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 The design of benefits, contributions, subsidies and eligibility criteria for poor population
groups need to be based on a profound understand of levels of poverty and risks and
vulnerabilities.
 Special attention needs to be paid to ensure that groups that are easily ‘overlooked’, such as
those without identity cards, those in very remote areas, indigenous and tribal populations, are
included.
 The inclusion of informal workers into the mandatory contributory systems is a major challenge
that needs to be tackled, with informal workers constituting more than 60 per cent of the global
workforce (ILO, 2018). In OIC countries, the share of informal employment is particularly high
in the African group and estimated to be frequently more than 70 and 80 per cent, and up to
around 90 per cent in Sierra Leone, Benin, Cote d’Ivoire, and Chad.
o In many countries, contributory health insurance schemes are open to informal workers on
a voluntary basis – here, the level of contribution will be crucial in defining how large the
share of the informal worker population will be who can afford to participate.
o Given the size of the informal workforce in some countries, health care services and benefit
packages will need to be designed with specific needs of this group in mind, e.g. informal
workers do not have access to sick leave and particular emphasis needs to be paid to
preventive care and services, and the promotion of healthier workplaces and practices.
Private sector engagement can contribute to efficiency and quality, but its activities in the health sector
need to be monitored and regulated in order to ensure that good quality healthcare can be accessed
by all parts of society. Unfortunately, there is no robust evidence yet as to which ‘mix of public and
private health provision’ work well or even best (Wadge et al., 2017). However, a positive starting
point for countries is to assess the level to which the private sector could complement governments in
providing integrated health services. Steps for such analysis would involve to
o Assess to what extent private providers are already serving patients and whether these
services are safe, effective and of good quality
o Examine to what extent patients from different socio-economic and socio-cultural
backgrounds can access these services and how barriers could be reduced
o Investigate how private health providers affect the larger health system, e.g. with respect to
availability of trained health workforce and the extent to which private providers work
with government and regulatory organisations, and how positive links can be strengthened,
and negative impacts mitigated.
Countries need to invest in high-quality integrated information management systems in order to
identify what works as well as challenges, uncover inequality in access to good quality healthcare and
health outcomes, and thus inform programming and financing priorities and decision-making.
Furthermore, disaggregated data which informs on health-related SDG indicators, particularly under
target 3.8 which relates to the UHC, needs to be collected and shared at all levels and different
programmes and sectors. This will inform policy and programming as mentioned, but also in order to
strengthening global partnerships by providing the opportunity to track progress on health
interventions and policy frameworks and how they contribute to access related challenges and better
health outcomes for all population groups. That way, experiences and learning can be shared globally
to advance this goal with the support of and to each other. Based on international experience, the
following ‘strategic areas for action’ (based on WHO, 2017d) are recommended
o Improve governance by strengthening robust collaboration between health and other
sectors, across public and private spheres under the oversight of a multi-sectoral
coordination mechanism
o Invest in individual-level, facility- based and population-based data from multiple sources
and capacities to handle, exchange and use such data for health
o All institutions and development partners should align their data, monitoring and
accountability efforts