The political economy of universal health coverage

1. The Political Economy of
Universal Health Coverage
THET Annual Conference 2017
London
23rd October 2017
Robert Yates
Senior Fellow and Head of UHC Policy Forum
Chatham House

2. What is Universal Health Coverage?
A simple definition on UHC:
All people receive the quality health
services they need without suffering
financial hardship

3. UHC is fundamentally about EQUITY
• Universal = Everybody. Nobody left behind
• Health services allocated according to need
• Health financing contributions according to
one’s ability to pay
• Healthy-wealthy cross-subsidise the sick
and the poor
• UHC can only be achieved through public
financing and switching to a public system
is inherently political

4. Afghanistan
Australia
Banglaseh
Bhutan
Cambodia
China
Fiji
India
Indonesia
Japan
Kiribati
Korea
Lao PDR
Malaysia
Maldives
Marshall Islands
Micronesia
Mongolia
Myanmar
Nepal
New Zealand
Pakistan
Palau
Papua New Guinea
Philippines
Samoa
Soloman Islands
Sri Lanka
Thailand
Timor-Leste
Tonga
Tuvalu
Vanuatu
Vietnam
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
0 2 4 6 8 10 12 14 16 18
OutofPocketspendingasashareofTotalHealthExpenditure
Public Health Spending as a % Share of GDP in 2014
Public Health Financing Replacing Private spending in Asia &
Australasia

5. Botswana South Africa
Mozambique Namibia
Sao Tome SwazilandMalawi
Congo Rep Lesotho
Gambia
Burundi
Eq. Guinea
Cape VerdeAngola
Kenya
Tanzania
Ghana
Liberia
Zimbabwe
Rwanda
Zambia
Ethiopia
Lesotho
Niger
Burkina Faso
SenegalDR Congo
BeninChad
Uganda
Mauritainia
Madagascar
-
Mauritius
Guinea
Togo CAR
Comoros
Mali
Guinea-Bissau Cote d'Ivoire
South Sudan Eritrea
Sierra Leone
Cameroon
Nigeria
Sudan
1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0
Public Health Financing Replacing Out-of-Pocket Expenditure in Sub-Saharan Africa
Seychelles
Gabon

6. UHC and health systems reforms are political
• Everybody wants good quality health
services with financial protection
• UHC is very easy to understand and sell to
electorates – people demonstrate for it
• UHC and health systems reforms can
deliver nationwide results quickly bringing
political benefits
• Leadership from the Head of State is
essential

7. WHO’s new DG is targeting political leaders

8. UHC leaders can become national heroes
Tommy Douglas
“Greatest ever
Canadian”
Aneurin Bevan
Founder of the NHS

9. The British Love their NHS

10. This love can be exploited

11. PM Thaksin became a hero in Thailand when
he brought the people UHC in 2002

12. Govenor Jokowi launched UHC reforms in
Jakarta one month after coming to power

13. In the televised Presidential debate he
promised to bring UHC to all Indonesians

14. Does South Africa have sufficient
political commitment to launch UHC?

15. Nigeria’s UHC Hero?

17. Might UHC help unify Myanmar and
deliver a quick win for the NLD?

18. A golden opportunity for UHC in the USA

19. Generating political commitment for UHC
• Involve politicians from the outset in UHC
planning processes
• Involve CSOs, trades unions, media etc
• Tailor messages for different audiences
• Promote the political benefits of UHC to the
head of state and within cabinet
• Link UHC reforms to other government
agendas – eg cutting fuel subsidies
• Exploit political windows of opportunity

20. Concluding thoughts
• UHC is mostly political especially introducing
an equitable public financing system
• UHC is popular with people and politicians
across the world – it brings politics into
health systems
• Worldwide political actors are the main
driving force behind UHC
• The global health community needs to raise
its game in engaging in the political
economy of UHC?

21. 21
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