Intended for healthcare professionals


Meeting the challenges of providing universal health coverage

BMJ 2013; 347 doi: (Published 29 October 2013) Cite this as: BMJ 2013;347:f6485
  1. Albert Mulley, director1,
  2. Tim Evans, director2,
  3. Agnes Binagwaho, minister of health3
  1. 1Dartmouth Center for Health Care Delivery Science, Hanover, NH 03755, USA
  2. 2Health, Nutrition and Population, World Bank, Washington, DC 20006, USA
  3. 3Ministry of Health, Republic of Rwanda, PO Box 84, Kigali, Rwanda
  1. albert.g.mulley.jr{at}

New approaches to service delivery must produce greater value for patients

Momentum is gathering around efforts to achieve universal health coverage—defined by the World Health Organization as universal access to needed health services without the patient experiencing financial hardship to pay for them.1 2 In December 2012, the United Nations General Assembly unanimously adopted a resolution endorsing universal health coverage and urging governments to provide all people with access to affordable healthcare.3 There is also strong support for making such provision a priority in the post-2015 global development framework that will succeed the millennium development goals.4 These developments are timely, for the health inequalities that leave more than a billion people without access to health services are increasingly recognized as an infringement of human rights and a constraint on the economic growth and social development of nations.5

The risk, however, is that a welcome global endeavor to ensure that more people can realize their right to health may default to a vast global investment in the replication of past mistakes.

The improvement in people’s health cannot be achieved by merely expanding and scaling up the healthcare delivery models of today. The 2010 world health report estimated that 20-40% …

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