[In this article in the Journal of Global Health, R4D’s Chris Atim and other contributing authors highlight five case studies of middle-income countries — Ghana, India, Indonesia, Kenya, and South Africa — with political commitment to and some progress toward universal health coverage (UHC). They also highlight how these countries’ UHC systems are still in the process of development and face specific challenges.]
Abstract
Background
Many countries have committed to achieving Universal Health Coverage. This paper summarizes selected health financing themes from five middle-income country case studies with incomplete progress towards UHC.
Methods
The paper focuses on key flagship UHC programs in these countries, which exist along other publicly financed health delivery systems, reviewed through the lens of key health financing functions such as revenue raising, pooling and purchasing as well as governance and institutional arrangements.
Results
There is variable progress across countries. Indonesia’s Jaminan Kesehatan Nasional (JKN) reforms have made substantial progress in health services coverage and health financing indicators though challenges remain in its implementation. In contrast, Ghana has seen reduced funding levels for health and achieved less than 50% in the UHC service coverage index. In India, despite Ayushman Bharat (PM-JAY) reforms having provided important innovations in purchasing and public-private mix, out of pocket spending remains high and the public health financing level low. Kenya still has a challenge to use public financing to enhance coverage for the informal sector, while South Africa has made little progress in strategic purchasing.
Conclusions
Despite variations across countries, therefore, important challenges include inadequate financing, sub-optimal pooling, and unmet expectations in strategic purchasing. While complex federal systems may complicate the path forward for most of these countries, evidence of strong political commitment in some of these countries bodes well for further progress.
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Photo © Kate Consavage/USAID
