There is No Such Thing as Universal Health Coverage without…

On Monday, 600 delegates from development partners, NGOs, think tanks, and civil society organizations gathered at the United Nations in New York for an interactive multi-stakeholder hearing on Universal Health Coverage (UHC). Stakeholders discussed pertinent issues and inputs needed for a political declaration that will be developed ahead of the High Level Meeting on UHC in September at the United Nations General Assembly.

The day kicked off with opening statements including an address from Dr. Tedros speaking from Ebola-stricken DRC, and a promise from Mr. Githinji Gitahi, UHC2030’s chair and CEO of Amref, to “not listen to organizations, but voices of those whose are not loud enough.” This was followed by three panels: UHC as a driver for inclusive development and prosperity, leaving no one behind, and multi-sectoral and multi-stakeholder action and investments.

Common themes included the need for improving multi-stakeholder cooperation among countries, development partners, and civil society; rallying political will; mobilizing domestic resources; regulating and legislating; and creating accountability for UHC.

Co-author Amanda Glassman sat on the first of the three panels, moderated by the lively Femi Oke, and made a few critical points:

  • Economic evidence should be used to ensure public spending goes to the poorest and neediest. Research demonstrates that the most cost effective intervention can offer 15,000x the health benefit than the least cost effective (more on that here); interventions must thus be evaluated to maximize health gains.

  • We should not dismiss the private sector as a partner in achieving UHC. While the private sector is often viewed as poorly regulated and fraught with perverse incentives, there are real opportunities for it to compete with a complement the public sector—as demonstrated in India and Canada—so long as regulation, incentives, and objectives are aligned with the organization of the health system.

  • Think tanks can play a critical, less talked about, advocacy role. Countries transitioning from aid may face funding declines for traditional advocacy from civil society organizations. This presents an opportunity for think tanks—local and global—to play an important role in providing a neutral evidence base to inform and influence ministries of health and finance in their spending decisions.

  • The measurement movement and strategic purchasing for population health are practical tools for delivering optimal primary health care (PHC). With mobile tech now enabling fragmented data systems to talk to each other, we know more about real-time health systems needs, which can better inform strategic purchasing for PHC.

Reiterated throughout the day was the phrase, “there is no such thing as UHC without…”

  • primary health coverage
  • coverage for HIV, TB and malaria
  • coverage for non-communicable diseases
  • coverage for neglected tropical diseases
  • coverage for family planning, sexual and reproductive health
  • strengthening PHC; strengthening health systems
  • access for the poor, needy, stigmatized and marginalized
  • access for refugees
  • gender equality
  • youth engagement
  • social justice
  • (horizontal and vertical) equity
  • prevention
  • treatment
  • efficiency
  • quality
  • and more

You get the point. The real challenge will be moving away from all the buzzwords and rhetoric towards an actionable plan that will accelerate countries’ progress towards UHC. In order to do this, we suggest:

  1. Focus on more money for health, but also more health for the money, as raised by Darren Welch of DFID. This would require shifting away from vertical disease programs that are often not evaluated for cost effectiveness or impact, and towards an evidence-based approach to population health spend. This could include establishing country-owned and run systems of health interventions and technology assessment to inform policy decisions and priority setting as well as establishing mechanisms for development partners—especially those transitioning out of countries—to do the same.

  2. Harness political will to accelerate progress towards UHC, but don’t let politics drive all the spending decisions. While the necessity for political will was a recurring theme, it is critical to also ensure that the political attraction of inaugurating a hospital or a cancer center does not supersede less exciting and visible investments (e.g., PHC, essential medicines) that get countries the best value for money and health gains. Our first point should support this.

  3. Leverage “what works” from countries like Peru and Thailand to develop real steps towards UHC. Peru’s former Health Minister Midori de Habich discussed the country’s experience building capacity of local academic institutions to provide evidence-based research that informs policies that deliver outcomes and impact. Thailand was also a shining example, repeatedly cited, of a relatively poor country that has achieved great success in moving towards UHC by taking an inclusive, systematic, and progressive approach. South-South collaboration and exchange of these experiences should inform the UHC process.

Having recently launched the third round of funding for the international Decision Support Initiative (iDSI), CGD and iDSI together will continue working closely with development partners at the global level and policymakers at the country level to accelerate the move towards UHC. UHC cannot cover absolutely everything, so we will continue to focus our efforts on using evidence to address trade-offs and to set priorities for health in countries that can’t always afford to pay for everything for everyone.


CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.