Going Universal: How 24 Developing Countries Are Implementing Universal Health Coverage Reforms

Summary: Dan: Hey, Paschal. Take a moment to think about your health. Breathe in; breathe out. How do you feel today? Good? Paschal: Pretty Good. Dan: Great. We all know that good health is an important part of day-to-day life. If you are not feeling well, you are not going to be as productive as you typically would be. And when we scale that same concept out to an entire country, it still applies. The healthier a population is, the more productive it is likely to be. Paschal: But we’ll all face illness at some point. So, what do you do if you are poor and living in a country in which health services are expensive or are hard to access? Seeking health treatment might be incredibly difficult. Dan: It’s a complex challenge, one facing many countries: How to ensure that all people have access to the health care they need without suffering financial hardship? In this episode, we’re looking at how developing countries around the world are working toward meeting the goal of universal health coverage. Paschal: Universal health coverage—making quality, affordable health care available to everyone—is seen by many as one element of building healthier, more-equitable, and inclusive societies. It is even a target that was recently adopted as part of the United Nation’s Sustainable Development Goals. So, here we are—the moment is now—everyone can start working toward this goal! Right? Dan: Actually, you might be surprised—and happily so—to learn that many developing countries have already taken up the challenge of providing universal health coverage. I wanted to find out more about this, and why it’s important that such efforts focus specifically on the poor, so I reached out to Daniel Cotlear. Daniel is the lead author of the new report titled Going Universal: How 24 Developing Countries Are Implementing Universal Health Coverage Reforms from the Bottom Up. Daniel Cotlear: “There’s now plenty of evidence showing that unless a very special effort is made to protect the poor, then health programs tend to be very pro-rich. The better off populations tend to have better contacts, better access because of where geographically they are in relation to the hospitals and clinics." Paschal: Starting with a focus on the poor sounds like an appropriate, but daunting challenge. How will countries achieve it? Dan: Well, the authors were careful not to offer prescriptions or recipes for implementing universal health coverage – this report is no roadmap. But they did note the different kinds of approaches countries were taking. Daniel Cotlear: “Some countries use what we call a “supply-side approach.” One where programs are developed that are trying to take more doctors, more health teams, better equipment into areas where the supply did not exist before. Others take what we call a “demand-side approach,” which is some way of making care more affordable" Paschal: It sounds as though a big part of the transition to universal health coverage is figuring out what approach works best for a given economy. Dan: Exactly. A lot of factors have to be taken into account when building a system for universal health coverage. Along the way each country needs to address its own unique circumstances and challenges. Daniel explained this as well. Daniel Cotlear: “So, countries are different in many dimensions. Two that are particularly relevant have to do with where they are in terms of development. Some of the countries that we studied across the 24 have relatively low income per capita. These countries also tend to have a larger proportion of the population in poverty and a very large proportion of the population in the informal sector. India is an example of that." The authors hope that the people working to implement universal health coverage can use this research to make better decisions.