Which UHC? Features for Equity and Universalism; Comment on “Universal Health Coverage for Non-Communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare”

Document Type : Commentary


Training and Research Support Centre, Harare, Zimbabwe


Equity and universality are implicit in universal health coverage (UHC), although ambiguity has led to differing interpretations and policy emphases that limit their achievement. Diverse country experiences indicate a policy focus on differences in service availability and costs of care, and neoliberal policies that have focused UHC on segmented financing and disease- focused benefit packages, ignoring evidence on financing, service, rights-based and social features that enable equity, continuity of care and improved population health. Public policies that do not confront these neoliberal pressures limit equity-promoting features in UHC. In raising the impetus for UHC and widening public awareness of the need for public health systems, coronavirus disease 2019 (COVID-19) presents an opportunity for challenging market driven approaches to UHC, but also a need to make clear the features that are essential for ensuring equity in the progression towards universal health systems.


  1. Fisher M, Freeman T, Mackean T, Friel S, Baum F. Universal health coverage for non-communicable diseases and health equity: lessons from Australian primary healthcare. Int J Health Policy Manag. 2020. doi:10.34172/ijhpm.2020.232
  2. Loewenson R, Villar E, Baru R, Marten R. Engaging globally with how to achieve healthy societies: insights from India, Latin America and East and Southern Africa. BMJ Glob Health. 2021;6(4):e005257. doi:10.1136/bmjgh-2021-005257
  3. Birn A-E, Nervi L, Siqueira E. Neoliberalism redux: the global health policy agenda and the politics of cooptation in Latin America and beyond. Dev Change. 2016;47(4):734-759. doi:10.1111/dech.12247
  4. Loewenson R, Mamdani M, Todd G, et al. The Role of an Essential Health Benefit in Health Systems in East and Southern Africa: Learning from Regional Research. EQUINET Discussion Paper 113. Harare: EQUINET; 2018.
  5. Loewenson R, Simpson S. Strengthening integrated care through population-focused primary care services: international experiences outside the United States. Annu Rev Public Health. 2017;38:413-429. doi:10.1146/annurev-publhealth-031816-044518
  6. Paul E, Deville C, Bodson O, et al. How is equity approached in universal health coverage? An analysis of global and country policy documents in Benin and Senegal. Int J Equity Health. 2019;18(1):195. doi:10.1186/s12939-019-1089-9
  7. McIntyre D. Health Service Financing for Universal Coverage in East and Southern Africa. EQUINET Discussion Paper 95. Harare: EQUINET; 2012.
  8. East, Central and Southern African Health Community (ECSA-HC); Regional Network for Equity in Health in East and Southern Africa (EQUINET). Securing COVID-19 Related Diagnostics, Health Technology, Medicines and Vaccines for African Public Health. Harare: EQUINET; 2020.
  9. Frenz P, Alfaro T, Orsini M, et al. Learning from Promising Primary Care Practice Models for the USA: Country Case Study Chile. Santiago: Escuela de Salud Pública, Facultad de Medicina Universidad de Chile; 2014.
  10. Loewenson R, Kaim B, Thole C, et al. How Does Target-Driven Funding Affect Comprehensive Primary Health Care in East and Southern Africa? Harare: EQUINET; 2019.
  11. Rodney AM, Hill PS. Achieving equity within universal health coverage: a narrative review of progress and resources for measuring success. Int J Equity Health. 2014;13:72. doi:10.1186/s12939-014-0072-8
  12. Loewenson R, Accoe K, Bajpai N, et al. Reclaiming comprehensive public health. BMJ Glob Health. 2020;5(9):e003886. doi:10.1136/bmjgh-2020-003886
  13. Roy A. The pandemic is a portal. Financial Times. April 3, 2020. https://www.ft.com/content/10d8f5e8-74eb-11ea-95fe-fcd274e920ca.
  14. López Cabello A. Pandemic momentum for health systems financialisation: under the cloaks of Universal Health Coverage. Glob Public Health. 2021:1-12. doi:10.1080/17441692.2021.1919736
  15. Jones T, Ho L, Kun KK, et al. Rebuilding people-centred maternal health services in post-Ebola Liberia through participatory action research. Glob Public Health. 2018;13(11):1650-1669. doi:10.1080/17441692.2018.1427772