2024–2027 Strategic Framework

 

Progress towards UHC is off track. According to the latest data, at least 4.5 billion people — more than half of the world’s population — are not fully covered by essential health services (2). Financial protection is also deteriorating, with 2 billion people experiencing financial hardship due to out-of-pocket health costs (2). People in vulnerable and marginalized situations, including those living in low- and middle-income countries, are most severely affected (3). Furthermore, recent data show that health systems in 136 low- and middle-income countries cannot deliver essential services to women, adolescents and children in need (7).

Progress towards UHC depends on complex, multifaceted factors. Barriers that hinder progress include lack of political will to prioritize people’s health, weak health and information systems, a shortage of health and community health workers, and inadequate health financing. However, reforms to create fiscal space and convert out-of-pocket payments into pooled funding for health are possible and within reach (8). The political attention displayed at the 2023 UN high-level meeting on UHC has yet to be translated into national political priorities, financing, policies and programmes.

UHC has risked falling off agendas since the peak of the COVID-19 pandemic, despite being the key to equitable, resilient health systems that leave no one behind and providing the foundation for health security. Resources may be diverted from national health systems due to increasing competition with other urgent priorities, such as food insecurity, new and expanding large-scale conflicts, and climate change, of which the impact on health and well-being is now widely recognized (9). Without UHC and adequate financing for national health systems, people and communities are more vulnerable to local, regional and global health shocks, placing international stability and prosperity at risk. Disease- and population-specific gains and broader development gains made over the past decades could also be lost. In the context of waning political support, geopolitical tensions, budgetary constraints and other crises, the case for UHC must be made collectively, more clearly and in a way that is compelling for all stakeholders.

The change that UHC2030 aims for by 2027 is the translation, by every country, of the commitments made in the 2023 UN High-level Political Declaration on UHC into laws, budgets, policies and programmes for the achievement of SDG target 3.8 by 2030. Ahead of the next UN high-level meeting on UHC in 2027, UHC2030 will continue to use the Action Agenda from the UHC Movement (10), which provides eight action-oriented policy recommendations and milestones for 2025 to advocate for and strengthen country accountability for progress.

UHC2030’s overarching goal for 2024–2027 is to harness the power of its constituencies and entities to influence the translation of commitments made in the 2023 Political Declaration into action towards the realization of SDG 3.8 by 2030.

Through collective activities and direct action by our constituencies, we can help to ensure that progress on UHC is on track to achieve 2030 targets. Our collective work will support the following UHC dimensions and enablers.

• Universality, equity and the right to health are the starting points of UHC and the key to expanding population coverage. UHC serves all countries and all people, but its implementation must start with the prioritization of the health needs and access of people in vulnerable and marginalized situations, among whom women, adolescents and children are disproportionately represented (7). To ensure that everyone, everywhere has access to health services, efforts must be made to tackle health inequities, barriers to human rights and gender inequality.
• The means to expanding service coverage and achieving UHC and health security is investment in resilient health systems, designed and based on country and population needs (11). The most inclusive, equitable, cost-effective approach is through primary health care (12), to ensure that services are of high quality, safe, comprehensive, integrated, accessible, available and affordable for everyone, everywhere (13). Health systems must be gender-responsive, rights-based, climate-resilient and adaptive. They should also leverage digital opportunities to improve health outcomes.
• Expanding and sustaining financial protection requires adequate public financing and engagement beyond the health sector. It is possible to remove financial barriers and prevent financial hardship by providing access to a core package of health services that are affordable or free-of-charge to people in vulnerable and marginalized situations (2). Securing adequate funding for UHC implementation requires countries to prioritize health, improve the efficiency of health financing, and establish pre-paid, pooled, compulsory contributions (2, 14) through cross-sectoral, multi-stakeholder collaboration and a whole-of-government approach.
• The inclusive governance of health systems through social participation, involving all relevant stakeholders and fostering youth engagement, contributes to building trust. This whole-of-society approach also helps to ensure that health policies and services are responsive, equitable and effective.

This section outlines the key activities and outputs of UHC2030 constituencies in 2024–2027, as part of their engagement with UHC2030.

Countries

Countries at all income levels can create the conditions in which the right to health is ensured, upheld and respected for everyone and commitments to UHC in the Political Declaration are met. On advocacy, countries will ensure that UHC is high on global and regional agendas by promoting the inclusion of UHC and health systems strengthening in multilateral negotiations. They will also advocate for achieving UHC targets, including prioritizing the health needs and access of people in vulnerable and marginalized situations in their own national institutional processes. Countries will strengthen their accountability and resolve barriers to progress towards UHC by using the State of UHC Commitment reviews (15) and other tracking tools to review progress and by improving reporting in voluntary national reviews on achievement of the SDGs. Building on the Lusaka Agenda (16) and the WHO Fourteenth General Programme of Work, countries will support alignment behind more efficient, effective global funding for health systems strengthening and UHC by promoting coherence on issues such as resource mobilization, project implementation, monitoring and evaluation, and replenishment for global health initiatives.

Multilateral organizations

As entities that work on multisectoral issues that transcend national boundaries and cannot be solved by one country or sector alone, UN agencies will highlight the importance of UHC for broader development and for population- and situation-specific targets. On advocacy, they will make efforts to ensure that UHC is included on agendas for global and regional policy events and processes through their regional and country offices and at headquarters. They will also ensure that UHC2030 materials inform relevant technical meetings and national policies. On accountability, they will support the dissemination of UHC2030 tools and products for tracking implementation, including in forums on subjects other than health. On alignment, they will support the channeling of international funding for health systems strengthening and will contribute to achieving country priorities by developing partnerships and taking country-level coordinated action.

As global financing entities, global health initiatives will ensure that funding is effectively aligned for achieving UHC. On advocacy, they will ensure that UHC is featured on global and regional agendas and that its importance is emphasized in multilateral and national processes. To strengthen countries’ accountability for progress towards UHC, they will provide evidence-based data and share experiences in measuring accountability. On alignment, global health initiatives will also work towards coordinating and aligning their investments in health systems and their overall work on health systems strengthening to build on the Lusaka Agenda.

Civil society organizations

Through the civil society engagement mechanism platform, civil society organizations will work to ensure that UHC policies are inclusive and equitable, and that attention is systematically paid to people in marginalized and vulnerable situations to ensure that no one is left behind. On advocacy, they will ensure that UHC is featured high on agendas by advocating for UHC at key global and regional events and on UHC Day, and they will make the case for UHC before national elections. On accountability, they will help to identify and address challenges, in particular for people left behind, by engaging with communities in need and at risk at country levels. They will hold countries accountable by contributing to the development of the State of UHC Commitment review and by using evidence from this and other reviews. On alignment, they will lobby global actors and engage with parliamentarians to strengthen national priorities for UHC.

Philanthropic foundations

Philanthropic foundations will use their convening power, expertise and funding to advance progress towards UHC. On advocacy, they will persuade the organizers of global and regional events to include UHC on agendas and to share evidence-based messages on UHC. On accountability, they will work to remove barriers to UHC and support strengthening and dissemination of tools for tracking UHC implementation. On alignment, they will ensure that their funding and that of other grantees supports health systems strengthening and UHC.

The private sector

The private sector will provide a collaborative platform for entities interested in fostering dialogue and cooperation on UHC. On advocacy, they will help to raise awareness about the importance of UHC in the global and regional arena by using UHC2030’s evidence-based messages to publish op-eds and engage in UHC-related events. To foster accountability, they will help monitor action on commitments and remove barriers to progress towards UHC, as detailed in the statement on private sector commitments to UHC in 2023 (17). On alignment, they will support health systems strengthening by facilitating collaboration in joint private sector-government events and exchanging best practices, in the spirit of building trust.