Following the occasion of the 50th anniversary of Japan’s own achievement of UHC (in 1961), the Japan-World Bank Program on Universal Health Coverage (UHC) was conceived as a joint effort by the Government of Japan and the World Bank Group to respond to the growing demand from low- and middle-income countries (LMICs) for technical advice on the design and implementation of UHC policies and strategies. The goals of UHC are to ensure that all people can access quality health services, to safeguard all people from public health risks, and to protect all people from impoverishment due to illness, whether from out-of-pocket payments for health care or loss of income when a household member falls sick.
Ensuring universal access to quality, affordable health services is the key to ending extreme poverty by 2030 and boosting shared prosperity—both in low-income countries and in middle-income countries, where most of the world's poor live. Countries as diverse as Brazil, France, Japan, Thailand, and Turkey that have achieved UHC are showing how these programs can serve as vital mechanisms for improving the health and welfare of their citizens, and lay the foundation for economic growth and competitiveness grounded in the principles of equity and sustainability. The good news is that many LMICs are also challenging themselves, measuring outcomes, and achieving remarkable progress.
KEY POLICY MESSAGES
Under the Japan-World Bank Group Partnership Program on UHC, 11 countries from low-, middle- and high-income groups were selected to represent a diversity of geographic and economic conditions. These countries are committed to the goals of UHC, and are willing to explore and share their experiences with others. While each country’s health system brings its own unique history and confronts its own set of challenges, each country’s experiences offer valuable insights into some of the common challenges and opportunities faced by other countries at all stages of UHC. The following key policy messages emerge from these studies:
- UHC adoption and expansion requires strong political leadership and long-term commitment, since the it involves a continuous process of carefully crafted political compromises that manages the threat of conflict among diverse interest groups, and brings together key stakeholders to negotiate difficult trade-offs.
- While economic growth helps with coverage expansion, it is not a sufficient condition for ensuring equitable coverage. Countries need to work pro-actively and continuously on policies that redistribute resources and reduce disparities across households in both payments for and access to health care.
- The process of moving towards UHC requires a balanced approach to revenue generation efforts and coverage-enhancing expenditure management. Even in countries that are under-spending on health care, stringent measures to manage costs are required to ensure the fiscal sustainability of UHC.
- Delivering effective health services to move towards UHC requires a coordinated approach to scale up health workforce capacities to meet the demands created by UHC targets. “Scaling up” goes beyond just adding new staff: It should take into account the labor market conditions, including the training capacity and the type of training, and the skill mix of health workers that reflects the local conditions and community needs. And, importantly, it should take into consideration the working environment, the workers’ own career aspirations, and both financial and non-financial incentives for higher performance.
- The process of moving towards UHC requires investments in a robust primary care and public health protection system to improve access, control preventable diseases, and manage health care costs.
 The 11 countries are Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey and Vietnam.