Intended for healthcare professionals

Analysis Health in South Asia

Expanding access to healthcare in South Asia

BMJ 2017; 357 doi: (Published 11 April 2017) Cite this as: BMJ 2017;357:j1645
  1. Shehla Zaidi, associate professor11,
  2. Prasanna Saligram, research scientist2,
  3. Syed Ahmed, professor3,
  4. Egbert Sonderp, senior health adviser4,
  5. Kabir Sheikh, senior research scientist2
  1. 1Community Health Sciences and Women and Child Health Division, Aga Khan University, Karachi, Pakistan
  2. 2Public Health Foundation of India, New Delhi, India
  3. 3BRAC, Dhaka, Bangladesh
  4. 4Karolinska Institutet, Stockholm, Sweden
  1. shehla.zaidi{at}

Policy initiatives aiming to improve access to healthcare in South Asia have proliferated in recent years, but are they enough to address widespread health inequity in the region, ask Shehla Zaidi and colleagues?

The South Asian region is faced with some of the world’s worst socioeconomic inequities, and these compound widespread gaps in access to healthcare.1 Although there is a fairly extensive body of literature on the disparities that contribute to health inequity and their effect on health outcomes, less is known about the response from policy makers in South Asia.

As the commitment to universal health coverage (UHC) gains increasing global momentum,2 regional initiatives for expanding health access for poor people have risen up the policy agenda, and universal coverage forms the overarching framework for health targets in the sustainable development goals.3 Equitable access can be accelerated by health ministries through action on financing, governance, or human resources to direct health resources towards poor people4 5 or through action on social determinants of health.6

In this article, we focus on the recent proliferation of policy initiatives in South Asia aimed at making access to healthcare more equitable. These initiatives typically involve insurance schemes and contracting of private sector services. Insurance schemes partially or fully subsidised by the government are thought to improve access through risk pooling and reducing point of service payments.7 The unpredictability of healthcare needs, rising costs of treatment, and underlying poverty have given impetus to use of insurance. Strategic contracting of services through formal agreements between health ministries and the private sector, funded by government budgets, is increasingly being used to fill coverage gaps in disadvantaged areas.8

Pulling together the main commonalities across the region, as well as underlining contextual differences, we look at three areas: existing policy …

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