Universal health coverage: Manifest destiny or Sisyphean pursuit?

Abstract

This project began with a debate and discussion between me and Professor Allyala Nandakumar (Nanda) in the Fall of 2018. Both of us were deeply involved in responding to United States Agency for International Development (USAID) and other donor programs in global health, public financial management (PFM), domestic resource mobilization (DRM), and private sector finance. My perspective was that of a USAID implementing partner, while Nanda’s as the Chief Economist for the Global Health Bureau at USAID. During that time, work being done by the World Bank (Dr Olusoji Adeyi and his colleagues) and USAID (Nanda and his colleagues) showed that even with rapid economic growth, few countries in Africa would be able to publicly fund an essential package of health benefits. Each of our previous work on the subject was calling for a more progressive and strategic approach to universal health coverage (UHC).