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What is the best model to bring healthcare to all? Our experts offer 11 ideas for increasing access to health services around the world

1 | Accept there’s no such thing as a ‘perfect healthcare model’

All healthcare models have their challenges in terms of systems capacity, fiscal space and good governance. I think the progress of countries like Thailand and Sri Lanka towards universal health is certainly laudable, but they each have different approaches to getting there. Thailand’s journey began incrementally and over the years through consistent investment in Primary Health Care (PHC). Meanwhile, India is more focused on achieving Universal Health Care (UHC) through mixed health markets featuring both public and private sector players. Priya Balasubramaniam, senior public health scientist and director, PHFI-RNE Universal Health Initiative, Public Health Foundation of India, New Delhi, India

2 | Have the same healthcare provider for the rich and the poor

If we have dual systems with the “national service” caring for the poor and the private sector caring for the rich, quality will be an afterthought. We need the rich and poor to be cared for by the same provider – this ensures that high quality will be a political priority as those with voting influence are directly affected by the quality of services provided. Jolene Skordis, director, UCL Centre for Global Health Economics, London, UK @JSkordis

3 | Give public-private partnerships serious consideration
The PPP model needs to be taken to scale in PHC in order to achieve UHC in a planned time frame. I have worked in many parts of the developing world and in general governments have not been able to step up. Now is the time to test new models as the old system is not working. We need a blended service delivery mechanism. We have to open up the insurance space and governments must push for universal insurance cover for all citizens. This is what we’re trying to do in Kenya. Siddharth Chatterjee, resident coordinator to Kenya, United Nations, Nairobi, Kenya @sidchat1 @UNDPKenya

To read the full article, click here.

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To answer this question, the International Food Policy Research Institute (IFPRI) and the Food and Agriculture Organization of the United Nations (FAO) organized a global event to accelerate progress to end hunger and malnutrition. This event is aligned with the imperatives of the Compact2025 initiative and the UN Decade of Action on Nutrition to make accelerated progress on hunger and undernutrition by 2025 to pave the way for achieving all the SDGs. Compact2025 was launched to support the achievement of SDG2 and the UN Decade of Action on Nutrition. The global event was held November 28–30, 2018, taking place in Bangkok, Thailand and brought together decision makers, practictioners, researchers, and other stakeholders from around the world.

Results for Development’s Augustin Flory and Emily Thacher were in attendance and led a side session, “Data Visualization Tools for Nutrition – Empowering Decision Makers to Accelerate Progress.”

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To this end, the SUN Movement Secretariat (SMS) Asia Hub organized a workshop convening 10 countries from across the Asia Region to accelerate governments’ efforts in the region to scale up nutrition financing. The workshop was supported by the Finance Capacity Development Platform (FCDP) and Capacity for Nutrition (C4N) and was held in Bangkok, Thailand from August 27 – 30, 2024.

Five key learnings and insights emerged from the capacity strengthening workshop on what’s necessary to transform nutrition financing in Asia:

1. Ministries of Finance and/or Budget and Planning must be engaged in nutrition financing discussions and can lead the way towards country-led innovations.
2. Country-led resource mobilization is a high priority, with a need to diversify funding sources and attract partners that will invest in government systems.
3. Mainstreaming nutrition into planning and budgeting is essential: so is a common understanding of how to leverage sectoral investments to optimize nutrition gains.
4. Accelerated advocacy efforts are necessary—backed with targeted, evidence-based messages and strengthened accountability systems.
5. Sharing experiences and learning across countries is essential to transform nutrition financing, which should be supported by regional partners.

Participants shared excitement for the way forward. Each country team outlined a vision of success for sustainable nutrition financing in their country and will take practical steps forward by convening partners and expanding on the work started at the workshop to develop sustainable financing frameworks for nutrition. The report additionally details six example actions that countries commit to take forward to strengthen sustainable financing for nutrition after the workshop.

Lessons learned shared above can be used broadly to accelerate global and regional discussions on how to scale up funding for nutrition sustainably, especially in context of the next Nutrition For Growth Summit and other milestones.

FCDP is a SUN Movement resource available to all 67 SUN Countries. The platform aims to transform the nutrition financing landscape by inspiring and igniting government leaders to elevate nutrition financing as a priority and accelerate impact across sectors.

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Many countries are pursuing government-sponsored health insurance as a primary path toward UHC. In these same countries, there are private health microinsurance (HMI) schemes sponsored by community-based organizations, commercial insurance companies or others that share many of the same goals as government-sponsored health insurance schemes.

A major barrier to provide social health protection in many low and middle-income countries is reaching informal workers and their families. Governments struggle to identify individuals, enrol them and collect premiums. These are functions that HMI providers are well positioned to manage. However, HMI schemes have difficulties in achieving scale and accessing sufficient resources. Governments are better positioned in both respects. These complementary assets open opportunities for collaboration.

This paper reviews country experiences in Cambodia, Ghana, India, Kenya, Thailand, Tanzania and the Philippines. It examines the hypothesis that government-sponsored insurance initiatives should collaborate with private actors to accelerate the expansion of health insurance to informal workers and their families.

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As an associate director with R4D’s Evaluation and Adaptive Learning practice, Mr. Salisbury collaborates with the Market Shaping teams in Tanzania and Ethiopia on projects to increase access to health commodities. He also supports the Governance Action Hub to track the program’s efforts to bring together coalitions of civil society, private sector, and public sector partners to achieve more equitable outcomes in the energy sector. In recent years, Mr. Salisbury has also facilitated many types of learning activities as part of the USAID-funded RF MERL program in Ethiopia, Tanzania, Uganda, and Mali.

Before joining R4D, Mr. Salisbury was a field coordinator in Ethiopia and Zambia for the World Bank Africa Gender Innovation Lab. As part of this work, he managed research activities for impact evaluations focusing on labor markets, vocational skills training, and women’s entrepreneurship. He also previously worked in Ghana on an evaluation of a national apprenticeship program.

Mr. Salisbury holds an MA in international development and a BA in international political economy from Georgetown University. In between his degrees he served as a Peace Corps Volunteer in Northeast Thailand. He speaks English, Thai and Lao.

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At Results for Development (R4D), Ms. Sadagopan is a program manager at the Governance Action Hub, an initiative to facilitate and strengthen coalitions for governance reform and action. In this role, she provides technical and operational support, managing partnerships and stakeholder engagement, as well as supporting implementation of workstreams on local development processes, state capture, and climate action/energy transition. Prior to this, she led the research engagement of Leveraging Transparency to Reduce Corruption, a program to promote transparency, accountability and participation in natural resource governance across Nigeria, Peru, Colombia, Mongolia, and Zimbabwe.

Prior to this, Ms. Sadagopan supported a behavioral evaluation of menstruation as a barrier to girls’ education in Nepal. She also worked in Thailand, first as a high school science and English teacher through a Princeton in Asia fellowship and then as a researcher focusing on Burmese armed ethnic conflicts through media and advocacy outreach.

Ms. Sadagopan holds an MPH in health behavior from the University of North Carolina-Chapel Hill as well as a BS in biochemistry and BA in human biology from North Carolina State University. She is a native speaker of English and Tamil, and speaks conversational Spanish and French.

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Dr. Mukti has held a number of faculty positions including dean of the faculty of medicine, head of public health division, director of the medical center, and director of the health graduate program on health financing and health insurance management — all at the University of Gadjah Mada, Indonesia.

Dr. Mukti also works as a consultant for international agencies in the area of social protection, health finance, and health insurance. He has published more than 30 publications and several books in the fields of health financing and insurance, public health, healthcare management and clinical epidemiology. In addition, he lectures at various universities around the world.

Dr. Mukti earned his medical degree from University of Gadjah Mada. He also holds a master’s degree in tropical hygiene from the University of Mahidol, Thailand, and a doctorate in public health from the University of Newcastle, Australia. In November 2017, he received an honoris causa degree in health from Coventry University, UK, for his contribution to initiate the public health security system in Indonesia.

His research interests and primary expertise are in health policy, health system strengthening, health care financing and universal health coverage in Indonesia.

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This eBook addresses the needs of varied stakeholders.  It provides ministry decision-makers and health system planners with an overview of how information and computer technology (ICT) may be employed to simultaneously support care delivery workflows, provider payment workflows, and the generation of health system management metrics and indicators. For teams tasked with developing the blueprints for eHealth or UHC initiatives, it describes a straightforward, step-by-step process to guide the development and documentation of ICT health systems and the evolution of these systems over time. It also provides guidance to help ministries select and specify the norms and standards needed to achieve national-scale system-to-system connectivity. The eBook is informed by on-the-ground experiences from a number of countries, including Canada, Colombia, India, the Netherlands, the Philippines, South Africa and Thailand.  These first-hand stories are documented in the text and through multimedia interviews.

The goal of the eBook is to contribute to the growing body of work regarding UHC and eHealth and is intended to be a companion piece to the ITU-WHO eHealth Strategy Toolkit and to JLN documents and tools about UHC and provider payor systems.

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