Message for political leaders on UHC Day 2021

The COVID-19 pandemic has underscored the considerable health, social, political and economic risks and consequences of failing to invest adequately and efficiently in health. Strengthening health systems, with a focus on equity and resilience, is crucial for both universal health coverage and health security goals and contributes to broader socio-economic progress. It has become more evident than ever that health is an investment and not a cost. Now more than ever, solidarity is needed. COVID-19 has widened health inequities both within and between countries. Everyone, everywhere should have access to quality essential health services without financial hardship – including COVID-19 vaccines, tests and treatments. It is simply not fair that some countries face acute COVID-19 waves and new variants unprotected. It is also a question of enlightened self-interest: no one is safe until everyone is safe.

Achieving universal health coverage starts with political accountability. Progress is possible but requires political leadership, better-aligned resources for health systems, and action for solidarity and equity. This year's review of the state of commitment to universal health coverage brings together diverse perspectives and voices. It shows that, despite governments' commitments, action towards universal health coverage is uneven and insufficient. So we call on political leaders to:

1. Accelerate the implementation of their commitments to achieve universal health coverage by 2030. Most countries have agreed firm national commitments and targets on universal health coverage, and an increasing number are reviewing their progress.
2. Develop and communicate clear pathways to achieve universal health coverage in your country. Country commitments and reporting on universal health coverage are often not linked to a clear strategy to achieve it yet.  Countries need solid national health strategies that include a clear role for local and regional governments.
3. Align health systems investments, using a primary health care approach. Government plans and reporting on universal health coverage are often fragmented across specific diseases or services. Still, universal health coverage is an opportunity to accelerate outcomes across health priorities based on a comprehensive approach to strengthening health systems.
4. Create space for meaningful social participation and value the involvement of non-state actors. Non-state actors still lack opportunities to participate in government-led planning, progress reviews or implementation towards universal health coverage.
5. Identify and reach all groups in society at risk of being neglected. A comprehensive approach to equity must include groups at the intersection of multiple vulnerabilities. The importance of equity is strongly acknowledged in governments' universal health coverage initiatives but need to be operationalized comprehensively.
6. Ensure gender-equitable leadership and gender-responsive health systems. Governments are not adequately addressing gender equality in their universal health coverage commitments, especially women's health and political leadership representation.
7. Collaborate beyond the health sector on both universal health coverage and wider health determinants.  Multisectoral action is crucial for universal health coverage, starting with strong cooperation between health and finance decision-makers. Improved collaboration with non-health sectors is also needed to systematically address the social, economic, environmental and commercial determinants of health.  

Action is urgent. World leaders and the global health community have a crucial second chance to secure a safer and healthier future for everyone. Leaders must both act at home on universal health coverage and come together to strengthen global health governance, irrespective of any wider political differences. We need resilient and equitable health systems that leave no one's health behind in crisis and in calm. We cannot afford to wait.

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This message is issued by UHC2030 co-Chairs, in consultation with the UHC Movement Political Advisory Panel of UHC2030.

Co-Chair of Steering Committee, UHC2030:

• Ms. Gabriela Cuevas Barron
• Dr. Justin Koonin

UHC Movement Political Advisory Panel, UHC2030:

• Ms. Emilia Saiz, Secretary General of United Cities and Local Governments
• Mr. Elhadj As Sy, Chair of the Board, Kofi Annan Foundation
• Ms. Joy Phumaphi, Executive Secretary, the African Leaders Malaria Alliance
• Prof. Ilona Kickbusch, Chair, International Advisory Board, Global Health Centre, Graduate Institute for International and Development Studies Geneva
• Prof. Keizo Takemi, Member of the House of Councilors, Japan
• Ms. María Fernanda Espinosa Garcés, President of the 73^rd Session of the UN General Assembly
• Dr. Vytenis Povilas Andriukaitis, Former European Commissioner for Health and Food Safety