Putting communities at the heart of health systems strengthening to achieve UHC

Universal health coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. It covers the full continuum of essential health services across the life cycle both in times of crisis and calm.

To make progress on UHC, we need to be accountable to communities’ needs and align our efforts and resources fully within national health plans. Failing to do so can lead to inefficient, inequitable, and fragmented approaches that lack accountability to populations most in need.

As a group of diverse organizations and partnerships that have come together as the UHC2030 Health Systems Strengthening Related Initiatives, we believe that people and communities lie at the heart of health systems strengthening through primary health care (PHC), as a foundation for UHC and the 2030 health-related Sustainable Development Goals (SDGs). 

Through our work, we know that reorientating health systems towards PHC has major benefits. Ninety per cent of essential health interventions can be delivered with significant cost efficiencies by integrating services into PHC. Seventy-five per cent of the projected health gains from the SDGs could be achieved through PHC, including saving over 60 million lives and increasing average global life expectancy by 3.7 years by 2030.¹ The COVID-19 pandemic has, however, led to setbacks in country UHC progress, and in some countries even stagnation. People in low- and lower-middle income countries have been especially vulnerable, but lack of progress is evident across all income levels.

Aligning sectors, partners, resources, and interventions behind country plans, ensuring the needs of vulnerable communities are addressed, and strengthening health systems through more holistic PHC efforts could increase efficiency, effectiveness, equity, and speed up progress towards UHC goals.

The UHC Action Agenda by the UHC Movement and recent Lancet commentary by UHC Political Advisory Panel members make the case for UHC as the umbrella to deliver health for all people and communities through strong health systems, essential public health functions, and effective pandemic prevention, preparedness and response. As part of the UHC2030 family, the Health Systems Strengthening Related Initiatives is focused on strengthening different aspects of health systems. We are committed to promoting the principles of UHC2030, the UHC Action Agenda, the UHC2030 Global compact for progress towards UHC and common approaches to strengthening health systems embedded in Healthy systems for universal health coverage through PHC.

In 2023, several health-related processes, including G7, G20, and the September UN High-level meetings, provide an opportunity for all countries and stakeholders to recommit to health systems strengthening and UHC using a PHC approach by aligning partners and resources with the needs of communities through the eight action areas in the UHC Action Agenda. 

UHC Action Agenda Eight Action Areas

1. Champion political leadership for universal health coverage.

2. Leave no one behind

3. Adopt enabling laws and regulations

4. Strengthen the health and care workforce to deliver high-quality health care.

5. Invest more, invest better

6. Move together towards universal health coverage

7. Guarantee gender equality in health

8. Connect universal health coverage and health security

As Health Systems Strengthening Related Initiatives, we believe that all stakeholders should continue to align behind and build on the OECD’s Paris declaration on aid effectiveness and Accra agenda for action.² Busan best practices in development cooperation, and the Country compact guidelines.

We also note that ‘aid effectiveness’ has in recent years been complemented by efforts to measure the alignment of partners with country priorities, namely the SDG3 GAP monitoring framework, which provides some encouraging data from governments and relevant authorities on the health coordination environment of the multilateral and global health initiatives. Other efforts, such as the World Bank-hosted Global partnership for social accountability, suggest representative mechanisms to hold partners and governments more accountable to community needs and measuring that accountability. We believe that accountability to communities needs to be measured, monitored and adhered to if progress is to be made in UHC. Without this, power imbalances in global health and inequities will persist, being further driven by needs of wealthy, global north partners who are not held accountable to the needs of communities. Minimum standards and indicators for community engagement developed through a multi-stakeholder consultation process provide a base for measurement that has been tried in a few countries resulting in plans for improving the engagement process for better outcomes.

Examples of efforts to strengthen mutual accountability between governments, partners and communities include civil society participation in Gavi, the Global Fund and the Civil Society Engagement Mechanism (CSEM) for UHC. However, accountability mechanisms often revolve around disease or program specific contributions by civil society and do not measure accountability for communities, who find it hard to be consistently represented when national plans and resources are being planned and implemented so that governments and partners are jointly accountable.

We also note with concern that increasingly, communities left behind live in fragile, urban poor or rural remote contexts or are affected by stigma and discrimination.

In 2023, as Health Systems Strengthening Related Initiatives, we ask for all governments and stakeholders to:

1. Rally behind, commit to, and help implement the Action Agenda of the UHC Movement;
2. Elevate health systems strengthening and UHC, with PHC as a foundation, to build resilient and equitable health systems that deliver for all people, in crisis and calm;
3. Ensure and support inclusive and participatory accountability mechanisms for greater alignment to deliver, especially for communities left behind; and
4. Redress inequities in health through greater ‘aid effectiveness’ and measuring progress and accountability, monitoring progress using the PHC measurement framework and indicators, and adopting an accountability framework between communities, governments, and other partners. Emerging mechanisms include Minimum quality standards for community engagement, Global partnership for social accountability for social, financial and political accountability and measuring alignment in the SDG3 GAP heat maps.  

Further information on the Health Systems Strengthening Related Initiatives:

Health Systems Strengthening Related Initiatives: As part of the UHC2030 family, the Related Initiatives is a diverse group of international partnerships, alliances, and networks focused on strengthening different aspects of health systems. The Related Initiatives are committed to promoting the principles of UHC2030, the Action Agenda of the UHC Movement and its eight action areas, the UHC2030 Global compact for progress towards UHC and common approaches to strengthening health systems embedded in Healthy systems for universal health coverage through PHC.

Health Related Initiatives	Contribution to UHC
Alliance for Health Policy and Systems Research	Supporting generation and use of evidence that strengthens health systems
Global Health Workforce Network	Facilitating global collaboration, dialogue and coordination on health workforce policy, action, and investment
Health Data Collaborative	Working with countries to improve health data and build capacity
Health Systems Global	Promoting health systems research and knowledge translation
Health Systems Governance Collaborative	Networking stakeholders in health systems governance for UHC
Joint Learning Network for UHC	Networking practitioners and policy makers to develop knowledge for UHC
Providing for Health (P4H) Social Health Protection Network	Strengthening collaboration for health financing and social health protection for UHC
The Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP)	Strengthening collaboration across health-related UN and other multilateral agencies for joint action and support to achieve the health-related SDGs targets through the PHC Accelerator (PHC-A) and other accelerators
UHC Partnership	WHO’s largest platform for international cooperation on UHC, with the goal to strengthen primary health care-based health systems, by strengthening country capacities for the development, implementation, monitoring and evaluation of national health policies, strategies and reforms to drive progress towards UHC
UHC2030	The global movement to build stronger health systems for UHC and (among other activities) plays a convening role for this group of health systems ‘Related Initiatives’

¹ Stenberg K, Hanssen O, Bertram M, Brindley C, Meshreky A, Barkley S, Tan-Torres Edejer T (2019). Guide posts for investment in primary health care and projected resource needs in 67 low-income and middle-income countries: a modelling study. Lancet Global Health, 7(11), e1500-e1510. doi:10.1016/S2214-109X(19)30416-4

² Countries, partners and civil society committed to five ‘aid effectiveness principles’: i) country ownership – led by a ministry of health with national priorities within one health plan, ii) alignment – partners supporting national priorities within one health plan using local processes, iii) harmonization – partners and donor governments coordinate, share information and simplify processes, iv) being results driven – shift to development results and results that get measured, and v) mutual accountability – donors, partners and governments are accountable for results.

Photo: © WHO / NOOR / Sebastian Liste

Category: Related Initiatives