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Universal Health Coverage

HP+ More recent Universal Health Coverage publications are available.

  • Tracking health budget allocations is critical in assessing whether resources allocated in the health sector are aligned to key policy objectives as articulated in policy documents. In Kenya, the Constitution requires that at least 15 percent of the national revenues should be allocated to the county governments to fund the devolved functions that include health. This study assessed the trends in allocations between 2013/14 and 2014/15, and sought to establish whether the allocations were aligned to sector priorities both at the national and county level.

  • Healthcare in many developing countries, including those in sub-Saharan Africa, is predominantly funded through out-of-pocket spending by households. Providing financial protection from exorbitant out-of-pocket expenses is an important tool for a country’s health system to ensure equitable access to care and ensure families are not unnecessarily faced with financial catastrophe and impoverishment. Using data from the Kenya Household Health Expenditure and Utilization Surveys and descriptive analysis, the Health Policy Project, with support from USAID and PEPFAR, estimated the incidence and intensity of catastrophic healthcare expenditure and impoverishment in Kenya in 2003 and 2007. Among other findings, the Catastrophic Health Expenditures and Impoverishment in Kenya analysis revealed that in 2007 an estimated 2.5 million people were pushed below the national poverty threshold as a result of paying for healthcare. Results from this analysis provide strong evidence for the need to implement policies that offer more financial protection to the poor and vulnerable in order to achieve the country’s overall goal of universal health coverage.

  • The government of Cote d'Ivoire is committed to the fight to gain control and turn the tide of the HIV epidemic. Striving to offer the best standard of HIV treatment, the country aims to adopt the new 90-90-90 target. The country also plans to roll out “test and offer” for the general population in the near future and begin piloting Option B+ for pregnant women in 2015. Such an intense scale-up of HIV treatment services will require intensified coordination to mobilize resources and effectively target those funds for treatment scale-up and sustainability.

    The aim of this cost-outcome analysis study was to estimate the cost of HIV treatment scale-up and the impact of such an expansion by estimating the cost of treatment for one person per year for adults, children, and pregnant women. Currently, limited data exist around the unit cost of HIV treatment in Cote d’Ivoire. To inform policy decisions on how best to finance scale-up of treatment with the limited resources available, understanding the outcome of HIV treatment—and the levers for improving the chances of successful treatment—is critical.

    The study found that the cost of the full year of treatment expected by following the national treatment guideline would be CFA142,431 (US$288) for adults, CFA217,603 (US$440) for children, CFA85,063 (US$172) for PMTCT Option B, and CFA 151,827 (US$207) for PMTCT Option B+. A total investment of approximately CFA147 billion (US$297 million) is required over the next five years, leading up to the year 2020, to achieve the 90-90-90 target and a 100 percent roll-out of the Option B+ approach for the prevention of mother-to-child transmission (PMTCT). This investment will save more than 35,000 lives and prevent more than 6,000 children from becoming infected via PMTCT compared to the status quo, in which treatment coverage increases at the historical pace.

  • In June 2013, President Uhuru Kenyatta of Kenya announced policies to remove user fees in dispensaries and health centers and to provide free maternal health services in all public health facilities. This report presents the findings of a study conducted in Kenya by the USAID-funded Health Policy Project (HPP) to establish baseline measures for evaluating the impact of these policies. The Kenya Ministry of Health, with support from HPP, identified the need to monitor and evaluate the impact of the policies on utilization, service provision, and revenue collection, among other indicators.

  • In order to expand and ensure widespread access to healthcare services and protect households from what are termed "catastrophic" health expenditures, Kenya needs alternative and sustainable healthcare financing mechanisms. The Health Policy Project supported the government of Kenya to analyze the long-term health delivery costs and health financing options available to the country. Employing a number of economic and health financing tools, the analysis, Healthcare Financing Options for Kenya: FY 2013/14–2029/30, revealed a need to increase domestic financing and improve the efficiency of the service delivery and social health insurance systems. Results from the analysis will be used to support the country’s move toward universal health coverage.

  • In March, the Kenya Ministry of Health convened an international consultation forum in collaboration with the World Bank Group and the United States Agency for International Development (USAID) through the Health Policy Project to deliberate on the challenges of providing universal health coverage (UHC) to all Kenyans, regardless of their ability to pay, and to explore strategic and sustainable health financing options. The Kenya Health Policy Forum reviewed options and lessons learned from other countries, and proposed recommendations on how the country can improve efficiency to achieve UHC.

    The meeting brought together local and international experts with diverse expertise spanning the health sector, including both the public and private sectors. Participants from Kenya included representatives from both levels of government, nongovernmental organizations, faith-based organizations, and the private sector. International speakers shared experiences from Brazil, Ethiopia, Ghana, India, and Mexico. Development partners who support Kenya’s health sector were also represented, including the USAID, the UK Department for International Development, the German Federal Enterprise for International Cooperation, and the World Bank.

  • While Tanzania has made significant progress on priority health indicators, the limited effectiveness of health financing constrains its ability to achieve more.Despite challenges Tanzania is making progress toward sustainable financing. This USAID and PEPFAR-funded Health Policy Project brief explores the country's prospects for sustainable financing and explores the linkages between financing and universal health coverage.