; 100 million are pushed below the poverty line as a result of paying for the services they receive.

The starting point for bottom-up UHC programmes is inequality—all too often the poor get much less from their health systems than the better off. When there is “implicit rationing” (often related to issues like limited presence of providers, patchy geographic access, crowding at facilities, and quantitative restrictions), the rich are often able to jump the queue.

Each of the UHC programs analysed in the book are seeking to overcome the legacy of inequality by tackling both a “financing gap” and a “provision gap”: the financing gap (or lower per capita spending on the poor) by spending additional resources in a pro-poor way; the provision gap (or underperformance of service delivery for the poor) by expanding supply and changing incentives in a variety of ways.

Dr Margaret Chan, WHO Director-General says, “I regard universal health coverage as the single most powerful concept that public health has to offer. It is inclusive. It unifies services and delivers them in a comprehensive and integrated way, based on primary health care.”