Providing health services to all persons in need of health care in a way that does not put them at risk of financial catastrophe requires a major redesign of health care financing policy. While each country is taking a different approach (South Africa is proposing a universal system which is largely tax funded while Tanzania is proposing a system which combines mandatory insurance for formal sector workers and community-based schemes for the informal sector), both are still at the challenging stage of policy formulation.

The new multi-million Rand project called UNITAS (Universal Coverage in Tanzania and South Africa) will track this policy formulation process to assist policy makers with managing the compromise that must be reached in ensuring the policy is acceptable to all critical policy actors.

The main component of UNITAS will be to support the implementation of policy aimed at achieving universal health coverage in South Africa and Tanzania, undertaking monitoring at district level, and will establish an 'early warning system' of implementation difficulties.

While it is expected that UNITAS will be of tremendous benefit to the health financing policy arena, the project faces an element of risk because if powerful stakeholders oppose universal health coverage proposals (in either country), the policy process could be stalled. However, Di McIntyre (Professor at the HEU and project coordinator) points out that "our assessment of the policy context in both South Africa and Tanzania from the Strategies for Health Insurance for Equity in Less Developed Countries (SHIELD) research project shows that there is very strong government commitment to pursuing universal coverage and that some interventions towards this goal, even if in a somewhat different form to that currently envisaged, will be implemented".

The SHIELD project assessed who pays for and who benefits from health care in both countries (as well as Ghana). Findings from the SHIELD project have been widely disseminated to senior policy officials, including South Africa's National Health Insurance Ministerial Advisory Committee and the Tanzanian National Forum on Health Financing for Equity. The SHIELD project will provide a baseline against which the impact of these financing reforms can be assessed by the UNITAS project.

Click here to download SHIELD findings.