Going Universal: How 24 countries are implementing universal health coverage reforms from the bottom up


September 25, 2015 – More countries around the world are rolling out universal health coverage programs designed to expand access to health care and reduce the number of people impoverished by paying for the health care they need. A new World Bank Group study, Going Universal: How 24 countries are implementing universal health coverage reforms from the bottom up, looks at how 24 developing countries have embarked on the long journey to universal health coverage, with a focus on expanding coverage to the poor—who too often get much less from their health systems than the better-off.

Expansion of universal health coverage is critical: According to the World Health Organization (WHO) and the World Bank Group, 400 million people do not have access to essential health services and 6% of people in low- and middle-income countries are tipped into or pushed further into extreme poverty because of health spending.

Countries studied in Going Universal  include:  Argentina, Brazil, Chile, China, Columbia, Costa Rica, Ethiopia, Georgia, Ghana, Guatemala, India, Indonesia, Jamaica, Kenya, Kyrgyz Republic, Mexico, Nigeria, Peru, Philippines, South Africa, Thailand, Tunisia, Turkey and Vietnam (see individual country case studies).

The authors documented and analyzed countries’ experiences based on a systematic data collection effort that captured in great detail how countries have been implementing universal health coverage reforms. The authors look at how policymakers in developing countries are tackling five key challenges: covering people, expanding benefits, managing money, improving the supply of health care services and strengthening accountability.

The report finds that the 24 countries’ programs are “new, massive and transformational:” Most were launched in the past decade, together they cover more than 2 billion people, and all are fundamentally changing the way health systems operate. Each of the programs aims to overcome a legacy of inequality by tackling both financing and provision gaps.