Policy brief Access to care and financial protection for all to protect the most vulnerable populations relatively quickly, as these tend to be left until last Effective oversight by government becomes critical-to ensure progress is actually being made in a balanced way Increase and redirect the funding for the health sector p Few coun tries would be able to speed up progress towards universal coverage without significant increases in the volume of tax-based, social insurance based and other prepayment contributions to the health sector. Attaining universal coverage, even for MNCH alone, requires significant injections of domestic and external funds; it also requires political authority and a wide support base in society to hamess and combine existing schemes in a universal coverage framework, and to protect the poor in the process. In countries where external resources play an important role, it is cessary to redirect these funding flows so that they are channeled increasingly through the institutions that organize the pooling and prepayment schemes-be they tax based, social health insurance based or mixed schemes. This will increase the predictability, stability and ultimately the sustainability of funding access to care and the financial protection of all mothers and children. For further information concerning The World Health Report easevisitourwebsiteathttp:/www.who.int/whr/en/ or contact: Joy Phumaphi, ADG FCH (phumaphij @who. int) Tim Evans, ADG ElP (evant@who int) Wim Van Lerberghe, Editor-in-Chief WHR05 (vanlerberghew @who. int) Cover photo credits: left, Liba Taylor-right, J. Gorstein/WHOPolicy brief Access to care and financial protection for all Respect basic principles of prepayment and pooling ► Pre-payment for health care can be organized by collecting health revenues through general taxation, social health insurance schemes or mixed systems. Whichever way financing is organized, two design features are especially important for governments striving for universal access with financial protection. First, no population groups should be excluded. Second, ma￾ternal, newborn and child health services should be part of the set of core services that are covered in the benefit package; policies to move towards universal coverage are just empty shells if they do not have the whole range of MNCH interventions at the core of the package of guar￾anteed benefits. If these two conditions are met, whether care can best be provided through public employees, or purchased from non-for-profit NGOs or private entrepreneurs, is a matter of what is most effective and efficient in a given context. Rapidly achieve universal coverage in countries where dense health care networks already exist ► To organize universal coverage it is necessary to consider all sources of funding in a country: public, private, external and domestic. Sometimes the political and economic context allows for a very rapid combination and extension of pre-payment schemes. Some low-middle income countries have made a quantum leap in extending entitlements to the whole population and achieving near-universal coverage. This is possible in conditions where the health care network is already well developed and political will can be mobilized to commit the additional public funds necessary for health care to include all citizens. Start early ► In many countries, it may take many years before access and financial protection are available for all. The road ahead may seem very long indeed, particularly for the poorest countries, where health care networks are sparsely developed, financial protection schemes hardly exist and health financing is highly dependent on external funds. It is important, particularly for the poorest countries, to move towards prepay￾ment systems from a very early stage and to resist the temptation to rely on user fees. This builds the institutional capacity to manage the financing of the system along with the extension of supply. It is also important that international funding, which often has a strategic role in these countries, be channeled through such nascent pre-payment and pooling schemes and institutions rather than through project or programme funding. This channeling must be done for two reasons. First, it helps build the institutional capacity to develop and extend supply, access and financial protection in a balanced way. Second, it makes external funding more stable and predictable – an essential condition to become more effective in tackling major system constraints such as the human resource crisis. Combine schemes ► There is no single road map for aciev￾ing universal coverage. As countries expand their health care networks, and simultaneously try to move away from user fees and provide financial protection, they often also supplement the limited coverage of public tax-based financing or social health insurance schemes through a multitude of voluntary insurance schemes: community, cooperative, employer-based and other private schemes. It requires a great deal of political savoir-faire to creatively combine all these schemes in view of moving towards universal coverage. Where the voluntary private prepayment schemes protect middle or higher income groups from financial catastrophe, limited public resources are earmarked for the poorest. Where social health insurance covers workers in the formal sector, it may be possible to extend coverage to dependents and the self-employed, using general tax revenue to pay insurance contributions for the poor. Various routes are possible, but during such a transition, population coverage is by definition incomplete. A major concern is how to protect the most vulnerable populations relatively quickly, as these tend to be left until last. Effective oversight by government becomes critical - to ensure progress is actually being made in a balanced way. Increase and redirect the funding for the health sector ► Few coun￾tries would be able to speed up progress towards universal coverage without significant increases in the volume of tax-based, social insurance based and other prepayment contributions to the health sector. Attaining universal coverage, even for MNCH alone, requires significant injections of domestic and external funds; it also requires political authority and a wide support base in society to harness and combine existing schemes in a universal coverage framework, and to protect the poor in the process. In countries where external resources play an important role, it is necessary to redirect these funding flows so that they are channeled increasingly through the institutions that organize the pooling and prepayment schemes – be they tax based, social health insurance based, or mixed schemes. This will increase the predictability, stability and ultimately the sustainability of funding access to care and the financial protection of all mothers and children. For further information concerning The World Health Report please visit our website at: http://www.who.int/whr/en/ or contact: Joy Phumaphi, ADG FCH (phumaphij@who.int) Tim Evans, ADG EIP (evanst@who.int) Wim Van Lerberghe, Editor-in-Chief WHR05 (vanlerberghew@who.int) Cover photo credits: left, Liba Taylor - right, J.Gorstein/WHO 3_universal_rsvd 1.indd 3 2005-03-24 18:42:20