Universal coverage for all? Health inequalities in MCH and health systems reforms in Brazil and India

Emerging economies are showing signs of health improvements with average levels of key health outcomes increasing but with levels of inequalities at times worsening. Using the National Family Health Surveys (1992, 1998, 2005) for India and Household Demographic Surveys (PNDS) (1992, 1996, 2006) in Brazil this paper analyses how the stages in public spending reforms in both countries have progressed at a time of health improvements and how they have might have had an impact on health inequalities focusing on maternal and child health (MCH). This has been at the forefront in low and middle income countries in widening access to health care. The aims of this paper are to chart the evolution of health reforms in both Brazil and India and to assess how inequalities in MCH have changed over this period. Without aiming to assess the impact, the following issues are addressed: Have health reforms over the last two decades improved or worsened inequality? What can be learnt from the experiences and how can we benefit from the comparison between Brazil and India? What are the key challenges in comparing two culturally and politically different countries? The paper shows how Brazil is succeeding in reducing inequalities whereas India has still a long way to go. This paper is set within a wider call for universal health coverage in LMICs.