Award Title: NIHR Global Health Research Unit on “Health financing for UHC in challenging times: leaving no-one behind”
Funder: Department of Health and Social Care

Abstract: RESEARCH QUESTION: How can countries’ health financing and resource allocation strategies be strengthened to accelerate the achievement of Universal Health Coverage (UHC) objectives, with particular attention to left-behind groups?_x000D_
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BACKGROUND: The COVID-19 pandemic has highlighted the socioeconomic importance of a resilient health sector. This presents a critical opportunity for change to strengthen progress towards UHC for low- and middle-income countries (LMIC), and to develop a coherent and resilient strategy for health financing and resource allocation. Central to the Unit are the specific needs and circumstances of the marginalised and poor; the Unit’s focus countries - Brazil, India, Indonesia and South Africa - comprise 45% of the world’s population living in absolute poverty, with large left-behind populations (geographically-isolated groups; slum dwellers; socially marginalised castes; ethnic or religious minorities; low-income districts/municipalities). Understanding how to advance UHC in these contexts provides significant opportunities for shared learning and knowledge spill-over benefits for other LMICs. _x000D_
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AIMS & OBJECTIVES: The Unit’s aim is to strengthen partner countries’ capacity to adapt health financing policies/ programmes for resilient, equitable and sustained progress towards UHC. This encompasses four objectives: (1) produce policy-relevant research and innovative health economics methods to address major health financing challenges that impede UHC progress; (2) strengthen capability in using health economics/ financing for decision-making among academic researchers and policy-makers; (3) strengthen and develop stakeholder coalitions with policy-makers, civil society partners and the public to improve the relevance and quality of policy-making; and (4) engage with international organisations and decision-makers to share findings, foster global uptake and influence global UHC policies._x000D_
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METHODS: Research is grouped into four main policy themes, complemented by four core methods areas. Each theme centres around country-specific and global research questions, with the aim of promoting cross-country collaboration and mutual learning within and beyond the four countries. This will be facilitated by the exploitation, preparation and collection of a wealth of data sources, combined with state-of-the-art methods of policy impact and economic evaluation, equity and political economy analysis. _x000D_
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TIMELINE: The five year timeframe will be divided into three phases: (1) inception phase (Feb-Oct 22), during which research plans are formalised in collaboration with stakeholders, and Unit management processes are set-up; (2) primary research phase (Nov22-Jul26), where data collection, analysis, stakeholder engagement, and training is delivered; and (3) final dissemination phase (Aug26-Jan27), in which we will gather and reflect on all Unit outputs, and share with beneficiaries. _x000D_
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IMPACT & DISSEMINATION: The Unit will strive for three broad outcomes: (1) inform health system financing reforms with its research outputs; (2) advance the global academic conversation on UHC attainment; and (3) strengthen health economics capability/ financing among early-career researchers and decision-makers in partner countries. This will be achieved by establishing national policy and advisory forums, delivering formal training and mentoring to academic researchers, and sharing research findings broadly via digital platforms and events.

Lay Abstract: Universal health coverage (UHC) is where all people have access to the health services they need, when and where they need them, and without financial hardship. UHC is an objective shared by countries worldwide. Many low- and middle-income countries (LMICs) have made progress towards UHC, but large challenges remain (due to COVID-19 and other crises). At the same time, the pandemic has highlighted the social and economic importance of health and UHC. There is, therefore, a critical opportunity for change that we embrace in this Unit; to strengthen progress to UHC in such challenging times, using the tools and perspectives of health financing and economics._x000D_
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Health financing is a key means to achieving UHC, and it is more than just raising money for health services. It involves deciding how to spend money in the health system, setting the right financial incentives for healthcare providers, and ensuring access to healthcare for all. While crucial to achieving UHC, health financing is often insufficient in LMICs owing to low prioritisation of economic resources and limited expertise. _x000D_
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This Unit will use the tools and perspectives of health economics and related disciplines to produce evidence and training to support governments in Brazil, India, Indonesia and South Africa to develop and implement health financing reforms, and accelerate progress towards UHC. These countries host almost half of the world’s poor and are all characterised by large gaps in health outcomes between rich and poor, underlining the global importance of achieving UHC in these locations._x000D_
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The Unit will deliver a programme of novel research involving the analysis of existing data, modelling, primary data collection and policy evaluation. This will be shared across four policy themes (PT) and four methodological areas (MA). The PTs involve analysis of national challenges identified through extensive stakeholder consultations: (1) raising money for health; (2) allocating money for health; (3) ensuring healthcare access for left-behind groups; and (4) the role of governance and the interaction between the health system and other sectors. The MAs will feed into the PTs by ensuring the application and development of rigorous, innovative methods to address the challenges identified._x000D_
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The main beneficiaries of the work will be state- and district-level policy-makers, managers and clinicians with key responsibilities for health financing policies, as well as civil society organisations supporting healthcare delivery to vulnerable communities. The Unit will engage and involve these stakeholders throughout its duration to co-design research plans, interpret and contextualise emerging findings and refine and disseminate key messages from our research. This will be achieved via regular forum meetings, part-time secondment of policy-makers to the research teams, and training. Strengthening research capability is a top priority of the Unit and we will deliver multiple training and development opportunities to researchers, especially early career researchers, policy-makers and other stakeholders. In summary, the work of our Unit will make a vital contribution to accelerating progress towards UHC in our four partner countries, especially among vulnerable populations, and will inform inclusive, national strategies to achieve this in many other countries.

Research Activity Codes: 8.2 HEALTH AND WELFARE ECONOMICS;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health Categories: GENERIC HEALTH RELEVANCE