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Abstract
In recent years, universal health coverage (UHC) has returned with a vengeance to the international agenda, raising complex and highly political questions about how health systems should be organised and financed. Drawing upon an extensive analysis of archival material, this article examines the International Labour Organisation’s (ILO) approach towards health systems financing in the second half of the twentieth century, exploring its evolving strategy towards social health protection in the context of international development, and its relationship with other international agencies, notably the World Health Organisation and World Bank. It argues that while the ILO’s role in international development has come into question in recent decades, its officials have nevertheless made a meaningful contribution to the promotion of health protection worldwide. Despite the wider marginalisation of universalism in post-war international discourse, ILO officials continually shifted their strategy to ensure that mechanisms of health protection such as social health insurance were prioritised in health systems development. ILO support contributed to some notable successes, such as the achievement of UHC in Thailand in 2002.
Highlights
In September 2012, Judith Rodin, President of the Rockefeller Foundation, and David de Ferranti, President of the Results for Development Institute, opened a new series of The Lancet by declaring how ‘a third great transition seems to be sweeping the globe, changing how health care is financed and how health systems are organised.’[1]. Alluding to the demographic and epidemiological transitions of the 18th–20th centuries, the transition Rodin and de Ferranti were referring to was the dramatic resurgence of international interest in universal health coverage (UHC): population-wide access to health services and financial risk protection against the costs of illness
An international UHC day since 2012 has popularised the benefits of universalism to a global audience; while most recently, UHC has been established as a target under the United Nations (UN) Sustainable Development Goals
Classical models of social security came into disrepute, as concerns were raised about the financing of Primary Health Care (PHC) and the inability of social security systems to expand to meet the needs of people in developing countries
Summary
C. SIRRS strengthen national floors of social protection, including access to essential healthcare and basic income security against sickness.[4] An international UHC day since 2012 has popularised the benefits of universalism to a global audience; while most recently, UHC has been established as a target under the UN Sustainable Development Goals. SIRRS strengthen national floors of social protection, including access to essential healthcare and basic income security against sickness.[4] An international UHC day since 2012 has popularised the benefits of universalism to a global audience; while most recently, UHC has been established as a target under the UN Sustainable Development Goals Such international agreements and movements highlight how UHC has returned with a vengeance to the international agenda, only a few decades after this ambition appeared ineluctably beyond reach. ILO officials defended SHI as part of a pluralistic mix of measures, recognising that, while it could not be expanded to meet the total health needs of populations, it remained ‘the most reliable financing mechanism with the biggest financial potential.’[16]
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