This document provides health and social protection actors and practitioners with an overview of the role of UHC as an important pillar for social protection. It highlights important features and characteristics of UHC using case studies from Tunisia, Sri Lanka, Ghana and Indonesia to better convey how universal health coverage can contribute to building resilient social protection systems. This may also be useful to inform the programmes of civil society organizations as well as non-profit organizations such as the IFRC’s National Societies.
Key Insights
Understanding UHC
Health is recognized as a basic human right, and UHC is commonly acknowledged as a vehicle for attaining that right (Eozenou et al., 2023). Universal health coverage aims to provide all individuals with access to adequate essential health services in a timely manner without having to incur financial hardship (WHO & World Bank, 2018; L4UHC, 2020; Chaudhuri et al., 2022).
Understanding Social Protection
Social protection is a portfolio of policies and programmes aimed at reducing poverty, inequality and vulnerability (Costella et al., 2022). Social protection programmes can be either contributory, which means that they are financed by contributions from employees and/or employers and specific to pre-agreed contingencies; or they can be non-contributory, which require no direct contribution from beneficiaries or employers to receive benefits.
Relationship between Universal Health Coverage and Social Protection
The objectives of UHC are aligned with the aims of social protection, as social protection works to provide individuals with financial protection from vulnerabilities throughout their life. UHC complements social protection via financial protection and poverty reduction; promoting gender equality and women’s empowerment; and strengthening the State’s capacity to respond to health crises such as epidemics and pandemics (IPU & WHO, 2022).
Case Study: Tunisia
The Constitution of Tunisia enshrines the right to healthcare in Article 38 by guaranteeing preventive healthcare and treatment for every citizen and ensuring the safety and quality of health services (Republic of Tunisia, 2014).
Case Study: Sri Lanka
Sri Lanka is recognized for its high-impact and low-cost UHC model, which had provided institutionalized free primary health care since the early 1950s and has since expanded towards more comprehensive UHC since 2014 (Rajapaksa et al., 2021; UNICEF, 2021).
Case Study: Ghana
The most significant development in Ghana’s healthcare system was the establishment of the NHIS (National Health Insurance Scheme) in 2003 with the goal of providing access to healthcare services for all residents of Ghana (NHIS, n.d.).
Case Study: Indonesia
Indonesia’s mandatory health insurance scheme is administered through the Jaminan Kesehatan Nasional (JKN). Launched in 2014 and managed by the social security organizing agency, Badan Pengelola Jaminan Kesehatan (BPJS), it provides accessible health services across the nation (Nugraheni et al., 2020).
Key Learning: Legal framework and constitutional guarantee enables using social protection for UHC
The integration of UHC and social protection requires a legal framework and constitutional guarantee to acknowledge and legally recognize social protection as a policy and programmatic option that can help to achieve UHC as a right of all citizens.
Key Learning: Leveraging and building on existing social protection systems offers a concrete entry point for UHC
One of the primary steps in establishing UHC through social protection is to build on existing social protection systems through collaboration between healthcare and social protection agencies, as Ghana does, to enrol beneficiaries of social protection programmes onto health insurance schemes.
Key Learning: Pro-poor approaches should underpin social protection and UHC
As seen in Ghana and Sri Lanka, overcoming barriers to accessing healthcare for poor groups is crucial to addressing and preventing the negative impacts of income poverty on health outcomes.
Key Learning: Sustainable financing mechanisms are a prerequisite for social protection to promote UHC
A long-term financing strategy that taps into different sources for a social health insurance fund is essential to progressively increase coverage and improve the quality of healthcare without creating a financial burden on people.
Key Learning: Long-term planning against future risks enables integrated healthcare and social protection systems
Countries are currently facing several challenges, including the impacts of climate change and ageing populations. To adequately offer protection against such risks, healthcare and social protection systems would benefit from conducting climate risks and impact assessments.
Key Learning: Monitoring and evaluation of the gains from integrating social protection and UHC is needed
Where countries are using social protection systems for achieving healthcare objectives, rigorous monitoring and evaluation assessments are necessary to enable other countries to learn from challenges and successes.
Key Learning: National Societies can support UHC goals and linkages with social protection
Red Cross Red Crescent National Societies in most countries are currently involved in providing healthcare to people in many ways, including mobile clinics, community health programmes, counselling services and psychosocial support.
Key Statistics & Data
- Globally, out-of-pocket (OOP) expenditure accounts for 16.4 per cent of current health expenditure (CHE) (WB, 2023).
- The SDG indicator for universal health coverage (SDG 3.8.1) has increased by more than 50 per cent from 45 points on a 100-point scale in 2000 to 68 in 2019 (WHO, 2023a; Yokobori et al., 2023).
- In 2020, Sri Lanka spent 4.07 per cent of its gross domestic product (GDP) on healthcare services (World Bank, 2023).
- Of exempt groups in Ghana’s NHIS, 60 per cent have been brought under coverage (Alhassan et al., 2016).
Methodology
The objectives of this brief are to: 1) provide an overview of the role of UHC as a crucial pillar of social protection; and 2) outline how it can support vulnerable individuals to cope with health-related risks. To achieve these objectives, country case studies were sourced. A report from the Organisation for Economic Co-operation and Development (OECD) ‘Towards universal social protection: Lessons from the universal health coverage initiative’ (2019) was used as a key resource and a snowballing technique was applied to identify other relevant literature. This technique was supplemented by searches on Google to find grey literature linking UHC and social protection; and was followed by a secondary, more targeted search of the following terms within PubMed Central and BMJ Open, as well as the World Bank and World Health Organization repositories.
Implications and Conclusions
The integration of social protection and UHC, as exemplified by the four country case studies (Tunisia, Sri Lanka, Ghana and Indonesia), holds promise for achieving sustainable development and climate adaptation goals. It reinforces the notion that access to healthcare is a fundamental human right. It reduces disparities in healthcare access, promoting social inclusion and enhancing financial stability. Policymakers should embrace this integration as a powerful tool for achieving broader societal and environmental objectives.
Key Points
- UHC is recognized as a basic human right and a key pillar of social protection systems.
- Equitable access, quality healthcare, and financial protection are essential dimensions of UHC.
- Social protection programmes can be contributory or non-contributory and include UHC, cash transfers, or guaranteed work.
- Integrating UHC and social protection can lead to financial protection, poverty reduction, gender equality, and strengthened state capacity to respond to health crises.
- Legal frameworks and constitutional guarantees are important for using social protection to achieve UHC.
- Sustainable financing mechanisms are a prerequisite for social protection to promote UHC.
- Countries seeking to integrate UHC and social protection could adopt a stepped approach by prioritizing healthcare access for the most vulnerable and income-poor groups, who are often targeted by social protection programmes.