Within Our Means: Why countries can afford universal health coverage

There is growing agreement that essential health services should be made available to the whole of society, especially its poorest members, through systems of universal health coverage (UHC). One key aspect of UHC is that the funding for health must be sufficient to provide essential health services for everyone. However, many Countdown to 2015 countries do not have enough resources to do this.

Funding for health needs to be raised in ways that are fair, and spent equitably and efficiently. This includes moving away from private and out-of-pocket spending – where the burden falls on the individual to pay for healthcare when they need it – to mandatory, prepaid and pooled funding where the financial risks of ill-health are spread across the population.

This paper makes the case that all developing countries can afford to increase their spending on health by making different policy decisions about how they raise and spend public money. Decisions about tax and spending are vital and within the control of governments, even of the poorest countries. Some countries will continue to need overseas aid, but this needs to complement domestic decisions, and strengthen the capacity of each country to generate additional revenue. In this paper, we calculate how some of the poorest countries with the highest burden of maternal, newborn and child mortality might meet the level of spending needed to end preventable deaths.