Social Policy in a Development Context

Social Policy in a Development Context Aims of the Series Social Policy in a Development Context is a series which places social policy at the centre of research while maintaining UNRISD's unified approach to social development. The series provides a new and exciting contribution to the literature in economic development and social policy. In economic development, social policy has been recognized as an inte- gral part of development, but the literature often falls short of elaborating social policy for a unified approach to economic and social development. In social policy, analysis has concentrated mainly on European and North American countries, and studies on developing countries often lack comparative rigour. The bridge between economic development and social policy will not only contribute to the academic research but also inform the policy debate at the international and national levels. More information about this series at http://www.springer.com/mycopy/series/[14480] Ilcheong Yi Editor Towards Universal Health Care in Emerging Economies Opportunities and Challenges Editor Ilcheong Yi Senior Research Coordinator, UNRISD Geneva, Switzerland ISBN 978-1-137-53376-0 ISBN 978-1-137-53377-7 (eBook) DOI 10.1057/978-1-137-53377-7 Library of Congress Control Number: 2016963611 © United Nations Research Institute for Social Development 2017 The author(s) has/have asserted their right(s) to be identified as the author(s) of this work in accordance with the Copyright, Designs and Patents Act 1988. This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Palgrave Macmillan imprint is published by Springer Nature The registered company is Macmillan Publishers Ltd. The registered company address is: The Campus, 4 Crinan Street, London, N1 9XW, United Kingdom Foreword Whether social services and protection are available to all people, or governments choose to take a more targeted approach to social policy, has been one of the most vibrant development debates over the past three decades. The United Nations Research Institute for Social Development (UNRISD) has long been on the front line of the struggle for more inclusive and sustainable development, promoting not only universal approaches but also the concept of transformative social policy—that is, state intervention that, in addition to providing social protection, directly affects redistribution, production and reproduction. An autonomous research institute within the United Nations system, UNRISD provides critical analysis and evidence on the political forces and institutional drivers that shape social policy. UNRISD has paid par- ticular attention to the comparative effectiveness of universal and targeted social policy and programmes, and how they help to reduce poverty and inequality in developing countries. This has led us to critique targeted approaches in social service provision based on evidence that, compared with universal approaches, targeting and selectivity are less cost-effective and sustainable, and are more likely to infringe human rights and weaken social solidarity. UNRISD research highlights the importance of universal social policy as both a means and an ends: a way of tackling persistent poverty and growing inequalities, and of reaffirming the values and goals of universality set forth in international agreements from the Universal v vi Foreword Declaration of Human Rights to the Millennium Development Goals and, most recently, the 2030 Agenda for Sustainable Development which also calls for the transformation of our world and for no one to be left behind. Universalism in social service provision is defined and redefined by interactions between diverse political forces and through policy processes at different levels of governance. Although recent international agreements, notably the 2030 Agenda, have swung the pendulum back towards universal social service provision, national-level forces (such as the imposition of austerity measures in many countries) strongly shape the definition, parameters and practice of universalism in social policy. Research that is both strategic and practical, moving beyond polemical debates to concrete evidence-based recommendations, can help countries identify the institutions, actors and processes conducive to more inclusive and sustainable forms of universal social service provision. When designing this research project with partners, UNRISD selected eight countries at different stages of universalization in their health sec- tors. These countries, characterized as ‘emerging economies’, attract academic and policy interest due to their economic performance regionally and globally. While academic research on their economic dynamics is abundant, research on how they have designed and implemented social policies, and how the latter interact with economic policies and political change, is relatively scarce. This book helps improve understanding of the dimensions, policy linkages and drivers of universalization of health care, and, through the study of countries along a broad spectrum of universalization in their health care systems, demonstrates that there are diverse pathways towards universalism in health care. Although it is almost impossible, and certainly not desirable, to dis- til general lessons that fit all socio-economic and political contexts from these case studies, there are still some common points that are indicative of strategies to achieve more inclusive and sustainable universal social policy. These include the necessity of creating mutually reinforcing mech- anisms between social movements and governments as a new form of politics of welfare expansion; the importance of continuously advocat- ing for and strengthening universality; and the imperative to engage and Foreword vii incentivize the private sector to work in the public interest. These all pose both challenges and opportunities to policy stakeholders involved in health governance, which itself is a sphere of negotiation, compro- mise and consensus building around fundamental values, key policies and political coalitions. Learning lessons from any developmental experience is not an easy task. The first step is to recognize that institutions and policies are context-specific. We expect this book and its case studies to inspire readers and policy makers in developing countries to cast off ‘one-size-fits-all’ recommendations, and to establish their own specific strategies, institutions and policies for universalization. UNRISD would like to take this opportunity to thank the Hospital do Coração (HCor) and the Ministry of Health of the Federative Republic of Brazil (through the Institutional Development Program of the Unified Health System/PROADI SUS) for generous financial support for this project. The research project was conceived in partnership with the World Social Forum on Health and Social Security and the Public Health Movement in Brazil, and was inspired by the 1st World Conference on the Development of Universal Social Security Systems held in Brasilia in 2010. Armando de Negri Filho’s knowledge and experience of the World Social Forum on Health and Social Security, Brazil’s Public Health Movement, the Innovations Laboratory at HCor, and a diverse range of universalization processes across the world were instrumental in the design and implementation of the project. Ilcheong Yi and Kelly Stetter (UNRISD), Olive Cocoman (now at the World Health Organization) and Elizabeth Koechlein (now at AcademyHealth) made tremendous contributions to this project and resulting book, with their roles ranging from project design and coordination to writing and editing. Elena Camilletti, Benedict Craven, Anna Dadswell, Rewa El Oubari, Louis Vargas Falbaum, Subhash Ghimire, Susanne Gjonnes, Roosa Jolkkonen, Sarah Parker, Claire Peterson, Giulia Scaroni, Saskia Sickinger, Portia Spinks, Emilia Toczydlowska and Barbara Walter, all formerly of UNRISD, provided research and other assistance at vari- ous stages. Professor Krishna D. Rao, Department of International Health, Johns Hopkins University, reviewed the entire manuscript and his valuable comments improved the quality of this book. UNRISD viii Foreword appreciates the contributions and support of many other people who cannot be named here, particularly anonymous chapter reviewers. UNRISD also gratefully

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