A Fair Path Toward Universal Coverage: National Case Study for Ethiopia, Uganda, and Zambia
As national health systems in developing countries make progress toward achieving universal health service coverage, many face ethical challenges. In its 2010 World Health Report, the World Health Assembly called on the World Health Organization (WHO) to develop a plan of action to support countries seeking to enhance universal coverage (UC). Such coverage is seen as having three interrelated dimensions: coverage of people, with needed health services and financial risk protection. The WHO asked a group of health ethicists from India, Zambia, Thailand, Uganda, Ethiopia, Norway, the UK, and the United States to develop guidelines to help countries address ethical issues while expanding universal coverage. In order to make the guidelines relevant to different national contexts, this project will conduct national case studies in Ethiopia, Uganda, and Zambia. Researchers will explore the country-specific ethical implications of choices made along each of the three UC dimensions. The study will examine ethical choices involved in providing essential health services in the three countries. Researchers will emphasize the equity implications, including: -the proportion of the population the various service benefit packages cover; -the types of prioritized services provided to those covered; -how governments finance various schemes; and, -whether the financing and the distribution are fair. More specifically, the research team will: -describe the composition of essential health service benefit packages and the selection criteria for the different countries; -examine equity in coverage with the various service benefit packages; -examine health financing institutional arrangements and governance structures; -analyze revenue generating mechanisms and their implications for fairness and equity in access to health care services; -describe the ethical challenges for policymakers and service providers implementing universal health coverage; and, -share the research findings with each country.