Progress Toward Universal Health Coverage: A Comparative Analysis in 5 South Asian Countries

Area of Science:

• Public Health
• Health Services Research
• Health Economics

Background:

• Universal health coverage (UHC) is a key United Nations Sustainable Development Goal.
• Progress toward UHC in South Asia requires investigation, particularly concerning health service inequalities and financial risk protection.

Purpose of the Study:

• To assess progress in universal health coverage across five South Asian countries.
• To evaluate inequalities in health services and financial risk protection indicators.

Main Methods:

• Population-based study utilizing nationally representative household survey data from Afghanistan, Bangladesh, India, Nepal, and Pakistan (2010-2015).
• Analysis of three UHC dimensions: access to basic services, financial risk protection, and equity.
• Estimation of coverage rates stratified by wealth quintiles, using slope and relative indices of inequality.

Main Results:

• Substantial variation in access to basic care across countries, with prevention and treatment coverage rates differing significantly.
• Generally low financial risk protection, indicated by incurred catastrophic health expenditures.
• Significant wealth-based inequalities in access to essential maternal and child health services, including antenatal care, institutional delivery, and skilled birth attendants. Sanitation and delivery services showed the least equity.

Conclusions:

• Health coverage and financial risk protection remain low in these South Asian nations.
• Inequalities in healthcare access, particularly linked to wealth, persist as a major challenge.
• Substantial improvements in preventive and treatment services, alongside enhanced financial security, are crucial for achieving UHC.