By Jane Pepperall, Principal Health Lead

For those of us invested in the Universal Health Coverage (UHC) journey over recent years, the UN High Level (HLM) Meeting on UHC in New York on 21 September is a much anticipated opportunity to review progress since the inaugural UHC HLM in 2019, as well as a clarion call to accelerate progress.

A commitment to UHC is a commitment for all people to have access to the full range of quality essential health services they need, when and where they need them, without that access resulting in financial hardship. UHC’s commitment to leave no one behind and to reach the furthest behind first resonates strongly with the equity agenda that is central to our efforts at Abt Associates to improve people’s well-being.

The continuing imperative of UHC

UHC remains a central strategy for the achievement of SDG 3, Healthy Lives and Well Being, and progress on UHC underpins all three of the health HLMs happening this week – UHC; the fight against Tuberculosis; and Pandemic Prevention, Preparedness and Response.

We know that progress towards UHC entails the continuing reorientation of health services towards Primary Health Care (PHC), an approach itself central to the equitable achievement of the vast majority of health gains being pursued across the SDGs. It has long been recognised that PHC is a ‘best buy’ for health sector resources – a reality more salient than ever in the current global economic climate and one which demands health sector resources be deployed in an integrated and efficient manner. The imperative for health sectors to centre their efforts around PHC is well understood – and never going to go away – and yet there is still much progress to be made.

In addition to promoting coverage of essential health services, UHC includes an explicit focus on financial protection to ensure that all people, but especially the poor and vulnerable, can actually afford to access them. This requires a shift away from an increasing reliance on potentially impoverishing out-of-pocket health expenditures in some regions, including much of Southeast Asia, towards scaled-up prepaid and pooled financing for health. Within our neighbouring Pacific and Southeast Asia regions, supporting financial protection typically includes optimizing the use of public-financed health budgets in the Pacific and supporting the effectiveness, equity and financial viability of established social health insurance schemes in Southeast Asia.

The sobering status of UHC

In contrast to the momentum building for this week’s HLM, the latest biennial UHC Global Monitoring Report released yesterday by the World Health Organization and the World Bank provides a sobering update. Whilst some regions had previously seen progress in coverage of essential services (driven largely by focussed efforts on TB, HIV and malaria), this progress is now seen to have stalled or worsened in many countries since 2015. In Pacific Island Countries progress had largely plateaued even before the challenges wrought by the pandemic. Unfortunately, this latest report also highlights a general worsening of the financial protection dimension of UHC.

The report underlines that about one third of the world population still lacks access to essential health services and some one billion people spend more than 10% of their household budget out-of-pocket on health. At the current rate of progress then, far from universal health coverage, up to one third of the world’s population will remain underserved by 2030. Behind that headline lies a raft of challenges with specific health issues such as sexual and reproductive health, maternal mortality and non-communicable diseases as well as with broader sector issues such as exclusion and inequality (in particular in relation to gender, disability and ethnicity), the global health workforce crisis and the need to shore up health sector resilience in the face of climate change.

Following through on commitments

This week’s HLM will see countries come together to reaffirm and renew political commitment to accelerate UHC, with PHC at its heart. COVID-19 has shown the importance of political commitment – delivering on UHC demands no less political commitment. The challenge of course will be for both national actors and global health partners to take the commitments made in the limelight this week and follow through on them with sincere and practical action at regional and national level.

Here in Australia, the UHC HLM comes fast on the heels of the government’s own new International Development Policy, released in August. This includes a welcome cited intention to help expand UHC and support sexual and reproductive health and rights and to contribute to the improved capacity of associated health systems. The Resolution emanating from the HLM will provide a timely echo from countries across neighbouring regions of their own expressed political commitment to UHC.

Moving forward, it is vital that development partners are purposeful in ensuring their support comes in behind national commitments to progressive health investment and more equitable health services and health outcomes. They simultaneously need to be aware not to contribute to regressive health sector resourcing that perpetuates inequality through deprioritizing essential health services for all, including for the rural underserved, in favour of less efficient investment in, for example, some hospital sectors or in relatively well-served urban areas.

Indeed, the mutual commitments from this week’s HLM can only be met through progressive universalism; through purposefully responding to the needs of the under-served and economically vulnerable; and through health sector investments that support rather than undermine progress towards effective, efficient and equitable health services. Only in this way can the global health community have a chance of ‘building back better’ and returning to New York  for the 2027 UHC HLM with a better story to tell on more equitable and affordable essential health services for all.