The Global Politics of Universal Health Coverage: A Comparative Analysis of WHO, World Bank, and USAID Political Discourses

This paper explores how leading international organisations—specifically the World Health Organisation (WHO), the World Bank (WB), and the United States Agency for International Development (USAID)—construct and communicate policy narratives around Universal Health Coverage (UHC). International organisations are typically regarded as norm setters and monitors of compliance. However, less focus has been given to the ways they actively shape policy discourses that convey normative claims for action, define priority goals, contextualise health challenges, establish values, and propose methods for achieving policy goals. This study addresses how these international organisation narratives communicate UHC to the world, exploring the underlying ideas that shape policy directions in global health. By selecting key documents produced by WHO, WB, and USAID, we undertake a qualitative, exploratory review of the dominant narratives that these actors project in global health policy circles, particularly those surrounding UHC. The selection process identified 35 documents that satisfied the study’s inclusion criteria, which required publication between January 2019 and June 2024, a global rather than regional or country focus, and a clear emphasis on UHC as a central theme. These documents vary significantly in format and purpose, ranging from global strategy frameworks and policy briefs to technical reports and monitoring papers. Using Fairclough and Fairclough’s (2012) political discourse analysis framework, we reconstructed each organisation’s reasoning by creating extended tables that capture claims for action (solutions proposed), circumstances (problem identification), goals, values, and means-to-goal frameworks. Each element was documented through direct quotes from the policy texts, enabling a detailed comparison of how WHO, WB, and USAID conceptualise and operationalise UHC. By translating these elements into concise narrative summaries, we highlight both convergences and divergences in their approaches to health policy transformation towards UHC. The analysis of UHC discourses from WHO, World Bank, and USAID shows noteworthy differences in their views on what UHC should encompass and how it should be achieved. One notable difference is that the WHO and World Bank emphasise pre-paid public funding as essential for UHC, whereas USAID does not share this view. These variations highlight that UHC remains a space for political negotiation and conflicting priorities, reflecting broader power dynamics in global health.