The Evidence-Based Approach to UHC: Three Case Studies that Get It Right

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Each year, more than 1 billion people are unable to obtain even the most basic health care services. An estimated 150 million people who lack these services experience financial catastrophe annually, and two-thirds of them are forced into poverty because of high out-of-pocket health expenses.

Universal Health Coverage (UHC) is the concept that all people can have access to the health care they need without experiencing financial hardship as a result. Called “the single most powerful concept that public health has to offer” by World Health Organization Director-General Margaret Chan, UHC has been hailed as a powerful tool to achieve not just better health, but more equitable health across the globe.

But how do we get the job done?

Countries need a flexible, comprehensive framework for UHC that they can adapt to local needs and integrate with new innovations. Equally important is UHC’s emphasis on improving the quality of health services. That’s why an evidence-informed approach, involving holistic, systems-level interventions, can serve as an effective roadmap for helping countries achieve UHC. Given limited financial resources, an evidence-based approach can help governments determine which health services benefits packages will cover. Although there are many evidence-informed decision-making tools available, governments frequently rely on health technology assessments (HTA) to help set health policies. Health technology assessment uses existing research to evaluate the impact of a given health technology on patients and the health care system as a whole. Although evaluations are most often associated with pharmaceuticals and medical devices, this approach can be applied more broadly to interventions that promote health – including preventive screening, rehabilitation programs, and service delivery.

Several middle-income countries have piloted such approaches to promote universal coverage and access to quality, affordable health services.


  • In Mexico, a comprehensive health care model called CASALUD uses best practices and new innovations to improve care, control, and prevention of non-communicable diseases. Community-based interventions are studied to see how patients can achieve sustainable access to quality health care.
  • In China, the government has worked with NICE International to develop evidence-based clinical pathways as part of a pilot program to increase the quality, affordability, and efficiency of care in rural public hospitals. These pathways have guided system-wide health reforms by defining standards of care; promoting and disseminating best practices; and increasing patient and provider satisfaction.
  • In India, a five-year research initiative called the UDAY project works to implement and evaluate comprehensive interventions for diabetes and hypertension that go beyond the typical clinic-based approach. Through collaboration with multiple partners, UDAY evaluates interventions that increase capacity of both patients and providers to improve care.


Though unique from one another, these case studies share similarities in their use of comprehensive health technology assessments to pinpoint locally appropriate solutions that improve health and expand access to care. Taking a closer look at systems-wide approaches will help countries find the UHC design that is most appropriate for their communities. By using an evidence-informed approach to make decisions about limited resources, policy makers and health care leaders can find sustainable, effective solutions to ensure no person needs to be driven into poverty simply for needing to access health care. That would be a job well done.


Download “Health Systems Approaches to Evidence-Informed Benefits Design: Country Case Studies” here.

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