If the workers are not healthy then the economy won’t be healthy – it’s a simple truth.

Ali Joseph, a driver in the Tanzanian port city of Dar es Salaam, knows this better than most. Driving to work one morning, a lorry ploughed into Ali’s autorickshaw, breaking his pelvis and burning his legs.



Ali’s injuries required hospital treatment. But with his earnings lost, the household finances could not support a long stay, a situation that contributed to his long-term disabilities. His wife, Amina, who previously earned a living selling padlocks to people stuck in traffic on the city’s congested roads, had to rotate street hawking with caring for Ali, a responsibility she shared with her daughters. Their eldest sons had to leave secondary school to make ends meet.



At a stroke, the family’s educational and economic aspirations had been shattered.

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If an accident, a routine diagnosis or even a pregnancy with complications can demolish a family’s means, surely countries should do everything they can to provide free healthcare? Universal health coverage, core to goal three on health in the UN’s sustainable development plans for 2030, addresses just this. According to this principle, everybody should be able to receive the health services they need.

With the glaring exception of the US, it is now the norm in high-income countries to have access to publicly funded healthcare that saves lives, stimulates growth, reduces poverty and builds nations.

But in many countries health services remain unaffordable; they are often far from home, and can be of uneven quality. Crises such as the Ebola epidemic bring into painful focus how where you are born may not only diminish your chances of getting the care you need, but also result in you dying from a disease or outbreak that could be treated elsewhere.

On his first day in office as the director general of the World Health Organization, the former Ethiopian health minster Tedros Adhanom Ghebreyesus nailed his colours to the mast. “Do we want our fellow citizens to die because they are poor? … Without health, people have nothing. Without health, we have nothing as humanity.”

He was supporting an idea that some previously dismissed as utopian, but which finally – if not yet universally – seems to be coming of age more widely.

It may have been in vogue in the 1980s for the World Bank to demand that even the poorest pay user fees for health, but big institutions are rethinking. This is because evidence shows (pdf) that even the most modest fees can block access to services, perpetuating poverty.

At the most absurd extreme, in countries such as Kenya and Nigeria, it is not unusual to find women and newborns held in hospitals until their family can find the fees to pay for their release. Many may not have had access to family planning services.

As well as the obvious health benefits, there are huge economic and political gains to be had from universal healthcare. Access to medical treatment is a human right, but if dignity and equity do not justify the investment in the view of some, economic outcomes should. In 2015, 267 economists from 44 countries signed the Economists’ Declaration on universal health coverage, which found that “returns were more than 10 times the costs”.

To build a productive workforce, employees and entrepreneurs need not just quality education and training, but sound healthcare too. In South Africa, for example, companies have learned the benefits of providing antiretroviral treatment through workplace health schemes.

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The South African government is introducing a national health insurance programme to improve healthcare in a country where insurance schemes cover only 16% of the population.

Transition can be daunting. This month, the Elders – a group of global leaders, represented by Mary Robinson and Graça Machel, who campaign for human rights – paid a visit to Tanzania. They were there to support the government as it prepares to introduce new policies that, it is hoped, will lead to healthcare for all.

Health in Tanzania, a country ranked 151 out of 188 countries in the UN’s latest human development report, receives 10% of the national budget, 5% less than promised when it signed the Abuja declaration.

The government has introduced reforms to procurement, but faces staff shortages in the sector, especially in rural areas, after a clearout of underqualified personnel.

The Elders argue that you begin with primary healthcare for women, children and adolescents, because they currently have the least access when it’s needed and the least economic power or independence to seek private alternatives.

As things stand, 30 women die every day (pdf) in Tanzania due to pregnancy complications or during childbirth. An estimated 268 children under the age of five die daily as a result of pneumonia, diarrhoea, malnutrition, infections, malaria and birth complications. And by the age of 19, 27% of adolescents are either mothers or pregnant with their first child.

Even if you are among the quarter who have some kind of insurance cover, it can take resolve to demand the care you need. Neema Komba, a Tanzanian unionist, presented herself at a hospital in Dar es Salaam, bleeding from a nail that had gone through her hand. She had remembered to take her national health insurance card only to be told that she should go to the pharmacy instead to obtain gloves and the stitches she needed, since the person responsible for the health insurance scheme was not there.

Neema stood her ground. “Am I to tell my husband’s employer that they should stop making contributions to this insurance because when we need help, there is none?” she asked.

“In the end it was only after being rude that I eventually was helped,” she said.

Committing public finance to health access for all is inevitably a political step. But increasingly politicians recognise its popularity. It worked for the Indonesian president, Joko Widodo, whose path to the presidency was bolstered by his health policies as governor of Jakarta, and also won favour for Thaksin Shinawatra in Thailand.

Most British people are aware of Aneurin Bevan’s efforts to establish our NHS. Canadians recognise the role played by Tommy Douglas. New Zealand will celebrate the 80th anniversary of its national health system next year. Much of Latin America has embraced universal healthcare. China has recently reinvigorated its approach. Ministers in countries such as Tanzania are exploring further reforms.

So who will step up now for the citizens of ambitious countries such as Nigeria and India, which surely should be making similar moves?