Political Motivation as a Key Driver for Universal Health Coverage

Executive Summary:

There are vast variations across countries in terms of public investments in health, health outcomes, and progress towards universal health coverage. However, neither economic status nor knowledge of solutions has borne out to be binding constraints to health improvements. The drivers of universal health coverage surpass the macro-economic context of a nation, and as pointed out by scholars (Atun et. al., 2013; Yilmaz 2017), are deeply linked with the extent of political prioritisation of healthcare. Low public investments in health in India, and the slow movement towards universal health coverage, underline the need for greater political prioritisation of health in the country.

While the role of politics in policy reforms has been established by several scholars (Reich 1995; Walt 1994; Bambra et al 2005), this paper seeks to identify the intrinsic motivations or incentives that drive political priorities. Drawing on the experience of nine countries, this paper seeks to contribute to the discussion on the political incentives for prioritisation of healthcare in countries like India and how these may be shaped or strengthened.

The paper finds that healthcare reforms happen in (at least) two stages: the existence and recognition of a national context and a problem, followed by the emergence of political opportunities and motivations that lead political leaders to address the identified problem. This paper distinguishes motivation as a crucial factor for analysis because, in the absence of strong incentives, not every political opportunity leads to an issue receiving attention. Our paper also finds that reforms are motivated by an incoming regime’s need to gain political legitimacy, its political ideology, or a combination of the two.

Importantly, political motivation does not always arise by itself, but it is often driven by external factors and stakeholders who contribute to creating or strengthening incentives for political attention. A more proactive role played by citizens and other actors who question the status quo and highlight the schisms in the social contract between a political regime and citizens may contribute to shifting the source of legitimacy for leaders.