An assessment of progress towards universal health coverage in Brazil, Russia, India, China, and South Africa (BRICS)

Abstract

Brazil, Russia, India, China, and South Africa (BRICS) represent almost half the world's population, and all five national governments recently committed to work nationally, regionally, and globally to ensure that universal health coverage (UHC) is achieved. This analysis reviews national efforts to achieve UHC. With a broad range of health indicators, life expectancy (ranging from 53 years to 73 years), and mortality rate in children younger than 5 years (ranging from 10·3 to 44·6 deaths per 1000 livebirths), a review of progress in each of the BRICS countries shows that each has some way to go before achieving UHC. The BRICS countries show substantial, and often similar, challenges in moving towards UHC. On the basis of a review of each country, the most pressing problems are: raising insufficient public spending; stewarding mixed private and public health systems; ensuring equity; meeting the demands for more human resources; managing changing demographics and disease burdens; and addressing the social determinants of health. Increases in public funding can be used to show how BRICS health ministries could accelerate progress to achieve UHC. Although all the BRICS countries have devoted increased resources to health, the biggest increase has been in China, which was probably facilitated by China's rapid economic growth. However, the BRICS country with the second highest economic growth, India, has had the least improvement in public funding for health. Future research to understand such different levels of prioritisation of the health sector in these countries could be useful. Similarly, the role of strategic purchasing in working with powerful private sectors, the effect of federal structures, and the implications of investment in primary health care as a foundation for UHC could be explored. These issues could serve as the basis on which BRICS countries focus their efforts to share ideas and strategies.

Strengthening health technology assessment systems in the global south: a comparative analysis of the HTA journeys of China, India and South Africa

“…In addition the wider healthcare system and country setting should be carefully considered [8–10]. Despite the context-specific nature of establishing and strengthening HTA processes, there are several potential lessons to be shared across countries of similar income and development levels, such as Global South and BRICS countries [10], several of which are on a path towards UHC [9]. Sharing knowledge through South-South collaboration and capacity building amongst these countries could provide valuable insights and support.…”

“…For instance, the BRICS (Brazil, Russia, India, China, and South Africa) countries are all on the path to UHC and have started developing HTA systems [9,12]. In addition, China, India and South Africa, are represented in a global network, the International Decision Support Initiative (iDSI) which aims to strengthen capacity to undertake HTA and support the utilisation of HTA evidence for resource allocation decisions in LMICs.…”

Closing the barrier between disease and health outcomes in Africa through research and capacity development

“…While there have been substantial financial difficulties in South Africa and particularly in the health sector over the past number of years [31], sufficient resources were gleaned to enable the research and postgraduate endeavour to expand. In 2008, the finances available for postgraduate and staff support through the HSRO in relation to research was approximately R1 million (USD ± 80,000).…”

Assessing geographical inequity in availability of hospital services under the state-funded universal health insurance scheme in Chhattisgarh state, India, using a composite vulnerability index

“…Low- and middle-income countries (LMICs) are increasingly adopting state-funded health insurance schemes as a strategy for achieving UHC [15,16]. Many of these countries have mixed health systems and their insurance schemes have sought to include private hospitals as providers of healthcare, along with public hospitals [15].…”

“…Many of these countries have mixed health systems and their insurance schemes have sought to include private hospitals as providers of healthcare, along with public hospitals [15]. However, evidence from India and other LMICs shows that there is a skewed distribution of health facilities and resources, with the formal private sector mostly concentrated in urban and richer areas and employing the majority of the medical specialists [8,16–21]. Studies have also found that insurance coverage is not a sufficient condition to ensure equity in healthcare utilization [22,23] and that non-financial factors, such as the nature, distribution and performance of health systems, are equally important for improved access [19,23–29].…”