Yogesh Rajkotia, ThinkWell’s Founder and CEO, spoke at the 2014 Africa Forum on Universal Health Coverage (UHC) in December in Addis Ababa. The event was hosted by the Korean International Cooperation Agency.

Over 90 countries have endorsed the United Nations resolution on UHC. Dr. Rajkotia’s presentation discussed health financing trends that have emerged from countries’ drive toward UHC. Over 55 countries have implemented or plan to implement health insurance programs. Over 50 countries have implemented or plan to implement results-based financing. Dr. Rajkotia explained the steep increases in such programs, “Countries are seeking more effective ways to use available funding. Increasingly, health financing mechanisms are being used to drive the efficiency of programs, thus financing is serving to reshape the health sector.” His advice to countries? “Think big and plan ahead.”

Dr. Rajkotia went on to describe the importance of developing specific solutions that work for each country’s context. Traditional, standard models no longer apply. Increasingly, experienced experts are emerging from low and middle income countries, thus making south-to-south information exchange and collaboration an effective way to access advice on adapting customized solutions.

Dr. Rajkotia acknowledged that “Power and politics remain critical factors in developing local solutions. Politics drives progress.” Health financing mechanisms, like providing health cards to each citizen, have increased awareness among citizens, and brought on calls for increased information and involvement. Another way in which health financing has influenced the dynamic is by the defining and strengthening of the purchaser’s role in health services. Purchasing agents — which in a sound design are independent entities, separate from a Ministry of Health — are gaining more purchasing power and more autonomy from Ministries of Health, and are also invested in the benefits offered and the quality of the health services delivered. Dr. Rajkotia points to positive examples of health financing reforms driving improvements to health access and quality, such as Ghana’s successful national health insurance scheme, and the opportunity created for Morocco by its Arab Spring neighbors.

Dr. Rajkotia’s presentation is available on



This past December, I spoke at the Korea Foundation for International Healthcare’s (KOFIH’s) 2014 International Forum on Universal Health Coverage (UHC) in Addis Ababa. I also had the opportunity to deliver a keynote speech at KOFIH’s 7 year anniversary celebration in Seoul in 2013. I spend a lot of time at various international conferences and knowledge sharing events, but I was particularly inspired to witness the interactions between Korean health systems practitioners and their counterparts across Asia and Africa. The Korean approach is different: in the way they bring people together to exchange information, in the way they approach development. This synergized well with my observations about what is needed to help countries achieve UHC.

The Evolving State of Health Systems in LMICs

In my speech in Addis Ababa, I spoke of the evolution of health financing in low- and middle-income countries (LMICs). I discussed how international partners, mostly from Europe and North America, drew from their own experiences to support this evolution in its early stages. They introduced concepts found in Bismarkian, Beveridge and market-driven models of health systems. But the growing global chorus to achieve UHC has created the impetus for countries to develop unique health systems models tailored to the LMIC context. And these models look very different than the traditional models from upper income countries – just look at the mixed models in Rwanda, Ghana, and Philippines.

So who is best suited to support LMICs as they continue their journey towards UHC? I believe that it’s LMICs themselves. Rooted in practicality, their thinking goes beyond the standard models and transcends conventional wisdom. And, with over 55 countries having introduced or planning to introduce insurance, and 50 having introduced or planning to introduce results-based financing, the pool of health systems practioners from LMICs is growing every day.

KOFIH seems to have embraced this reality into their approach, while at the same time offering lessons from their own bumpy journey towards UHC.

The Difference from Korea

The South Koreans’ approach to foreign assistance is undoubtedly influenced by their own remarkable transformation – from a country devastated by the Korean War in the 1950s to becoming the 12th largest economy in the world today. Since the end of the war until the late 1990s, Korea received $12 billion in foreign assistance, while today Korea is providing $1.7 billion in foreign assistance annually as an OECD Development Assistance Committee member.

At the same time, they project an unbiased and agnostic approach to assistance. In examining KOFIH’s work, it is clear that they do not push particular models, methodologies, or agendas. Their role is largely informative and facilitative – bringing peer countries together to share knowledge, exchange experiences, and generate solutions. They pair Korea’s innovative health agencies, such as Health Insurance Review and Assessment Service (HIRA) and National Health Insurance Service (NHIS) with budding counterpart agencies in LMICs. They understand that development is a process, and naturally, every process is unique. Most importantly, they do not expect any individual country’s development to look like South Korea’s.

The Koreans are still finding their feet in how to best engage in foreign assistance. Their strategies will surely evolve as they continue to learn about the dynamics in LMICs, narrow their focus, and harmonize their various foreign assistance agencies. But they are on to something. And it is a refreshing message for low- and middle-income countries, one I believe should be emulated by other providers of foreign assistance.