NIHR Global Health Research Unit on Health financing for Universal Health Coverage in challenging times: leaving no-one behind 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 (owing to COVID-19, the current war in Ukraine, climate change related natural disasters, and other crises). At the same time, the COVID-19 pandemic has highlighted at the global level 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.

The Unit will use these tools and perspectives to carry out in-depth, policy-relevant analyses on specific health finance-related topics, engage with communities and stakeholders, and conduct capacity building. The Unit’s research will comprise the analysis of existing data, modelling, primary data collection and policy evaluation. This will be shared across four policy themes and four cross-cutting methodological areas. The policy themes revolve around a set of national and international 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, including the interaction between the health system and other sectors. The methodological areas will feed into the policy themes by ensuring the application and development of rigorous, innovative methods to address the challenges identified. They cover (1) methods of evaluating the impact of policies, (2) the analysis of distributional (“equity”) effects, (3) ways of assessing value-for-money of the policies in question, and (4) aspects of political economy.

The collaborative research programme builds directly on the work of the University of York’s NIHR Global Health Econometrics and Economics Group (GHE2), which focussed upon Brazil, Indonesia and South Africa. For the Unit, India is included as an additional research location. These four ‘middle-income’ countries comprise nearly two billion people and 45% of the world’s population living in absolute poverty. The countries are characterised by substantial within-country economic and health inequalities, hosting large marginalised and left-behind populations (e.g. geographically-isolated populations, slum dwellers, socially marginalised castes, and ethnic or religious minorities). Understanding how to advance UHC in these contexts, and among diverse vulnerability profiles, provides significant opportunities for mutual, between-country learning and knowledge spill-over benefits to other low- and middle-income countries.

The long-term aim of the Unit is to strengthen countries’ ability to adapt health financing policies and programmes for resilient, equitable and sustained progress towards UHC. It will be achieved by the production of rigorous evidence on the key health financing and resource allocation challenges. Through the work it plans to do over a five year period, the Unit aims to inform national and international policy agendas, in particular to support national and regional governments in Brazil, India, Indonesia and South Africa in developing, implementing and evaluating health financing reforms, with a view to accelerating progress towards UHC. 1)Produce policy-relevant, actionable research, applying and developing innovative health economics methods to address major health financing challenges that impede UHC progress.
2)Strengthen and expand research capability in using health economics/financing for decision-making in partner countries among both academic researchers and policy practitioners (including via south-south knowledge exchange network).
3)Strengthen and develop stakeholder coalitions with policymakers, civil society partners and the public in partner countries to improve the relevance and quality of policymaking in health financing, and foster a greater use of health economic evidence in decision-making.
4)Engage with international organisations / stakeholders / policymakers (e.g. WHO, PAHO, the World Bank, bilateral donors) to share findings, foster global uptake and influence global UHC policies.