Both community based health insurance and free health care policies have been adopted in an increasing number of countries in recent years. In two recently published Policy Briefs we review the impact of both in terms of contributing towards UHC in their health systems. Our perspective on the role of CBHI is that whilst beneficiaries often have some improved access to health services, improvements in financial protection are limited and fragmentation in the health system overall typically increases as a result. In terms of free health care policies, when well designed and implemented, these can be effective in extending coverage in countries with few resources and hence be part of a UHC health financing strategy.
A large increase in the number of primary health care units in the past decade resulted in a doubling of health posts and five times more health centres in Ethiopia. The health workforce required to meet the increase in demand did not keep pace, and the emerging imbalance raised concerns related to aspects of both technical and allocative inefficiency. In order to augment human resources for health, a new cadre of health extension worker was trained and deployed to health posts to meet family and community demands. The paper discusses the reforms in Ethiopia that successfully scaled up the health workforce by creating health extension workers, shifting tasks, and expanding primary health care units.
Public financial management (PFM) rules govern how budgets are formed, disbursed and accounted for. This is centrally important to universal health coverage to make sure increases in public spending translate into expanded health coverage. National health authorities should aim to effectively engage with national budgetary authorities to foster credible, priority-oriented health budgets, ensure efficient flows and execution and strengthen accountability.
Public financing is central to making progress toward universal health coverage (UHC). By applying a method to separate out external sources of public expenditure on health, a new WHO publication – Towards UHC: thinking public – sheds light on the actual role of domestic public funds in financing health. It provides a powerful call for countries to “think public” as they develop their health financing strategies in support of UHC.