Paper short abstract:

How UHC will be implemented in poor countries raises many issues. Particularly, in those nations whose health sectors are characterized by chronic and structural underfunding, as in most African countries. This paper examines the feasibility of UHC policy, from the analysis of the Nigerien case.

Paper long abstract:

This paper aims at reflecting on the viability of UHC approach in low-income African countries. Over the last decade, African governments have strived to find solutions that enable the most deprived segments of the population to access public health care. Consequently, financial mechanisms that charge users before illness episodes happen, in terms of risk sharing benefits, have been studied in order to bring poor people closer to health facilities and to prevent households from exhausting their financial resources during episodes of serious illness. This idea is not entirely new. The Equity Funds created in the early 2000s were based on a similar principle in which UHC approach underlies, that is, to promote access to healthcare facilities for those who were unable to pay for it. However, this initiative has not been successful due to, among other things, never-ending funding problems. Based on the Nigerien experience, this paper will discuss the feasibility of UHC policy by exploring two different aspects. The first relates to public healthcare system's dysfunctionality and ineffectiveness. Without a resolution of these issues, UHC will be doomed to failure. And the second concerns the security of permanent and regular health funds. When half the population lives on less than two dollars a day, taxing the informal sector or promoting mutual health organizations will not solve the health funding issue. Therefore, it is concluded that public-private partnerships, like Global Fund, are probably the most sustainable long-term solution.