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Submitted by Monica Mutesa on
In principal it seems ALL key actors are agreed on UHC. Tying down the who seems to be almost done.... the what is a little way down the road ..... the HOW seems to be the one thing that is farthest down the road could result in derailing the extremely popular UHC train. There are many divergent views on how this will be actualised. One line of thought is that to achieve UHC the Social Health Insurance way is the best. Many policy makers are hailing the Ghanaian SHI experiment as showing the way to go. Evidence from Ghana reveals that their social health insurance scheme is paid for by everyone through taxation, but doesn't offer everyone coverage. It is letting people fall through the cracks .Thanks to CSO activism/alertness they got authorities to downgrade their claims on the 'fantastic' numbers they claimed they were reaching. Enter Zambia where SHI is hurtling headlong to be the vehicle that the authorities will use to achieve UHC. The removal of user fees was one of the issues which was addressed by the newly elected PF government. But alas not long afterwards a new SHI scheme is on its way which could put this life-saving free healthcare initiative at risk. Good old tax financing has for all intents and purposes been relegated to the back seat! And with the phasing, in the roll out of SHI (first to formally employed) there is a risk that it will create a two tier system within the health sector and flies in the face of equity. The recently released report on Tax avoidance of a British Food company by Action Aid, seem to have crystalised my argument for the fact that there aren't enough taxes being raised to fund the social sector. The excuse that tax funded systems cannot provide quality care seems to be premised on weak analysis. The Ghana example again shows that despite the fact that premiums for the SHI are collected, the system is still supported by the use of tax funds. A joke taking the rounds in the CSO community is that it will cost more to collect premiums than the money that the schemes will collect and the schemes will still resort to taxes. Taxes should be the route to take. I end with a statistic and a question. 48,000 children could have been sent to school if the British Food company had paid their taxes! How many other culprits are out there evading/avoiding tax who if brought to book would contribute to ensuring UHC through fair taxation fairly spent? thanks