26th International Association for Management of Technology Conference - IAMOT 2017

Universal Health Coverage (UHC) is one of the Sustainable Development Goals (SDGs). The SDGs comprise of 17 goals that integrate the three dimensions (economic, social and environmental) of sustainable development, with one of the key objectives being to ensure healthy lives and promote well-being for all. UHC forms part of the targets concerned with population health and well-being under SDG 3. The World Health Organisation (WHO) defines UHC as “ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the population to financial hardship”. This global call for UHC has led to a number of countries taking the initiative to transition towards UHC. However, numerous challenges are encountered during the planning and implementation of effective UHC, with one of the major challenges being the unavailability of adequate contextual evaluation tools to inform the mechanisms that a country should employ to successfully transition to UHC. Recent studies aimed at providing decision support to countries on the path to UHC mainly focused on factors that affect the shift towards UHC in isolation (monocausal), with a primary emphasis on the financial feasibility of such UHC concepts. The purpose of this paper is thus to investigate the possible contribution of complex causality methods towards gaining alternative or new insights into the factors, and causality between such factors, that influence UHC. The ultimate objective being to contribute to the quest for UHC by addressing the question, “Which factors, or combination of factors, affect which UHC outcomes?”. In order to gain insights on the factors (and indicators) that shape the UHC landscape, the WHO’s health financing diagnostics and guidance framework were used as an initial point of departure. The factors that contribute to, and influence, the success of UHC were divided into three distinct components namely; health financing arrangements, health system status and country contextual factors. A literature- and subsequent comparative analysis of complex causality methods resulted in Qualitative Comparative Analysis (QCA) being deemed the most appropriate method to assess causality linkages between factors that influence UHC. QCA focuses on the effects of combinations of causal conditions and multiple cases linked to an outcome, as compared to regression methods, that focus on isolated net-effects of causal conditions and probabilistic models that only examine the incremental influence of independent variables on an outcome. To confirm these findings, the properties of UHC and QCA were then studied with the purpose of finding the concord between the two, aimed at unearthing the possible contributions of complex causality methodologies to informing UHC policy. The paper subsequently proposes an approach, through the application of QCA, that contributes towards priority setting when moving towards UHC. The research is relevant to the “resilience through differentiation in the age of globalization” theme of the conference as it will contribute to the world transformation goals.