The Political Economy of Universal Health Coverage (UHC): Barriers to Implementation in Fragile States

Universal Health Coverage (UHC) has become a global health priority since its first emergence in 2007, and it seeks to guarantee that every person is able to get health services when they need it without experiencing any form of financial jeopardy. The realization of UHC in a fragile state is, however, unique because of weak general governance, political frailty, economical weaknesses and less organized health systems. This paper looks at the political economy of implementing UHC in fragile states, and explores how challenges of institutional weakness, donor dependency, and socio-politics make efforts cumbersome. With a thorough literature and policy review across 3 regions (Sub-Saharan Africa, Southeast Asia, and the Middle East), the research paper identifies structural obstacles, such as low fiscal capacity, lack of development of health workforce, and mismatch between national priorities and external aid. The evidence shows that to implement successful UHC strategies, it is not just technical health system strengthening that is needed, but also inclusive governance reform, sustainable finance mechanisms, and robust political commitment. The article highlights how the involvement of community and the development of trust can aid in strengthening the uptake of policy and powering service delivery. Policy suggestions prioritize the coordination of donor efforts with national plans and the importance of fiscal sustainability, investment of health infrastructure and human resources, and the opportunity to use UHC as a means of stabilizing a wider socio-political situation. Combining insights into political economy with health systems analysis, this paper offers a new body of knowledge on how to overcome the obstacles to UHC in fragile settings, as well as contributing to the international debate on equitable access to health.