The International Labour Organization's Measure of Legal Health Coverage: Is it Conceptually Strong?

In 2014, the International Labour Organization (ILO) issued its annual World Social Protection Report. This report aimed to provide practical information on social protection that could be used by stakeholders for the roll-out of universal health coverage, including a new measure of legal health coverage (i.e. rights-based protection). Because this measure has estimates for 47 African countries, it potentially holds significance as a monitoring tool for the expansion of universal health coverage and the right to health across the African continent. This study examined whether the ILO’s legal health coverage measure could actually be used to quantify LHC in Africa. To do this, the study assessed (i) whether the measure matched the ILO’s own stated definition/concept of legal health coverage and (ii) whether the measure sufficiently reflected the concept of legal health coverage as defined in the academic literature. The findings of this investigation indicate that the ILO’s measure was operationalised in a way that failed to capture key conceptual elements of legal health coverage.