Contribution to MMI Annual Report 2014

Until recently, many of the debates around Universal Health Coverage (UHC) addressed health coverage in middle-income countries and emerging economies. How the debates play out in fragile and transitional states is largely unknown. Therefore, Cordaid commissioned a qualitative study into perceived feasibility of pathways to UHC in fragile and transitional states.

International institutions such as the World Bank and World Health Organization have given support to UHC as one of the Sustainable Development Goals, being part of the post-2015 development agenda. However, most of the pilots concentrate on the feasibility of UHC in middle income countries. In a study published in 2014, Cordaid, having a strong track record on health interventions and focusing primarily on fragile states and contexts, asked whether the concept of UHC is applicable to fragile countries like South-Sudan and Afghanistan.

The two general aims of the Cordaid study were to understand and advance universal health coverage (UHC) in fragile and transitional states and to articulate the specific roles which civil society organizations – from local to international – may play in the process.

The report shows that for fragile and transitional states, the road to achieving UHC will be more complex, requiring an increased focus on community needs and national ownership in the design and implementation of health policies. Therefore, the international community – funders and NGOs alike – have to ensure that the pathway to UHC in fragile and transitional states will be given the extra attention and tailored support that it needs, taking into account their particular challenges and requirements.

The findings of the qualitative study inspire Cordaid to further its mission on building flourishing communities by:

  • Focusing more on providing capacity development to local organizations and communities involved in policy dialogues.
  • Supporting national governments through technical assistance in formulating better and more responsive policies for universal health coverage.
  • Making the link with the international level by advocating for a rethink of existing approaches on universal health coverage in fragile and transitional countries.
  • Capitalizing on the opportunities that the UHC discourse and activities provide for restoring state – civil society relations within countries.

Is Universal Health Coverage (UHC) in fragile states impossible? No, says Arjanne Rietsema, Cordaid’s head of mission Zimbabwe. “But it takes two to tango: a committed state and a demanding population. Civil Society Organizations can assist communities in setting up a system for the latter.”



Contribution by Cordaid to the Annual Report 2014 of the MMI Network