Reconceptualising Universal Health Coverage (UHC) for global distributive justice: The case of the Drugs for Neglected Diseases initiative

Since its inclusion in the Sustainable Development Goals in 2015, the global health target of achieving Universal Health Coverage (UHC) has largely stalled. This article contends that one of the reasons for this lacking progress refers to the fact that the current definition of UHC does not sufficiently account for the transnational realities of global health. This article seeks to develop a more conceptually robust understanding of what UHC is, and what is normatively required to achieve it. In this context, the article proposes a novel definition of UHC that is adapted to the transnational realities of global health and advances an understanding of UHC as a global distributive justice norm. This normative theorising draws on literature in global distributive justice, which has largely been neglected in research and policy-led efforts to understand UHC. In this reconceptualisation, the article accentuates three required discursive shifts: from 'good health' to 'fair health'; from 'assistance' to 'duty'; and from 'cost' to 'investment'. To illustrate the conceptual and empirical validity of this reconceptualisation of UHC, it is then empirically applied to the activities of the Drugs for Neglected Diseases initiative (DNDi) in its health system strengthening efforts on Chagas disease in Latin America.