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PMAC 2017: Paths to Universal Health Coverage for Marginalized Groups Explored at USAID Session

PMAC session flyer featuring a photo of a mother and child

February 13, 2017

BANGKOK, Thailand—Progress toward universal health coverage (UHC) will not guarantee that historically marginalized populations will benefit from new health insurance schemes. To truly reach people in marginalized groups, a multi-pronged approach that includes demand-side interventions to improve service utilization; empowered communities demanding accountability; and, mechanisms to identify, reach, cover, and empower neglected or stigmatized populations are essential. 

This was the topic of a dynamic side-session—Extending Coverage to Marginalized Groups—hosted by USAID on January 29, 2017, at the Prince Mahidol Award Conference (PMAC) in Bangkok, Thailand.

The side-meeting, organized in collaboration with USAID-funded projects Health Policy Plus (HP+), Health Finance and Governance (HFG), and Sustaining Health Outcomes through the Private Sector Plus (SHOPS+), tackled both financial protections for the poor and scale-up of targeted schemes and included dynamic conversations among health economists and health reform experts, researchers, and practitioners from around the world in attendance.

Jennifer Adams, USAID’s acting assistant administrator in the Bureau for Global Health, provided opening remarks and stressed USAID’s dedication to creating an enabling environment to promote sustained equitable access to essential, high-quality health services that are responsive to people’s needs and don’t cause financial hardship.

USAID Senior Family Planning Policy Advisor, Margaret Reeves, set the stage for the morning’s conversation. “Achieving UHC is a complex matter—just defining who is marginalized and who is poor is a complicated task. Add to that debates about priorities, what will be funded, and how, and it gets more complicated. Truly achieving health for all requires a mix of strategic policy and complex financing decisions, with inclusive debate among all stakeholders about priorities,” said Reeves. That session also featured health economists Davidson Gwatkin, Suneeta Sharma of HP+, and Ricardo Valladares, from Health and Education Policy Plus in Guatemala (HEP+). 

Gwatkin outlined a key theme of the day when he said that UHC is, at its heart, an equity issue, describing the complexity and magnitude of inequalities in health and the economic drivers of health-seeking behaviors. Ricardo Valladares discussed the important role of civil society engagement to ensure government accountability and provided a case study of the evolution in Guatemala’s health policy and the proactive role of civil society over the past decade. Suneeta Sharma focused on the need to design and implement UHC policies that are evidence-driven, politically smart, sustainably financed, and rights-based.

“When we talk about developing and implementing UHC policies, we need to be prepared to make hard decisions,” Sharma said. “Affordability versus comprehensiveness, sustainability of UHC-oriented schemes versus inclusion of the marginalized; quality improvements with efficiency. We need both supply-side strategies and demand-side financial incentives to ensure effective coverage for the poor.”

Davidson Gwatkin also led a talk show-style panel with Prastuti (“Ibu Becky”) Soewondo and Thomas Maina exploring the progress of health schemes in Indonesia and Kenya.  Maina, of HP+ Kenya/East Africa’s program, discussed Kenya’s launch of the national health insurance fund’s revamped free maternity services program. Soewondo, of the government of Indonesia’s National Team for the Acceleration of Poverty Reduction (TNP2K), discussed the scale-up of national single-payer health insurance alongside other social sector safety net interventions.

Afternoon panels focused on health financing for marginalized groups and the role of governance in improving access to health services for the most marginalized in society. At the end of the all-day meeting, the attendees engaged in a group discussion about the way forward in achieving health for all, with a focus on marginalized populations.

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