The Bahamas’ Path to Universal Health Coverage

In 1973, The Bahamas gained independence from Great Britain and embarked on the journey of nation-building. Among its national priorities in the post-independence era was the recognition of health as a fundamental pillar of development. The vision for Universal Health Coverage (UHC) first appeared in the 1983 Speech from the Throne. However, it would take nearly 35 years for this vision to begin materializing with the launch of the National Health Insurance (NHI) program in 2017. 

NHI Bahamas emerged in response to alarming trends in public health, including a rise in noncommunicable diseases and the prevalence of unhealthy lifestyles. The country consistently exceeds regional averages in rates of obesity, hypertension, and cancer. The burden on the healthcare system—stretched thin across the archipelago—is immense, and escalating healthcare costs have rendered the system increasingly unsustainable.

Faced with these realities, the NHI program was introduced as a critical step toward reform. Its central mission is to transform the health system by making quality care accessible, affordable, and equitable for all Bahamians. The country’s journey toward UHC has centered on improving care standards, integrating the healthcare sector, and strategically expanding coverage in phases.

Within just ten days of its launch, NHI Bahamas registered over 10,000 beneficiaries—a figure that has since grown to more than 160,000 in a nation of under 400,000 residents. A robust network of credentialed healthcare providers now spans the archipelago, and technological innovations have enabled the program to monitor and track population health effectively. These achievements signal a clear and attainable pathway to comprehensive UHC.

At its core, NHI Bahamas focuses on primary care, offering essential services such as physician visits, lab work, antenatal care, and infant health services. Reforms under the program have elevated healthcare standards, introduced modern reimbursement mechanisms, and placed an emphasis on wellness and preventive care. The patient-centered approach has fostered greater public engagement and awareness.

In parallel with its healthcare reforms, NHI Bahamas has spearheaded the digital transformation of the national health system. The introduction of electronic health records in 2019 marked a turning point, laying the groundwork for improved data collection, reporting, and evidence-based decision-making. Embedding technology into the program’s framework has proven to be one of its most impactful achievements.

Across the Caribbean, countries and territories are working toward achieving UHC. Yet, many of our systems remain fragmented, outdated, costly, and difficult to sustain. It is imperative that we strengthen health infrastructure—both within our own nations and through regional collaboration.

The Bahamas’ journey offers several key lessons for others embarking on the path to UHC. Here are three core takeaways:

1. Just Get Started.

Too often, our progress is stalled by over-planning and a desire for ideal conditions. We commission endless studies, hoping for the perfect moment. But the evidence is clear: our current systems are failing. Every delay exacerbates the burden on citizens. Begin where you are. Identify strengths, quick wins, and pressing gaps. Understand your system—what works, what doesn’t—and take the first step. As the old adage goes: “The best way to eat an elephant is one bite at a time.” Start chewing.

The best way to eat an elephant is one bite at a time.

2. Make the Journey Your Own.

While valuable insights can be drawn from global experiences, your UHC approach must reflect your country’s unique realities. In the Caribbean, resources—financial, human, and material—are often limited. It’s essential to tailor your UHC model to your cultural context, geographic structure, health literacy levels, and capacity for systemic change. Build a system that meets your needs, maximizes your assets, and defines success on your terms.

3. Engage Stakeholders Early and Often.

Stakeholder engagement is not optional—it’s essential. UHC must be implemented with stakeholders, not to them. Consult and collaborate with all affected parties: policymakers, healthcare providers, insurers, unions, community groups, and the general public. Their input, feedback, and buy-in are critical to successful design, implementation, and sustainability. Maintain open channels for dialogue, and adapt as needed. Inclusion builds ownership and trust.

The road to Universal Health Coverage is a journey—not a final destination. Along the way, there will be challenges, changes, and victories. The path may not always be clear or linear, but persistence is key. From the bright shores of The Bahamas, we extend our encouragement and solidarity to our Caribbean neighbors. Let’s continue sharing our experiences, learning from each other, and advancing together toward a healthier future.