1. ACHIEVING UNIVERSAL HEALTH COVERAGE Lessons from International Experience Mukesh Chawla Dhaka, February 18, 2014

2. The Reality Check The concept of universality is elusive – many different meanings and interpretations Many different views on the fundamentals – – Who? What? When? Where? How? Never seems to be enough money in the system Bottom line: UHC is not easy – yet, many countries have embarked on the UHC journey

3. Three BIG things we can learn from these experiences ONE You do not need a lot of money to start TWO It comes down to choices (== political decisions) THREE It’s very important to get the supply side right

4. Let’s Talk Money How much you need depends on what you want to buy, how much and for whom No matter how much you have, it will not be enough Most of what you think you have control over will probably not be available Most of what you think is available you probably have no control over Once you can show what you can do, money will mysteriously become available – usually

5. Choices are Difficult – but sooner they are made, the easier it is Making choices is not a science, it’s an art Three dimensions of choices are critical – People, Services, Intensity Strong temptation to make these choices simultaneously – but fixing one of the three much more practical Politics is your friend – embrace it to make your life easy There’s a lot of merit in planning for P*S*I to be greater than your budget

6. Shortage of funds will slow UHC progress – but supply constraints will kill it Supply-side requirements can never be overestimated – it’s a matter of time before induction and inducement effects begin dominating Building self-enforcing incentive compatible mechanisms is key – everything else will probably fail Pressures to expand before consolidating the existing system can be very disruptive

7. So what does this mean for UHC in Bangladesh? International experience is very encouraging – and suggests full speed ahead Lot of merit in consolidating financing – fragmentation sets in place contradictory incentives Probably not worth spending too much time on getting it totally right – concentrating on 80% is a much better bet Getting the supply side right is key – compromises will not help matters And finally, get the incentives aligned – of providers, consumers, financers, policy makers and everybody else

8. mchawla@worldbank.org