Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia

The implementation of national health insurance reforms designed to move towards universal health coverage by 9 low-income and lower-middle-income countries in Africa and Asia  is reported. Five countries at intermediate stages of reform (Ghana, Indonesia, the Philippines, Rwanda, and Vietnam) and four at earlier stages (India, Kenya, Mali, and Nigeria) are considered. These countries’ approaches to raising prepaid revenues, pooling risk, and purchasing services are described using the functions-of-health-systems framework. Their progress across three dimensions of coverage: who, what services, and what proportion of health costs is assessed using the coverage-box framework. Patterns in the structure of these countries’ reforms including use of tax revenues to subsidise target populations and steps towards broader risk pools are identified. Trends in progress towards universal coverage, including increasing enrolment in government health insurance and a movement towards expanded benefits packages are reported. Common, comparable indicators of progress towards universal coverage are needed.