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Many developing countries are considering insurance as a means of pursuing Universal Health Coverage. A key challenge to confront is how to achieve high levels of health insurance enrolment. For voluntary schemes this entails mass awareness raising and promotional activity, though as schemes move to compulsory enrolment, monitoring and enforcement are required. This paper focuses on Ethiopia, which has made state health insurance for the informal sector a central pillar of its Universal Health Coverage strategy. The paper shows that high enrolment requires particular forms of state capacity, captured by Michael Mann's concept of state 'infrastructural power'. The paper draws on detailed case studies of insurance implementation in the Tigray and Oromiya regions of Ethiopia to illustrate variation in state infrastructural power and the implications for health insurance. Findings suggest that the potential of state health insurance as a means of promoting health access for a broad section of the population may be limited to the minority of countries or regions within countries exhibiting high levels of infrastructural power.

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COVID-19 accentuates the case for a global, rather than an international, development paradigm. The novel disease is a prime example of a development challenge for all countries, through the failure of public health as a global public good. The COVID-19 pandemic has highlighted the falsity of any assumption that the global North has all the expertise and solutions to tackle global challenges, and has further highlighted the need for multi-directional learning and transformation in all countries towards a more sustainable and equitable world. We illustrate our argument for a global development paradigm by examining the implications of the COVID-19 pandemic across four themes or 'vignettes': global value chains, digitalisation, debt, and climate change. We conclude that development studies must adapt to a very different context from when the field emerged in the mid-20th century.

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With Universal Health Coverage (UHC) now entrenched among the top global development priorities, questions arise as to the conditions under which politicians commit to UHC and why certain strategies for health financing and access are favoured over others. The Ethiopian government has been piloting and scaling-up Community-Based Health Insurance (CBHI) for the informal sector since 2010 and is establishing Social Health Insurance for formal sector workers as a means of achieving UHC. CBHI covers 11 million people making it one of the largest health insurance schemes in Africa. This paper employs a process tracing methodology to examine the political drivers of the adoption and evolution of state health insurance based on 28 key informant interviews conducted between 2015 and 2018 with politicians, policymakers and donor officials. The paper highlights the inadequacy of existing theories-focusing on interest group mobilisation, electoral competition and bureaucratic actors-for explaining the Ethiopian case. Instead the paper proposes an 'Adapted Political Settlements' framework that explains the state's push to expand CBHI and stalled progress on SHI. This framework highlights the interests and ideas of the ruling coalition as important drivers of reform. In a context of ruling party dominance and minimal threat from electoral competition, the ruling coalition has sought to build political legitimacy through the delivery of socioeconomic progress, including health services. The policy idea of health insurance, meanwhile, has secured elite commitment due to its fit with deeply held ideas within the ruling coalition concerning the importance of self-reliance and resource mobilisation for development. Finally, the centralisation of power within the ruling coalition prior to 2012 enabled the emergence of a long-term developmental vision and the marginalisation of opposition to health insurance, while fragmentation of the ruling coalition since 2012 has led SHI to stall.

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The use of natural flood management (NFM) measures to address severe flooding received considerable public attention during December 2015-January 2016 storms. Within the Warwickshire-Avon Catchment, UK, high arable and improved grassland land cover with small, isolated communities at risk, lead to the exploration of novel techniques that use farmland high up in flood-prone catchments to hold water and reduce outflow discharge. This paper will discuss the methodology used to identify areas in the Warwickshire-Avon, which could be used to install NFM measures to attenuate the storm peak and provide wider ecosystem services, principally addressing total phosphate and sediment entering the receiving watercourse. This involved constructing a GIS database of catchment geomorphological characteristics whilst simultaneously engaging with those significant stakeholders of farmers and landowners to capture local input and produce a model for applied NFM for future projects looking to explore the role of working with natural processes (WwNP) for flood risk reduction within the agricultural environment. The advantages, disadvantages and key lessons learnt are also presented in this paper, to recognise the benefits and limitations of communities and catchments exploring such methods for flood risk management (FRM).

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