The mediating influence of the sub-national

Working through lower levels of government to enhance the implementation of national UHC initiatives

Over the last 15 years, the concept of universal health coverage (UHC) has become ever more central to international health policy discussions.

Many countries have adopted UHC – the essence of which is that people should receive the quality, essential health services they need without financial hardship - as an important goal and a way of framing national-level healthcare delivery improvement initiatives.

Sub-national levels of government such as states, provinces and districts often play a central role in the implementation, and eventual success or failure, of national attempts to achieve and deepen UHC.

In the implementation chain, the political, economic, social and policy contexts of sub-national levels of government mediate national UHC initiatives, so that they might not be automatically implemented or not be implemented as intended.

Sub-national levels of government are therefore key to the fidelity with which national initiatives are implemented and have a major impact on how citizens experience the frontline delivery of these initiatives.

This policy brief synthesizes the results of research in Nigeria, Ghana and South Africa to highlight key lessons for enhancing the implementation of national UHC initiatives through sub-national levels of government. Click here