#UHCDay 2021: Elevating Health Financing as the Cornerstone of Universal Health Coverage

Investing in health yields massive social and economic returns. To mark this year’s Universal Health Coverage (UHC) Day on December 12, we’ve brought together recent work from CGD’s global health policy team to advance #HealthForAll through an elevated financing agenda.

As the devastating toll of COVID-19 shows the financial and human costs of inadequate policies, now is the time for bold action in health financing. Here are seven ways CGD seeks to drive lasting change for UHC. 

1. Protect essential health services amid intense fiscal pressures and protracted pandemic recovery

Since the start of the pandemic, CGD has been keeping close tabs on the collateral consequences of COVID-19 for essential health services. According to the GFF, for each COVID-19 death, more than two women and children have lost their lives due to COVID-related disruptions. As countries continue to suffer from the economic fallout of COVID-19, budgetary space for essential health services is severely constrained.

CGD research underscores the need for donors to scale up support to address preventable illness and death and avoid further setbacks on decades of progress, with a focus on mitigation strategies targeting women and girls. Given unpredictable aid flows (as demonstrated by FCDO), external partners should also commit to directing these resources to country budgets so that governments can continue to build financing, implementation, and oversight functions.

2. Boost revenues and improve outcomes through health taxes

The growing global burden of non-communicable diseases from consumption of tobacco, alcohol, and sugar-sweetened beverages will increasingly strain health systems. Recent analysis from CGD finds that corrective taxes on these products can result in substantial macroeconomic benefits from better health.

CGD experts also estimate that health taxes levied on tobacco products, alcohol, and sugar-sweetened beverages could close at least half of projected revenue shortfalls from COVID-19 in lower-income countries. International financial institutions should play a central role in promoting health taxes as part of the fiscal response to the pandemic and as a promising way to protect on-budget health spending for UHC.

3. Design and update benefits packages that serve as a roadmap to UHC implementation

The creation of a health benefits package (HBP)—a defined list of essential services to be funded with public monies—is an important step in countries’ journey to UHC. Through the International Decision Support Initiative (iDSI), the CGD team has been collaborating with country governments around the world to select services and products for HBPs that help optimize health gains based on available resources and policymaker priorities.

The HBP implementation process continues long after the plan is first developed and involves regular review and evidence inputs. To this end, CGD also partnered with the Joint Learning Network for UHC to facilitate cross-country knowledge sharing on HBP implementation and revision challenges, such as evidence generation and use, transparency and consultation processes, and political economy factors.

4. Enhance coordination among development partners and governments to integrate programs with country systems

Vertical programs focused on one disease or programmatic area remain a common disbursement mechanism for donors, despite widespread recognition of the need to shift to government systems. For countries simultaneously aspiring towards UHC and facing increased pressure to take ownership of health care provision, all while battling a global pandemic, there is little guidance on how to incorporate externally funded programs into HBPs and budgetary processes.

CGD’s examination of how countries have previously approached these issues surfaced key challenges and enablers related to program integration and transition, including the importance of proactive coordination and collaboration among development partners. To successfully integrate vertical programs, donors and governments must take a holistic approach to allocative efficiency and work together to reform operational systems (e.g., procurement, infrastructure, and human resources) that advance programmatic sustainability and allow UHC policies to translate into effective practice.

5. Use evidence to inform COVID-19 prevention and treatment

Amid stretched budgets and competing priorities, policymakers face tough choices about how to treat critically ill patients and how much of which COVID-19 vaccines to buy and at what price.

On treatment, CGD collaborated with research teams in Kenya, Tanzania, the UK, and Sweden to assess the cost-effectiveness of a scalable package of essential emergency and critical care (EECC). Results launched at a CGD event earlier this week suggest that EECC implementation should be a first priority, ahead of advanced critical care like mechanical ventilators, given EECC’s high value for money.

On vaccines, CGD teamed up with the Africa CDC Health Economics Unit to develop a toolkit for collecting evidence on COVID-19 vaccines to help answer procurement questions. Through rigorous analysis, countries can make evidence-based decisions about how to finance COVID-19 vaccination without jeopardizing funding for essential services and UHC plans.

6. Gear up for the next pandemic

With the human and economic cost of global pandemics resonating more broadly now than ever before, governments must rally sustained financing and effective governance to ensure that the world can prevent, detect, and respond to future pandemic threats.

CGD supported the G20 High-Level Independent Panel on Financing Global Commons for Pandemic Preparedness and Response, which recommended not only investments in globally networked surveillance and the supply of medical countermeasures, but also enhanced commitment to health systems strengthening at the country level for collective health security. The COVID-19 pandemic has demonstrated the need for resilient national health systems as the foundation for detecting and preventing the spread of emerging outbreaks—and responding adequately when emergencies occur.

7. Leverage global health procurement and supply chain reforms

Shifting disease burdens and transitioning funding sources have complicated health product markets. This changing landscape necessitates better regional, national, and subnational procurement and supply chain practices—including cooperative purchasing, supplier diversification, and quality regulation—to improve access to safe, effective, and affordable essential medicines.

Yet, as highlighted by CGD’s ongoing work on health procurement and supply chains, the importance of these vital functions is often overlooked. By prioritizing support for more efficient country-driven procurement, donors can stretch scarce resources further and potentially generate significant savings that can be (re)allocated to the health sector to progress toward UHC goals.

A better future for health financing

At the UN General Assembly in 2019, global leaders committed to the Political Declaration on UHC. With less than ten years until the SDG deadline and two years until the follow-up 2023 High-Level Meeting on UHC, it is time for decision-makers to put their money where their mouths are by mobilizing greater resources for health amid the crisis and maximizing value for money of health spending. The above areas are a good place to start.


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.