Universal Health Coverage in LMICs

Following on from World Health Day on the 7th of April, when there was a spotlight on Universal Health Coverage (UHC) as a Sustainable Development Goal, this article explores UHC in lower and middle-income countries (LMICs).

Key points
  • Politics inevitably has an effect on global health and implementation of associated programmes

  • UHC is a concept where people have access to essential medicines and healthcare services irrespective of financial circumstances

  • While UHC has been successfully implemented in some countries, challenges still remain to make it sustainable in low and middle income (LMIC) settings

How is politics relevant to global health?

Cities and states have been engaging in cross-border collaborations to manage health long before the concept of global governance became relevant. Although the concept of global governance itself is still widely debated among international relations scholars, promoting public health on a global basis has been termed Global Health Governance (GHG). Today, the WHO – which aims to improve and achieve equity in health worldwide – embodies the integration of health into the multilateral governance system.

Despite attempts to depoliticise health, most scholars seem to agree that politics has a role in health because it plays a key role in determining health outcomes. Three distinct periods from the 1990s onwards demarcate the changing levels of activity in global health. 1990 to 1997 was a period of stagnation in health outcomes in terms of innovation and funding. The period 1998 to 2009 was characterised by rapid expansion in funding, increased complexity in health architecture and improved health outcomes. Since then, there has been a period of uncertainty.


What is UHC?

UHC champions the access of medicine and healthcare services by all, irrespective of their financial circumstances. During these recent decades, there has been increased evidence that the UHC improves health outcomes, leading to countries to implement health-related goals for all. However, many LMICs have yet not created a UHC system.

Why is UHC a global priority?

Implementing UHC brings about a host of population-wide health and economic benefits for the countries involved. Ensuring access for the poorest and most vulnerable could potentially contribute to reduction in poverty occurring due to making large out-of-pocket payments. While the perceived focus might be on developing countries, there have also been instances of people being unable to afford healthcare in countries such as the USA. The loss of healthy individuals, especially those of working age, would have a knock-on effect on the economy and productivity of a country.

How is politics critical to the implementation of UHC?

Since the UHC scheme would need to be implemented on a nationwide scale, it is inevitable that it would need to be a state-sponsored enterprise. The first question that governments would need to address is the financing of such a system. There are models of mandating contributions to a common pool as in the UK, which countries could adapt based on their requirements. In order to achieve this, there needs to be extensive research into the optimal extent of health coverage. Sources of inefficiency should be identified in consultation with stakeholders and organisations such as the WHO.

Have any LMICs already started implementation of UHC?

Success stories of UHC include Thailand and Mexico. In both cases, governments were able to ensure that health service utilisation increased while providing increased financial protection for the most vulnerable populations. This resulted in a marked difference in mortality rates, while decreasing proportions of out-of-pocket expenditures. UHC is also being explored in Afghanistan and El Salvador.

What lies on the road ahead?

While UHC is an ideal solution for both populations and governments, it is definitely fraught with challenges. There are issues such as the ageing population, the increasing burden of non-communicable diseases and the inability of government machinery to respond quickly. Moreover, there are also a number of workers in the informal sector who may not have government-issued ID and therefore fall through the gaps of government systems. Thus, governments need to adopt a creative approach while designing UHC systems and avoid a ‘one size fits all’ approach.

Further reading

About the authors

Noemie, Yi Hyun and Akhila are members of the Global Politics in Health Team at Polygeia Cambridge. Noemie and Yi Hyun are both undergraduates reading the Human, Social, and Political Science Tripos and Geography respectively. Akhila is an MRes/PhD student in Nanotechnology, with a special interest in public policy and governance.

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