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

The International Labour Organization’s (ILO) 2014/2014 World Social Protection Report included several indicators for quantifying the expansion of Universal Health Coverage (UHC), including measures for both effective and legal health coverage (LHC). Its measure for LHC, a critical component of UHC, purports to quantify rights-based protection in the area of health for 47 African countries. This paper is the second of a two-part series critiquing the ILO’s LHC measure. Paper 1, “The ILO's measure of LHC: Is it conceptually strong?” analyses the strength of the ILO’s concept of LHC. This paper explores the measure’s reliability through (i) an investigation into the trustworthiness of the sources cited in the metadata for African estimates; and (ii) a quantitative analysis. The quantitative analysis used simple linear regressions to examine whether the measure could significantly predict de facto access to primary health care in African countries, both for the national average and the poorest fifth of country populations. The World Health Organisation’s (WHO) measure of birth coverage (the percentage of births attended by skilled health personnel) was used as a proxy indicator for access to primary health care. This study’s findings indicate that only one-fourth of the ILO’s African coverage estimates are reliable. Statistical results indicate that the ILO’s measure cannot be used to predict access to primary health care in Africa) for total country populations or for the poorest quintile.