there are many problems that remain in the still-embryonic coalition. Some criticism has come from the perception that the BRICS economic credentials are waning with the recession in Russia and the serious slowdown in Brazil and South Africa. Even the stars as far GDP growth is concerned, China and India, are marginally slowing down. The group’s environmental ambitions are limited, at least in the short term, when looking at the trade-offs between environmental management and rapid economic growth. Finally, it is argued that the political leverage of the block is also declining. Indeed, a new movement called ‘BRICS from below’ started in South Africa, has been claiming that BRICS is promoting ‘maldevelopment’ based on elitism, consumerism, and eco-destructive corporate-friendly policies. Other critiques have pointed out that though all the BRICS nations clearly have sustainable development as a priority of government policies, the group did not speak in one voice during the Open Working Group debates on SDGs set by the UNDP. The lack of progress of sustainability indicators in the BRICS has remained a cause of concern. A 2016 publication by the UN Sustainable Development Solutions Network and Bertelsmann Stiftung found that BRICS nations’ rankings on a sustainability index were very poor. Among 149 countries studied, Russia was ranked 47th, Brazil 52nd, China 76th, South Africa 99th, and India 110th.
Concluding Remarks
The world has been changing with regard to the distribution of economic power. The USA, Europe, and Japan have all been caught in low growth traps. The powerhouse of economic activity has been shifting discernibly to countries like China and India. In such a world, it is important that global leadership in diplomacy and policy debates be provided by new nations. Arguably, in terms of the future, the problem of sustainable development remains on the top of the list of concerns. Acceptable solutions are hard to find. Implementing them is a further challenge. It calls for a new kind of thinking that approaches economic wealth creation, innovations, and new ideologies that define the ‘good life’ for future generations in a way that is different and fit for the future. The BRICS group fits the bill in many ways. However, despite the advantage of size and geographical dispersion, they have too many problems of their own. The global consensus and the shared vision necessary are still indistinct. There is an opportunity for BRICS to take up global leadership in this context. Whether they succeed or not remains to be seen. It might be a tough ask. If they fail, however, the result may be costly for the future of humanity.
References
Kweitel, J. et al. (2017). “The BRICS Bank Needs a Bold & Participating Strategy for Sustainable Development”. Available at: http://www.opendemocracy.net (accessed May 23, 18).
O’Neill, J. (2001). Building Better Global Economic BRICS, New York: Goldman Sachs.
Papa, M. (2017). “Can BRICS lead the way to Sustainable Development?” Available at: http://www.sustainable-goals.org.uk (accessed May 23, 2018).
Santana, N. B. et al. (2014). “Sustainable development in BRICS countries: An efficiency analysis by data envelopment analysis”, International Journal of Sustainable Development & World Ecology, 21(3): 259–272.
Sarkar, R. and A. Sinha (2018). Economics of Sustainable Development, NY: Business Expert Press.
United Nations (2013). World Economic & Social Survey: Sustainable Development Challenges, New York.
1http://www.globalcitizen.org/ People’s Report Card (2016) (accessed June 3, 2018).
2http://www.esri.go. Comparative Analysis of the BRICS: Report prepared by the Mizuho Research Institute Ltd. For the Commission of the Economic & Social Research Institute (2005).
CHAPTER 7
Universal Health Coverage in BRICS: What India Can Learn from the BRICS Experience?
Indrani Gupta* and Samik Chowdhury†
*Health Policy Research Unit, Institute of Economic Growth, Delhi, India
† Ambedkar University, New Delhi, India
Introduction
Universal Health Coverage (UHC) has been a major topic of discussion and debate in the recent past globally, especially since the passage of a UN General Assembly resolution on UHC in December 2012.1 While global organizations such as the WHO and the World Bank have defined UHC, it is still not apparent whether all countries interpret UHC in a similar fashion. It has been argued that UHC has been labeled in a variety of ways and implemented based on the interpretation by countries, indicating the need for a global operational definition (O’Connell, 2014). Evidence does exist, however, to indicate that broader health coverage generally leads to improved health, especially for the poor via better access to services (Rodrigo and Smith, 2012).
The first Global Monitoring Report on Tracking UHC, brought out jointly by WHO and the World Bank,2 defines UHC thus: all people receiving the health services they need, including health initiatives designed to promote better health (such as anti-tobacco policies), prevent illness (such as vaccinations), and to provide treatment, rehabilitation, and palliative care (such as end-of-life care) of sufficient quality to be effective, while at the same time ensuring that the use of these services does not expose the user to financial hardship. The Sustainable Development Goals (SDGs) also contain a specific goal for UHC, making progress towards UHC a global as well national imperative.
Over the last decade or more, India has also been articulate about the country’s need to have UHC. However, the recent history of the country’s attempt at greater health coverage raises the issues of interpretation of UHC specifically, as well as prioritization of health in general. The BRICS countries as a whole are not necessarily the best examples of how UHC is to be implemented. The group is small, the economic and political situations are somewhat different, and the experiences are diverse. Nevertheless, this diversity of experiences is possibly sufficient to understand the “do’s and don’ts” in the path to UHC, and would contain important lessons for India. There are earlier analyses on this subject as well where a slightly different set of indicators have been used to look at the progress towards UHC (Marten et al., 2014). We aim to expand the analysis substantially with more recent data and also use a slightly different approach to understand where India’s position vis-à-vis the other BRICS countries in the context of UHC.
We start by laying out a framework to understand how one might measure progress towards UHC in the second section. In the third section, we look at the health status and disease profile in these countries, which is important to understand priorities within any UHC package. In the fourth section, we look at selected indicators discussed in first section to understand the countries’ progress towards UHC. Fifth and sixth sections analyze governance and health reforms, respectively. In the last section, we present our conclusions based on the analysis on how countries have fared and what India might take away as valuable lessons from these varied experiences.
Understanding UHC in BRICS Countries: A Framework
The World Health Report of 2010 (Evans and Etienne, 2010) laid out a simple list of three questions that countries need
