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Upper-middle-income countries

Achieving universal health coverage in Peru

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Janice Seinfeld and Nicolas Besich, of Videnza Consultores in Peru, wrote an assessment of their country’s progress towards universal health coverage for GNHE.

You can read the full assessment here.

The authors’ concluding points are:

  • The health sector in Peru is fragmented, consisting of a non-integrated set of sub-systems aimed at serving different segments of the population.
  • Over a third of the population remains uncovered and out-of-pocket payments account for over a third of health care financing.
  • More than 75,000 households are impoverished annually as a result of health care payments.
  • One of the most neglected segments of the population in terms of health insurance is the one including lower-middle and low-income individuals. This segment is not classified as poor and thus cannot access subsidized insurance through the publicly financed SIS. At the same time, they mostly work in the informal sector and therefore are not able to access the mandatory insurance scheme for formal sector workers, EsSalud.
  • There are several problems that account for this state of affairs:
    • the large informal labour market
    • the fragmentation of the health system
    • fragmented and inadequate funding for the public sector
    • the poor responsiveness of health services (especially in the public sector)
    • bottlenecks associated with the integration of the purchasing and provision functions of EsSalud
    • difficulties in implementing strategic purchasing
    • the absence of a risk-pooling mechanism for different insurance plans
    • the inefficient and inequitable distribution of human resources
  • In response to these problems, in 2013 the Ministry of Health announced a comprehensive reform of the public health sector:
    • reorganisation of the sector and public agencies
    • strengthening the funding of SIS and EsSalud
    • the modernisation of the management of public investments in the sector
    • the modernisation of the national health system (e.g. to shift the focus to promotion, prevention and early detection)
    • a comprehensive reimbursement policy
  • The impact of these reforms is not yet known.
  • Some important areas that need attention with respect to promoting financial protection are:
    • the definition of an explicit benefit package and actuarial projections about its costs
    • improving the efficiency of available resource use
  • Any budgetary increase must be justified by the increased ability of the government to attain its health objectives.


Read more in: Seinfeld J, Besich N. 2014. Universal health coverage assessment: Peru. Global Network for Health Equity (GNHE). Available at:

Low-income countries

Achieving universal health coverage in Tanzania

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Gemini Mtei and Suzan Makawia, of the Ifakara Health Institute in Tanzania, wrote an assessment of their country’s progress towards universal health coverage for GNHE.

You can read the full assessment here.

The authors’ concluding points are:

  • Despite the significant contribution of public and donor resources in Tanzania, benefit distribution is still pro-rich, even for some public providers (especially hospitals).
  • Benefits are pro-poor only in primary care facilities, which in many cases are characterized by poor quality and unavailability of certain services.
  • Out-of-pocket payments are inequitable.
  • Impoverishment due to catastrophic payments for health care translated into about 480,000 people falling into poverty in 2007.
  • The Tanzanian government has committed itself to attaining universal coverage through the expansion of health insurance coverage to 30% of the population by 2015 and increased government allocations to the health sector.
  • A challenge to the achievement of this target, though, is the high dependency on donor funding, especially as some donors are pulling out of health sector basket funding due to concerns about value for money.
  • Catastrophic health care payments and impoverishment might increase as long as donor funds remain unsustainable and if general tax allocations to the health sector do not increase.
  • More attention also has to be paid to extending coverage among the poor.
  • The range and quality of public sector services also need to be improved as this where most poor households access the health system.


Read more in: Mtei G, Makawia S. 2014. Universal health coverage assessment: Tanzania. Global Network for Health Equity (GNHE). Available at: