Despite the hugely damaging impact of the COVID-19 pandemic on health systems across the world and the case for universal health coverage (UHC) never being stronger, a recent WHO report on global health financing has shown an alarming contraction in domestic public spending and multilateral financing for health. This reflects dwindling political commitment to health and threatens WHO’s Triple Billion Agenda and the attainment of the Sustainable Development Goals.
Regrettably, just like in the 1980s, fiscally conservative economists argue that this situation is the new norm and that countries won’t therefore be able to afford ambitious UHC reforms. This was what Thailand was told by the World Bank in 2001 after the Asian Financial Crisis, but thankfully the incoming Prime Minister ignored this advice and launched perhaps the most successful publicly-financed UHC reforms of the twenty first century. Indeed there has been a striking tendency throughout history, for some of the world’s best UHC reforms to emerge from crises – be that after conflict, political upheaval, public heath emergencies, even financial crises (as was the case in Thailand).
Over the last two years, the Chatham House Commission for Universal Health has been researching this phenomenon - of crises catalysing UHC reforms and in its forthcoming report will argue that the permacrisis world of the early 2020s may provide the perfect opportunity for progressive leaders to launch UHC reforms.
This is because, in addition to the obvious health benefits, UHC can deliver substantial economic and societal benefits and political benefits to the leaders that bring universal care and health security to their people. The Commission report will present 7 case studies of countries that have launched successful post-crisis health reforms in the last 40 years including: Brazil, Uruguay, Thailand, Cyprus, Ukraine, Rwanda and China. Common features of these reforms have been a political priority to reach full population coverage quickly and that countries have allocated roughly 1% of GDP in tax financing to achieve this goal – even during a financial crisis.
It is our hope that these findings will encourage and inspire today’s leaders that they too could adopt this strategy and launch ambitious UHC reforms in response to the multiple crises of the early 2020s. In fact, there are already signs of history repeating itself, with President Ramaphosa of South Africa likely to sign into law an act to create a tax-financed National Health Insurance system before elections in May. Similarly, the Presidents of Egypt, Kenya and Tanzania have signalled their intention to prioritise universal health reforms as flagship policies for their terms in office.
Political leaders in large middle-income countries in South Asia have also been exhibiting increased interest in launching or expanding universal health reforms in a region which has historically exhibited low levels of public health spending and therefore high levels of health-related impoverishment. For example, in Bangladesh, Prime Minister Sheik Hasina, in launching her election manifesto in December 2023 announced: “A Universal Health System will be established to ensure equal health care for all citizens,” that would provide “primary health care and medicine distribution free of cost”.
Our Commission shows that pledges like this are perfectly feasible and affordable, even during a period of crisis, if there is genuine political commitment to allocate the necessary public financing and oversee the systems reforms needed to bring health services to everyone.
