BackgroundContributory social health insurance for formal sector employees only has proven challenging for moving towards universal health coverage (UHC). This is because the informally employed and the poor usually remain excluded. One way to expand UHC is to fully or partially subsidize health insurance contributions for excluded population groups through government budget transfers. This paper analyses the institutional design features of such government subsidization arrangements in Latin America and assesses their performance with respect to UHC progress. The aim is to identify UHC conducive institutional design features of such arrangements.MethodsA literature search provided the information to analyse institutional design features, with a focus on the following aspects: eligibility/enrolment rules, financing and pooling arrangements, and purchasing and benefit package design. Based on secondary data analysis, UHC progress is assessed in terms of improved population coverage, financial protection and access to needed health care services.ResultsSuch government subsidization arrangements currently exist in eight countries of Latin America (Bolivia, Chile, Colombia, Costa Rica, Dominican Republic, Mexico, Peru, Uruguay). Institutional design features and UHC related performance vary significantly. Notably, countries with a universalist approach or indirect targeting have higher population coverage rates. Separate pools for the subsidized maintain inequitable access. The relatively large scopes of the benefit packages had a positive impact on financial protection and access to care.Discussion and ConclusionIn the long term, merging different schemes into one integrated health financing system without opt-out options for the better-off is desirable, while equally expanding eligibility to cover those so far excluded. In the short and medium term, the harmonization of benefit packages could be a priority. UHC progress also depends on substantial supply side investments to ensure the availability of quality services, particularly in rural areas. Future research should generate more evidence on the implementation process and impact of subsidization arrangements on UHC progress.

BackgroundHealth sector employment is a prerequisite for availability, accessibility, acceptability and quality (AAAQ) of health services. Thus, in this article health worker shortages are used as a tracer indicator estimating the proportion of the population lacking access to such services: The SAD (ILO Staff Access Deficit Indicator) estimates gaps towards UHC in the context of Social Protection Floors (SPFs). Further, it highlights the impact of investments in health sector employment equity and sustainable development.MethodsThe SAD is used to estimate the share of the population lacking access to health services due to gaps in the number of skilled health workers. It is based on the difference of the density of the skilled health workforce per population in a given country and a threshold indicating UHC staffing requirements. It identifies deficits, differences and developments in access at global, regional and national levels and between rural and urban areas.ResultsIn 2014, the global UHC deficit in numbers of health workers is estimated at 10.3 million, with most important gaps in Asia (7.1 million) and Africa (2.8 million). Globally, 97 countries are understaffed with significantly higher gaps in rural than in urban areas. Most affected are low-income countries, where 84 per cent of the population remains excluded from access due to the lack of skilled health workers. A positive correlation of health worker employment and population health outcomes could be identified. Legislation is found to be a prerequisite for closing access as gaps.ConclusionsHealth worker shortages hamper the achievement of UHC and aggravate weaknesses of health systems. They have major impacts on socio-economic development, particularly in the world’s poorest countries where they act as drivers of health inequities. Closing the gaps by establishing inclusive multi-sectoral policy approaches based on the right to health would significantly increase equity, reduce poverty due to ill health and ultimately contribute to sustainable development and social justice.

Global health diplomacy is an interdisciplinary field that bridges global public health, international relations, and multisectoral public policy with a goal to achieve global health. It enables global cooperation to promote health and manage a range of global health threats, such as noncommunicable and infectious diseases, climate change, environment health, food security, and persistent health inequities, to name a few. While health is not always on the agenda of other sectors, there has been increasing recognition of its significance across other domains. Health is influenced by complex social, economic, and political landscapes, demonstrating the importance of global health diplomacy now more than ever. Global events and initiatives, such as the COVID-19 pandemic, the Paris Climate Agreement, the Framework Convention on Tobacco Control, and the International Health Regulations, illustrate the multitude of issues and instruments used in global health diplomacy, requiring complex interactions between various sectors and state and nonstate actors. Coordinated action for health requires collaboration at all levels of governance inclusive of regional, bilateral, and multilateral alliances. This not only requires policy coherence and coordination between sovereign states but also among other major global players such as civil society organizations and intergovernmental and nongovernmental organizations, as well as public-private partnerships. Furthermore, to effectively manage these global health threats and promote health and health equity worldwide, it is necessary for foreign diplomats to recognize and navigate the intersections of health with other sectors. Considering other non-health-related disciplines such as the impact of economics, trade, and social influences on global health, there have also been calls for the inclusion of multisectoral approaches to global health diplomacy. As a global health leader, it can be difficult to navigate these complex conditions. An understanding of the fundamentals of diplomacy and global health governance is needed to effectively negotiate health processes. However, this is not always straight forward, as health diplomats must also consider the foreign political interests of their allies to effectively integrate health and promote coherence across foreign policy agreements in alignment with global health goals. Diplomats play a vital role in the formation of global partnerships, and while the importance of health is becoming more relevant to diplomats today, the need for global health leaders with diplomacy skills is essential to facilitate global cooperation and policy coherence for global health.

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