Clearly written and rigorously thought through, this ‘how-to’ document explains in detail how a government can plot a path of reforms that will lead to universal health coverage (UHC) for its population. Though developed to support Pakistan’s Khyber Pakhtunkhwa provincial government in its ambitious recent introduction of a social health protection (SHP) scheme as a pivotal element of its vision for UHC, this study also has relevance for a broader audience. Taking a holistic perspective, it presents a systematic overview of the great variety of factors that need to be taken into consideration in planning to achieve UHC. These include information on demography, disease burden and access to health services, alignment with national and provincial health policies, analysis of fiscal, political and legal constraints, criteria for the benefits package and for the selection of beneficiaries and their potential expansion, the interplay of stakeholders (government, insurance companies, health providers) and data and system requirements, as well as the issues of health financing, portability of benefits, and cross-subsidisation for risk pooling.

These general principles are addressed in the context of Khyber Pakhtunkhwa’s rapid expansion of social health protection, with information on the successive projects and their management mechanisms and interconnections. Political will and vision are highlighted as essential prerequisites for reform: in 2017, for instance, the provincial government increased its health budget by 39% and granted an autonomous status to major public hospitals to enable their participation in the SHP scheme. Once developed, the author cautions, the roadmap to UHC should remain a living document, regularly updated under the responsibility of a specially appointed task force.