Joint Learning Network for Universal Health Coverage

On June 9, 2011, in Mombasa, Kenya, I made a presentation (in a “fishbowl” format) to the participants in the Joint Learning Network on Universal Health Coverage (JLN) workshop on covering the informal sector. During that session, I posed as an advisor to the Minister of Health of "Jasmania," a fictional country that is trying to expand universal health coverage to their informal sector.

I presented Jasmania’s situation and the issues I was confronted with in advising the Minister. I then asked a panel of experts comprised of JLN workshop participants from Ghana, India, Indonesia, Malaysia, and the Philippines to provide me with advice from their own countries experience. Session participants were also invited join in the discussion and provide advice.

I was grateful for, and impressed by, all of the advice and insights I received from the JLN panel and fishbowl participants.

On April 1, 2011, Japan marked the 50th anniversary of universal health care. To celebrate Japan's achievements in health The Lancet published six theme papers and eight comments that document the evolution of health care in Japan.

Series Papers

• What has made the population of Japan healthy?

• Japanese universal health coverage: evolution, achievements, and challenges

• Cost containment and quality of care in Japan: is there a trade-off?

• Population aging and well-being: lessons from Japan's long-term care insurance policy

• Re-invigorating Japan's commitment to global health: challenges and opportunities

• Future of Japan's system of good health at low cost with equity: beyond universal coverage

At the Mombasa workshop on expanding coverage, participants had the opportunity to participate in four site visits of Kenyan medical facilities, including one private and one public facility.

Touring Pandya Memorial Hospital, a not-for-profit private facility located on the coast of Mombasa, I was struck by the similar sets of issues faced here and many other hospitals – including our JLN member countries. These include quality, revenue generation, administrative logistics, and integration of information systems. The facility began in 1947 as a small clinic, comprising a maternity unit and surgical wing, and was the first private multiracial hospital in Kenya. It has since expanded to a 95-bed facility offering outpatient and casualty, laboratory, renal, maternal and child health services, among many others.

Our group had the opportunity to walk throughout various parts of the hospital, visiting the pharmacy, ICU, and general, children’s, and maternity wards.

Health Minister Aaron Motsoaledi unveiled South Africa’s national health insurance (NHI) plan last Friday that seeks to extend universal health coverage to all citizens by 2025. The plan will be phased in over the next 14 years, starting with pilot schemes in 10 areas in April 2012. The idea of extending coverage to all was first discussed at the African National Congress’s (ANC) 52nd Annual Conference in December 2007 and reinforces South Africa’s Bill of Rights provision that “everyone has the right to have access to healthcare services, including reproductive healthcare.”

Under South Africa’s current two-tiered approach, health care is heavily skewed towards the private sector. Though only 20% of South Africans seek care in the private sector, the majority of resources are concentrated there and it has effectively distorted pricing across the public sector.