Parallel Session 1.4

Addressing the Political Economy of UHC

31 January 2020

15:30 - 17:30 hrs.

Background :

Experiences from pioneering countries in their Universal Health Coverage (UHC) journey present valuable learning opportunities for others. The journey towards UHC is path dependent and context-specific, and at times, it is not an easy path as each country may have their own specific challenges of expansion of the three dimensions of the UHC cube, population coverage, benefit coverage, and financial risk protection.

The political decisions on UHC, inter alia, are not always evidence based as intended. Decisions are often the results of intentional and unintentional power-plays amongst various stakeholders, including how to manage the resistance of interest groups, shifting entrenched positions, and redistributing resources for health. All of these issues are within the scope of ‘political economy’. A better understanding of political economy is vital to accelerate UHC progression. Debates about expanding UHC within a country involve competing visions about the appropriate roles of the public and private sectors; market and state; the commitment and worldview of society, local and central government; the duties and entitlements of youth and elderly, sick and healthy, and rich and poor; and the contribution of health to the advancement of society. Considerations of politics and power shape the decision of a country’s leaders to commit to UHC. 

This session will interrogate the political economy of reform in these and other areas, drawing on personal experiences with reform implementation and analysis. 

Objectives :

This session engages longstanding themes in the UHC discussion, including questions of universality versus targeting, a generous benefit package versus limited service coverage, high versus low level of financial protection, the appropriate relative roles of the public and private sectors and, importantly, provider payment methods of closed versus open-ended methods. By drawing on the experiences of panelists, this session will illuminate specific examples of these general challenges and discuss the strategies that were used to navigate them. To do this, we pursue four objectives: 

  • To illustrate different approaches to financing UHC and critically analyse the roles and strategies of different actors in shaping these approaches;
  • To describe the scope of different packages of benefits provided through UHC, including the extent of treatment offered as well as preventive and promotive dimensions. The roles and relative weights of different actors (public, private, commercial) in determining these benefit packages will be interrogated;
  • To assess from current experience the extent to which risk protection has been achieved and to analyse why such coverage has not been achieved in different settings. The roles of key actors, especially governments, will be explored. 
  • To discuss and prioritise the combination of actions (e.g. political commitment, research, advocacy, social mobilization) required to move towards UHC, i.e. expansion of population coverage to all with leaving no one behind, improved access to health services, enlarged scope and improved quality of services and financial risk protection.