The goal of universal health coverage is receiving growing attention. How best to improve risk pooling and to ensure that the most socially disadvantaged receive priority in having their health care costs met, are questions yet to be answered, particularly within the African context where very few countries have achieved universal health systems. South Africa is introducing National Health Insurance, where formal sector workers will make mandatory contributions which will be pooled with allocations from general tax revenue. Tanzania is integrating existing health insurance schemes for formal and informal sector workers under the management of a single insurer. Translating such health financing reforms into intended changes ‘on the ground’ requires a well functioning monitoring and evaluation system which provides data that allow policies to be improved over time, and consequently strengthen their potential to achieve universal health coverage.

This research aims to support these reforms intended to achieve universal coverage in South Africa and Tanzania by monitoring and evaluating the policy processes. Specifically, it seeks to: track policy formulation and planning for implementation; monitor the progress of policy implementation at both the national and district levels, with an emphasis on identifying implementation problems and serving as an ‘early warning system’ for policy makers and implementers; evaluate the impact of interventions aimed at progressing towards the goal of universal coverage; engage with policy makers and implementers at all levels about the research findings throughout the study period; and synthesise the results from the studies in the two countries, and compare these with experiences in other countries, to draw out policy implications on health financing mechanisms and implementation strategies supporting the achievement of universal coverage for quality health care in low- and middle-income countries.