Four in ten people living in absolute poverty worldwide live in Brazil, India, Indonesia, and South Africa, and this research unit will work with those countries to redesign how they pay for healthcare so the poorest are not left out. The COVID-19 pandemic exposed what happens when health systems are underfunded and fragile. Even before the pandemic, these four countries struggled to extend coverage to slum dwellers, remote communities, low-income districts, and marginalised ethnic or religious groups. Standard health financing models often bypass these populations. The unit will analyse what actually works—examining real-world data on spending, insurance schemes, and budget allocations—to identify financing policies that reach the people other systems miss. If successful, the research could reshape how governments in these countries and beyond allocate health funds. That means more clinics in underserved districts, fewer catastrophic out-of-pocket payments for poor families, and stronger health systems that do not collapse under the next pandemic. The unit will also train a new generation of local health economists and policy analysts, building lasting capacity to keep these reforms on track long after the five-year grant ends.
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RESEARCH QUESTION: How can countries’ health financing and resource allocation strategies be strengthened to accelerate the achievement of Universal Health Coverage (UHC) objectives, with particular attention to left-behind groups? BACKGROUND: The COVID-19 pandemic has highlighted the socioeconomic importance of a resilient health sector. This presents a critical opportunity for change to strengthen progress towards UHC for low- and middle-income countries (LMIC), and to develop a coherent and resilient strategy for health financing and resource allocation. Central to the Unit are the specific needs and circumstances of the marginalised and poor; the Unit’s focus countries - Brazil, India, Indonesia and South Africa - comprise 45% of the world’s population living in absolute poverty, with large left-behind populations (geographically-isolated groups; slum dwellers; socially marginalised castes; ethnic or religious minorities; low-income districts/municipalities). Understanding how to advance UHC in these contexts provides significant opportunities for shared learning and knowledge spill-over benefits for other LMICs. AIMS & OBJECTIVES: The Unit’s aim is to strengthen partner countries’ capacity to adapt health financing policies/ programmes for resilient, equitable and sustained progress towards UHC. This encompasses four objectives: (1) produce policy-relevant research and innovative health economics methods to address major health financing challenges that impede UHC progress; (2) strengthen capability in using health economics/ financing for decision-making among academic researchers and policy-makers; (3) strengthen and develop stakeholder coalitions with policy-makers, civil society partners and the public to improve the relevance and quality of policy-making; and (4) engage with international organisations and decision-makers to share findings, foster global uptake and influence global UHC policies. METHODS: Research is grouped into four main policy themes, complemented by four core methods areas. Each theme centres around country-specific and global research questions, with the aim of promoting cross-country collaboration and mutual learning within and beyond the four countries. This will be facilitated by the exploitation, preparation and collection of a wealth of data sources, combined with state-of-the-art methods of policy impact and economic evaluation, equity and political economy analysis. TIMELINE: The five year timeframe will be divided into three phases: (1) inception phase (Feb-Oct 22), during which research plans are formalised in collaboration with stakeholders, and Unit management processes are set-up; (2) primary research phase (Nov22-Jul26), where data collection, analysis, stakeholder engagement, and training is delivered; and (3) final dissemination phase (Aug26-Jan27), in which we will gather and reflect on all Unit outputs, and share with beneficiaries. IMPACT & DISSEMINATION: The Unit will strive for three broad outcomes: (1) inform health system financing reforms with its research outputs; (2) advance the global academic conversation on UHC attainment; and (3) strengthen health economics capability/ financing among early-career researchers and decision-makers in partner countries. This will be achieved by establishing national policy and advisory forums, delivering formal training and mentoring to academic researchers, and sharing research findings broadly via digital platforms and events.
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