UHC Forward: Towards Universal Health Coverage

Across the world, countries at all income levels are aspiring to the goal of universal health coverage (UHC). Hardly a week goes by without a government making an announcement about extending coverage, either in terms of new population groups covered, new services added to a benefit package or people receiving higher levels of financial protection. In fact Mexico (the new chair of the G20) is about to announce that it has reached UHC six months earlier than schedule.

In line with the theme of the World Health Organization’s World Health Report of 2010, these countries are recognising that reforming one’s health financing system is essential to achieving UHC.

There is no doubt in my mind that there is real momentum today in the quest for universal health coverage in Africa. Health financing has become a priority topic for discussion at the international and national levels, sometimes even catapulting onto the agenda for campaigning presidential candidates. It has not always been so. One tangible manifestation of this new and timely interest in health financing is the vibrant and growing communities of practice (CoP) spawned by Harmonization for Health in Africa.

Panelists representing Ghana, Mali, Indonesia, Rwanda and the World Bank discussed the challenges of raising revenues for covering the informal sector at the JLN workshop session in Mombasa on June 7, 2011. Debated were the relative merits of different strategies for raising revenues such as general taxes, payroll taxes, special earmarked taxes, donor and community contributions.

During the June 7, 2011, JLN workshop session on raising revenue to cover the informal sector it emerged that most countries, in fact, utilize a mix of financing sources, although one source may be more dominant than the others. The financing source may also differ according to the population group(s) being targeted – thus payroll taxes tend to predominate when it concerns the formal sector, while a mix of sources is more relevant to cover the informal sector due to the many complexities of raising sufficient premium income from that sector and the large numbers who may not be able to pay premiums for themselves.