Towards Universal Health coverage: Why financing is key


This page in:

This blog is part of a series on Universal Health Coverage (UHC). The series includes contributions from external bloggers and reflects their view. Follow the conversation on Twitter #healthforall.


Universal Health Coverage is a fundamental part of the Sustainable Development Goals, but, despite what is implied by the name, UHC is not just about health – it is also about sustainable economic growth. That is why I was so pleased to see Ministers of Finance and Planning attending the Sustainable Financing for UHC session at this year’s World Bank Spring Meetings, because their role in making UHC a reality will be as critical as that of Health Ministers.

Having been a Minister of Finance myself, I understand the challenges that they often face on planning and on budget, in terms of balancing investments among competing priorities. That is why it so important to convince them to support Health Ministers by investing more in health and by doing what they can to make UHC a fundamental part of economic development.

As I have always said in many sessions, the dialogue between Ministers of Health and Ministers of Finance and Planning is not always a warm or cordial one, so we need to find out how to relate to one other.  What is the language that Ministers of Health need to have in order to convince their Finance colleagues to pay attention to health among the competing priorities?

The first step is the investment case, to understand why UHC should be so important to all governments and why investing in it should be a priority. As Nelson Mandela once said: “Health cannot be a question of income; it is a fundamental human right.” But while this is true, it is important to remember that we should also invest in health because it makes for sound economics.

Towards Universal Health Coverage: Why Financing is Key

The fact is that at both the individual and societal levels, there are few investments that are as economically sound and transformational as investing in health. We know this is not just speculation; there have been many studies to back this up, which we now need to bring to the attention of the Ministers of Finance. Research has found that for every dollar invested in childhood immunization – an example I like to give because I’m chair of Gavi – we can expect to save $16 in healthcare costs, lost wages, and lost productivity due to illness. And if you consider the full value of people who are living longer, healthier lives, then the return on investment increases even further to $44.  Where could you get a better rate of return than that?

In low-income countries and lower middle-income countries, health has been found to contribute to annual growth in income to the tune of about 1.10 percent annually. And in Sub-Saharan Africa, the contribution is even larger at about 5.7 percent.

In addition, investments in health also help to prevent both outbreaks of disease and the economic impacts that come with that. In 2014, the Ebola epidemic in West Africa was estimated to have knocked-off about $2.2 billion of the GDP of the three hardest hit countries:  Sierra Leone, Liberia, and Guinea.

However, despite this huge opportunity, spending on health in low-income countries and low middle-income countries remains low. I’m particularly worried about the latter because they’re in a transition where they’re being taken off concessional financing – so there is a gap in their financing and one we really need to look at.

There are two further aspects of spending and health that are important. The first is efficiency. Finance Ministers need help from their Health colleagues to increase the efficiency of health spending because sometimes just spending more appropriately and efficiently can add resources before we even think of additional monies. One intervention to tackle these inefficiencies is to ensure that the most cost-effective interventions, or what we call the “best buys,” are the ones prioritized.  Good examples of a best buys include: nutrition; health promotion to reduce NCDs; birth attendants, contraception and, again, childhood immunization.

Health enhancing sectors would also play an important role in this. I also make the case that Ministers of Finance don’t just see the amounts allocated to the health sector as the only health interventions because clean water could do even more for health of babies than direct intervention—so could infrastructure, or even electricity. When we look at investment in health, from the health perspective, we also need to take some of those into account.

The second point is that, in addition to all this, you have to increase the overall envelope of resources to improve taxation and domestic resource mobilization, something everyone is talking about right now.

I’ve been involved in the Task Force on Fiscal Policy for Health, which recently released their report, co-chaired by Larry Summers and Mayor Bloomberg. Our study showed that raising tobacco, alcohol, and sugary beverage taxes is very important and significant to improving health. We estimated that we can prevent 50 million premature deaths and raise $20 trillion of additional revenues over the next 50 years if countries implement taxes to raise prices of tobacco, alcohol, and sugary beverages by 50 percent. These are products that are harmful anyway—and we need the additional revenues for health – so it would be a win-win solution.

So, what can development partners do? The good news is that countries are not in this alone. An African proverb says “If you want to go quickly, go alone. If you want to go far, go together”.

International partners working with countries can ensure that, one, we spend efficiently what we have, and, two, we prioritize well. After doing this we then look at how to increase the additional resources for the health sector.

Initiatives like the World Bank Spring Meeting session I attended can help. The potential here is partly to help us look at these issues from the point of view of Ministers of Finance and develop the dialogue between the two sides that can make engagement most productive. The session a highly productive opportunity to begin that process, and we left with new call to action to try to put in place the kinds of measures that can help us move forwards and bring us closer to UHC.


Reflections by Dr. Ngozi Okonjo-Iweala, Chair of the Board Gavi, the Vaccine Alliance following her keynote speech at the 2019 World Bank Spring Meetings Session entitled Sustainable Financing for Universal Health Coverage: Aligning Around A Country-Led Vision on Saturday, April 13, 2019


Join the Conversation

Anirudra Sharma
June 26, 2019

I found this topic "Towards Universal Health coverage: Why financing is key" very important. But, I want to add here the nutrition as well which is the key for Child Survival, Growth and Development as well as development of the Human Capital for the Nation.

Sampson Ezikeanyi
June 26, 2019

Thank Madam Chair for this contribution. You just nailed it by bringing out the cognitive dissonance in the budgeting process between the two key ministries (Finance & Health) and your recommendation on finding country level and global platform to always bring them together with big data on the economic cases is highly commendable. I will still say that no matter how much evidence is provided, the 'politics' go beyond evidence to interests, ideology, philosophy, and belief of the major actors especially the ruling party at that time (left wing or Right wing or mixed). I recommend the broader and higher engagement with the leader of the ruling party (The president) and the legislatures (e.g National Assembly, Congress, House of Common, e.t.c). Dr. Sampson Ezikeanyi

Ogoloma David
July 29, 2019

Like to read more of this.

Ekpenyong Bassey
June 26, 2019

In discussing health, what value is there for transformation of local to accepted standard while considering sustainability?

Kellys Davids
June 26, 2019

Universal Health Coverage as enunciated in this year's World Health Day has been in the front burner of discussions in health campaigns within our communities. Personally, I led a discussion on World Health Day on The topic on Rhythm 94.7from over here in Bayelsa State Nigeria. Unless and until Social Health Insurance is practically and effectively done to include the informal sector, Health financing will still seem a mirage.
Madam, I really admire your foray into Health Economics occasioned by your position in GAVI. There are young Nigerians like me who are passionate about Health Economics especially as it affects the the young and vulnerable who are doctors in Public Health practice like myself who are praying to God for sponsorships to undertake exchange programs no matter how short to enable them domesticate great models in the Nigerian setting as regards health financing and UHC as driven by the SDG. Please ma, any assistant in this regards will be helpful.


Caleb Dominic
June 26, 2019

That Nigeria and African indeed failed to tap the immeasurable gift of human resources, intellectuals, professionals, men and women of high integrity but filled almost every segment of governance and ministerial positions with not too grounded persons is a serious dislocation.
African rulers need good advisers in areas like this,health and economic development.

June 26, 2019

Very great, generous and educative to share you knowledge with the public. God bless you richly.

Claire Kalu
June 26, 2019

UHC is a topical issue which affects people from all walks of life, especially those in low and low-middle income countries. This discussion is quite didactic and edifying for those of us coming from this side of the divide, moreso, when such speech comes from such an urbane and highly knowledgeable mind in the person of Prof. Ngozi Okonjo-Iwuala, a world - reknowned Economist.
I am not an adept in the field of economics, but there is no gainsaying the fact that for modern man to live a longer and healthier, there is need for governments from low and low- middle income countries to invest in health, desist from syphoning monies allocated to that sector, but rather to see to the judicious use of same to better enhance resources.
Provision of the basic necessities of life like clean water, consistent supply of electricity and good infrastructure will no doubt go a long way to solving most of the health problems in the aforementioned economies.
I am totally in consensus with the reflection of the erudite Prof. Governments should learn from her very sound and well-articulated suggestions.

Dr. Ikechukwu E. Onyekwelonwu
June 26, 2019

Your views, Prof. on UHC is well taken. We all need committed, concerted and co-ordinated approach to ensure success in this regard. Thanks for your effort.

Gaurav Yadav
September 18, 2019

Dear world bank thoughts are good and obviously praising.
I am from India and I will not feel insult in saying that we are so far away from achieving such targets (health as fundamental right).such a huge investment there govts does in health sector bit on ground ppl aren't getting benefits.
Even on each small demographic areas there is primary health care(PHC) but those doctor's use to sell medicines and they are never regular .
So what ppl's tendency is skipping from those PHC's And they visit private and non-qualified doctor's and they pay huge price (sometimes even their life).

No inspection body is working .curruption is on huge level from up to down.
Do have a bird's eye on these small things .
My humble request.

Biko Agozino
August 01, 2019

Good reflections Dr. Okonjo-Iweala. Keep up the good leadership.

In addition to your powerful emphasis on the crucial importance of finance for UHC, may I suggest that education is equally important?

By this I mean that impoverished countries should make sustaied investment in research and developmenr in the healthcare sector. For ibstance, I am the authoe of ADAM: Africana Drug-Free Alternative Medicine full of indigenous knowledge systems that are cost-free. The market model of healthcare does not have all the answers especially for people in poor countries who cannot access expensive drugs but also for people in rich countries who want to avoid serious side effects.

Biko Agozino
Prifessor if Sociology and Africana Studies, Virginia Tech.