The report celebrates the growing momentum for Universal Health Coverage which has the potential to transform millions of lives. Unfortunately, in the name of UHC, some donors and developing country governments are promoting health insurance schemes that exclude the majority of people and leave the poor behind. Oxfam presents evidence to show that while social health insurance has worked to achieve UHC in a number of high-income countries, attempts to replicate the same kind of employment-based models in developing countries have proved unsuccessful.
Rather than focus efforts on collecting contributions from people who are too poor to pay, Oxfam calls on governments and donors to prioritise general government spending for health – on its own or pooled with formal sector payroll taxes – to successfully scale up UHC. National and international tax reform, as well as development aid, can help generate significant resources for UHC and should be prioritised.
At its core, UHC is about the right to health. This means moving away from the idea of an employment or contributory basis for entitlement. People must be entitled to receive benefits by virtue of their citizenship and/or residency and not because they are formally employed or have paid to join a scheme. Women and men living in poverty must benefit at least as much as the better off every step of the way.