Introduction
Universal Health Coverage (UHC) remains a critical global goal, ensuring that all individuals can access essential health services without financial hardship. However, over 120 countries still do not have UHC, and at least 31 of these are classified as fragile, conflict-affected, or post-conflict states. These regions face unique challenges that exacerbate health system fragility, making the implementation of UHC both urgent and complex.
While the immediate health benefits of UHC are well-recognised, its broader role in post-conflict recovery and state-building requires further exploration.
The Immediate Benefits of UHC in Fragile Contexts
Two aspects of UHC’s impact in conflict-affected settings are well understood:
Addressing immediate health crises: In fragile and conflict-affected states, healthcare systems are often overwhelmed by the direct and indirect consequences of conflict. UHC provides a structured framework for delivering essential services, reducing preventable deaths, and controlling disease outbreaks. Access to care during crises stabilizes population health and reduces mortality, particularly among vulnerable groups such as women and children.
Mitigating financial catastrophe: Conflict often drives households into poverty, and healthcare costs are a significant contributor. UHC reduces out-of-pocket spending by pooling financial risks and ensuring access to affordable care. This alleviates financial hardship and helps families maintain stability during recovery periods.
UHC as a Cornerstone of Recovery: Four Key Roles
Beyond these immediate benefits, UHC plays a foundational role in recovery by strengthening the health system as a cornerstone of social cohesion and governance. Four aspects are particularly noteworthy:
1. Workforce Productivity and Economic Recovery
Post-conflict recovery depends heavily on a healthy and productive workforce. Without access to affordable healthcare, untreated illnesses and injuries lead to absenteeism, diminished workforce participation, and lower productivity. This, in turn, slows economic recovery and prolongs reliance on external aid.
Case Insight: In Rwanda, expanding health coverage after the 1994 genocide was a critical component of the country’s economic resurgence. By 2011, Rwanda had achieved 96% health insurance coverage through Community-Based Health Insurance (CBHI), significantly improving access to care and workforce health. This health system investment directly supported the country’s broader development agenda.
2. Restoring Trust in Institutions
In post-conflict settings, access to healthcare is a tangible demonstration of governance effectiveness. It serves as a visible public good that builds trust in government institutions. Conversely, the inability to deliver basic services, including healthcare, exacerbates public dissatisfaction and undermines fragile peace agreements.
Key Point: UHC can serve as a platform for rebuilding legitimacy, signalling stability, and fostering confidence in governance. In contexts where trust is already eroded, ensuring equitable access to healthcare is a critical step toward rebuilding social contracts.
3. Promoting Equity and Social Cohesion
Conflict often deepens inequalities, creating or exacerbating divisions along ethnic, regional, or socioeconomic lines. UHC mitigates these inequities by prioritizing need-based healthcare access over ability to pay, fostering inclusivity and reducing potential sources of tension.
Example: Targeted health system reforms that focus on marginalized populations can bridge divides and prevent resentment among underserved communities. While not conflict-specific, evidence from health equity programs demonstrates their potential to reduce disparities in access and outcomes.
4. Stabilizing Fragile Systems
A functioning health system is a cornerstone of resilience in fragile states. It provides essential services, anchors governance structures, and serves as a stabilizing force during uncertain transitions. Beyond clinical care, health systems act as platforms for broader public health initiatives, such as vaccination campaigns and disease surveillance, which are critical in preventing future crises.
Conclusion
Universal Health Coverage is more than a health policy goal; it is a tool for recovery, resilience, and peacebuilding in conflict-affected regions. By addressing immediate health needs, fostering equity, and strengthening trust in institutions, UHC creates the foundation for long-term stability and development.
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