"Contracting private providers accelerates progress toward universal health coverage"

"CTIONS IN INEQUALITY: A POLICY PERSPECTIVE 137 cilities to serve patients.63 As of 2013, health funds covered more than 2.5 million people in 51 of Cambodia’s 81 districts, supporting more than a million health center consulta- tions. Between 2000 and 2015, the under-5 mortality rate in Cambodia fell from 108 to 29 deaths per 1,000 live births, one of the most rapid rates of decline in the world.64 In Kwara State, one of the poorest states in Nigeria, a community-based health in- surance pilot scheme that was conducted in partnership with the national health in- surance system and private providers is re- ported to have increased the use of health care by 90 percent among beneficiaries of the program. It raised their use of mod- ern health care providers and facilities, cut health expenditures by half among benefi- ciaries, and increased their awareness of the importance of health status. Services were financed by contributions from the state government, the national health insurance system, and payments from community insurance programs. Beneficiaries incurred meager copremiums of US$0.14 per person per year without having to make other out- of-pocket payments.65 In Rwanda, the national health insur- ance program, Mutuelle de Santé, currently covers about 90 percent of the population and provides free coverage for the extreme poor.66 Out-of-pocket spending fell from 28 percent to 12 percent of total health expen- ditures during the program’s first decade. These and many other experiences con- firm that there is no unique model of suc- cess in universal health care.67 For example, direct public provision networks in China, Colombia, Mexico, and Thailand effec- tively cover everyone not covered by exist- ing social health insurance mechanisms. Brazil and Costa Rica have unified govern- ment-run health insurance and the public provision network into a single health sys- tem aimed at covering everyone.68 Most of these countries have defined an explicit benefit package, legally mandated in some cases, as in Colombia and Thailand, while others simply guarantee a minimum pack- age of services, as in Chile. Other countries have expanded coverage to specific popu- lation groups or specific types of interven- trition to vitamin A and zinc supplemen- tation, would avert 900,000 deaths among under-5-year-olds in the 34 countries with the highest under-5 mortality rates, at a cost of US$9.6 billion.59 Because of such vast benefits in terms of the lives saved, progress toward universal health care constitutes the most promising and fair strategy to reduce health inequal- ities, raise the human capital of the poor, and contribute to increasing future earn- ings and narrowing income gaps simulta- neously. Achieving universal health care re- quires the delivery of timely health services to those who need them, but who are cur- rently outside any form of health care be- cause of their inability to pay, geographical distance to care providers, cultural and gen- der norms, or citizenship status. Universal health care also implies financial protection against catastrophic or impoverishing ex- penditures among those who receive health services. Reaching underserved populations inevitably requires narrowing existing cov- erage gaps and supplying affordable ser- vices. In practice, to reach universal cover- age, health coverage among the poorest 20 percent of"

"increasing future earn- ings and narrowing income gaps simulta- neously. Achieving universal health care re- quires the delivery of timely health services to those who need them, but who are cur- rently outside any form of health care be- cause of their inability to pay, geographical distance to care providers, cultural and gen- der norms, or citizenship status. Universal health care also implies financial protection against catastrophic or impoverishing ex- penditures among those who receive health services. Reaching underserved populations inevitably requires narrowing existing cov- erage gaps and supplying affordable ser- vices. In practice, to reach universal cover- age, health coverage among the poorest 20 percent of a population must expand much more quickly than the coverage among the more well off.60 There are multiple examples of substan- tial progress toward universal health care among low- and middle-income countries. Thailand’s Universal Coverage Scheme en- hances equity by bringing a large uninsured population under the umbrella of a national program, greatly reducing catastrophic health payments among the poor, and im- proving access to essential health services.61 Within a year of its launch, the scheme was covering 75 percent of the population, in- cluding 18 million previously uninsured people.62 In Cambodia, efforts to achieve more comprehensive access to health services are articulated through health equity funds. The funds are multistakeholder initiatives in which nongovernmental organizations re- imburse public health facilities for treating poor patients, largely eliminating prohibi- tive fees and improving the quality of care by supplying cash incentives for staff and fa- 138 POVERTY AND SHARED PROSPERITY 2016 quality within each stage of education. Countries made definite progress toward these goals. For example, worldwide, there was a 64 percent rise in enrollment in pre- primary education, and 80 million more children are now enrolled in school rela- tive to a few years ago. Yet, only a third of countries met all the goals by 2015. Indeed, UNESCO data show that 58 million children of primary-school age and 63 million chil- dren of lower-secondary-school age are cur- rently not in school.72 At least 250 million children of primary-school age either fail to advance to grade 4 or do not achieve the minimum learning targets in a given year. In India, 47 percent of children in grade 5 were unable to read a second-grade text; in Peru, half of grade 2 pupils could not read at all.73 Poor-quality education has a strong socioeconomic dimension. The poorest children are four times less likely than the richest children to receive primary educa- tion. Among the estimated 780 million il- literate adults worldwide, nearly two-thirds are women. (In Sub-Saharan Africa, half of all women are reportedly illiterate.) Within countries, certain population groups—the poor, women, rural residents—face greater hurdles in gaining access to quality educa- tion. Large differences in learning outcomes measured through test scores among chil- dren are correlated with household incomes across the developing world. Children in the poorest households systematically score below children in the richest households in developing countries; the gap exceeds 50 percentage points in countries such as Gabon, Peru, and South Africa (figure 6.3). For example, there is no reason poor children in Gabon or India should perform, on average, three or four times less well in mathematics than their richer peers. Allow- ing such educational disparities to prevail is unjust and"