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Domestic public financing is the key to universal health coverage


The dwindling role of aid financing could provide the impetus for developing countries to expand domestic public health spending.

On the eve of the United Nations high-level meeting on universal health coverage (UHC), the World Bank and the World Health Organization (WHO) have published a sobering report which shows that the world is alarmingly off track to reaching the Sustainable Development Goal (SDG) target on achieving universal health coverage. The global UHC monitoring report highlights that 4.5 billion people – over half the world’s population – are not covered by essential health services and over 2 billion people suffer severe financial hardship when accessing health care.

Reforming health financing systems will play a vital role in improving these statistics and there is now a consensus among countries and global health agencies that public financing mechanisms are the best way to ensure that everyone can access and afford the health services they need. Only pooled and progressive public financing can ensure that healthy wealthy people adequately subsidize the poor and sick, who tend to be excluded in health systems reliant on voluntary private financing.

But in a world recovering from the COVID-19 pandemic and facing multiple new crises, where will the public financing come from to help extend health coverage across the world?

Given the experiences of the last four years, it would appear highly unlikely that international aid financing will close the financing gap. Even at the height of the COVID-19 pandemic – which threatened all countries – the lack of solidarity shown by rich countries towards poorer countries was striking. As G7 countries hoarded vaccines, failed to finance multilateral mechanisms adequately and blocked attempts to transfer vaccine technologies to the global south, many developing countries felt abandoned by the West.

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