World leaders commit to redouble efforts towards universal health coverage by 2030

Today, 21 September 2023, at the United Nations (UN) General Assembly High-Level Meeting, world leaders have approved a new Political Declaration on “Universal Health Coverage (UHC): expanding our ambition for health and well-being in a post-COVID world”.  

The declaration is hailed as a vital catalyst for the international community to take big and bold actions and mobilize the necessary political commitments and financial investments to attain the UHC target of the Sustainable Development Goals (SDGs) by 2030.

The UHC target measures the ability of countries to ensure that everyone receives the health care they need, when and where they need it, without facing financial hardship. It covers the full continuum of key services from health promotion to prevention, protection, treatment, rehabilitation and palliative care. Alarmingly, global progress towards UHC has been largely stagnating since 2015, before stalling in 2019.

The urgency of the declaration is evident in the staggering statistics ...

International conference celebrating the 45th anniversary of Alma-Ata and 5th anniversary of Astana declarations

On 23 October WHO/Europe, together with UNICEF and the Government of Kazakhstan, is co-hosting an international conference to celebrate the 45th anniversary of Alma-Ata and 5th anniversary of Astana declarations on primary health care. The conference "Primary health care policy and practice: implementing for better results" will be an official side event of the 73rd session of the WHO Regional Committee for Europe, to be held in Astana, Kazakhstan, in October 2023.

The Conference will:

• take stock of progress implementing the commitments in the Declaration of Astana on primary health care since 2018, including the impact of the COVID-19 pandemic, and demonstrate concrete results;
• shift focus from concepts to action by identifying implementation success factors based on country experiences; and
• identify policies and practices to future-proof primary health-care transformation for moving towards universal health coverage, for greater resilience in the face of emergencies, and better health and well-being. 

Structure ...

Regional framework on the future of primary health care in the Western Pacific

Regional Framework on the Future of Primary Health Care (PHC) was adopted by Member States at the seventy-third session of the Regional Committee for the Western Pacific in 2022. The framework outlines five key attributes of PHC including people and community-centered, continuous, high-quality and equitable, integrated, and innovative. It highlights five strategic areas of actions needed which pivot around models of service delivery, individual and community empowerment, workforce and provider base, financing, enabling and supportive environment to enable this transformation. It calls on critical health system transformation for the future to achieve Universal Health Coverage and Sustainable Development Goals.

Universal health coverage is a matter of equity, rights, and justice

The Coalition of Partnerships for Universal Health Coverage and Global Health calls on all countries to urgently reinvigorate progress towards health for all.

At the High Level Political Forum in July and the three UN High-level meetings on health, upcoming in September, 2023, all countries must recognise that progress in providing tuberculosis care, strengthening pandemic preparedness, and delivering the human right to health through universal health coverage are interrelated goals, requiring a concerted focus on the most vulnerable and marginalised populations.

UN General Assembly High-Level Meetings on health 2023: Universal Health Coverage

Successes and challenges of primary health care in Australia: A scoping review and comparative analysis

Australia has achieved universal health insurance for its population since 1975 - a major step forward for increasing access to primary care (PC). Nevertheless, there are reports of several multi-layered challenges, including inequity, that persist. This analysis aims to undertake a scoping review of the success, explanatory factors, and challenges of Primary Health Care (PHC) in Australia guided by the World Health Organization (WHO)-defined key characteristics of good PC.

Civil society feedback on the Zero Draft of the 2023 Political Declaration on UHC

The 2023 UN High-Level (HLM) Meeting on Universal Health Coverage (UHC) provides countries and all stakeholders with the opportunity to not just recommit to UHC but take concrete actions toward building resilient and equitable health systems. While some progress has been made since the 2019 HLM on UHC that resulted in a comprehensive Political Declaration, more than half of the world’s population still lacks access to essential health services. The situation was further exacerbated by the COVID-19 pandemic.

As the UHC2030 Co-Chairs recently stated in their reflection on the UHC Political Declaration 2023 Zero Draft, Member States must show political leadership and “move from commitment to action”. Following the release of the zero draft of the political declaration, the Civil Society Engagement Mechanism (CSEM) launched a survey to collect feedback from civil society to identify priorities for strengthening the zero draft, and ultimately, the Political Declaration. Over the span ...

Regional technical meeting on integrated care delivery

This report summarizes the discussion that took place during the Regional technical meeting on integrated care delivery. It represents a continuation of the discussion held as part of the Regional technical meeting on strengthening the integrated delivery of long-term care in the European region, in December 2021, bringing an expanded focus on integration as a transversal issue for health and long-term care systems and an important stepping stone for achieving universal health coverage. Participants discussed and shared evidence and lessons learned on the principles, the practice, the enablers and on-going challenges to improving coordination within and across health and long-term care systems, with particular attention to integration of primary care and community-based long-term care services.

Silver Opportunity - Building Integrated Services for Older Adults around Primary Health Care

We live in a rapidly aging world, in which people who are age 60 and older outnumber children under the age of five. This book reveals large and growing gaps in care for older adults in countries at all income levels and shows how to leverage reforms for improving health outcomes for older adults and create healthier, more prosperous communities. Aimed at policy makers and other health and development stakeholders who want to promote healthier aging, Silver Opportunity compiles the latest evidence on care needs and gaps for aging populations. It argues that primary health care should be the cornerstone of integrated service delivery for older people, but primary health care systems must first build their capacity to respond to older people's health needs. It presents an original framework for policy action to advance primary health care-centered, integrated senior care; documents the experiences of pioneering countries in delivering community-based ...

Primary Health Care: The Foundation of Universal Health Coverage

In recognition of Universal Health Coverage Day, Management Sciences for Health convened a group of policymakers and practitioners on December 15, 2022, to examine person-centered primary health care as the foundation of achieving UHC and Sustainable Development Goal 3. Half-way into the lifespan of the SDGs, what needs to be done to ensure that communities are involved in the design of their primary health care systems? What are global best practices for primary health care and what are we learning from them? How can we ensure these experiences are brought to bear as we approach 2030? 

Primary Health Care System Strengthening Project in Sri Lanka: Status and Challenges with Human Resources, Information Systems, Drugs and Laboratory Services

A Primary Healthcare-System-Strengthening Project (PSSP) is implemented by the Ministry of Health, Sri Lanka, with funding support from the World Bank for providing quality care through primary medical care institutions (PMCIs). We used an explanatory mixed-methods study to assess progress and challenges in human resources, drug availability, laboratory services and the health management information system (HMIS) at PMCIs. We used an explanatory mixed-methods study to assess progress and challenges in human resources, drug availability, laboratory services and the health management information system (HMIS) at PMCIs. We conducted a checklist-based assessment followed by in-depth interviews of healthcare workers in one PMCI each in all nine provinces.

2nd International Conference on Public Health in Africa

Kigali Convention Centre, Kigali, Rwanda | 13-15 December 2022

CPHIA 2022 will provide a unique platform for African researchers, policymakers and stakeholders to come together and share perspectives and research findings in public health while ushering in a new era of strengthened scientific collaboration and innovation across the continent. Building on CPHIA 2021, this year’s conference will also serve as a catalyst to build more resilient health systems that allow African countries to better prepare for and manage emerging health threats while also addressing long-standing infectious diseases.

Conference Tracks:

Track 1 Epidemiology, Diagnostics and Clinical Management of Emerging and Re-emerging High Consequence Infectious Diseases (HCID) in Africa

Track 2 Increasing Local Production in Africa: Advocacy, Research and Development Capacity in Diagnostics, Therapeutics and Vaccine Manufacturing

Track 3 Strengthening Health Systems for Equitable and Universal Health Coverage in Africa

Track 4 Women in Health – From Recipients to Providers to Leaders

Track ...

UN General Assembly Third annual ministerial meeting on Universal Health Coverage: investing in health systems strengthening through a primary health care-oriented approach

The UN General Assembly is the main policy-making organ of the Organization. Comprising all Member States, it provides a unique forum for multilateral discussion of the full spectrum of international issues covered by the Charter of the United Nations.

This year’s discussions will focus on addressing the various challenges the world faces, including the COVID-19 pandemic. These challenges call for global action, and the General Assembly is a critical opportunity for all to come together and chart a course for the future.

As we look to strengthen health systems in the wake of COVID-19, re-orientation of resources toward primary health care and essential public health functions will be critical for the achievement of UHC and the health-related SDGs.

This event, hosted within the UN General Assembly, is organized by the Co-chairs of the Group of Friends of UHC and Global Health (Georgia, Japan, Thailand), WHO, UHC2030, IFRC, UN Foundation ...

LIVE: Q&A on primary health care and universal health coverage. #AskWHO

Live with Dr Jim Campbell Director of the Health Workforce Department at the WHO and Shannon Barkley Technical Officer for Primary Health Care at World Health Organization's Special Programme on Primary Health Care from the World Health Organization (WHO) Seventy-fifth World Health Assembly 2022.

Estimating the threshold of health workforce densities towards universal health coverage in Africa

There have been past efforts to develop benchmarks for health workforce (HWF) needs across countries which have been helpful for advocacy and planning. Still, they have neither been country-specific nor disaggregated by cadre—primarily due to data inadequacies. This paper presents an analysis to estimate a threshold of 13 cadres of HWF density to support the progressive realisation of universal health coverage (UHC).The analysis found that a unit increase in the HWF density per 10 000 population is positively associated with statistically significant improvements in the UHC SCI of countries (β=0.127, p<0.001). Consistent with current knowledge, the HWF is a significant predictor of the UHC SCI. Attaining at least 70% of the UHC SCI requires about 134.23 health workers (a mix of 13 cadres) per 10 000 population. 

Universal Health Coverage Partnership

The UHC Partnership helps deliver WHO’s support and technical expertise in advancing universal health coverage through a primary health care approach in 115 countries, representing a population of at least 3 billion people.

The UHC Partnership is one of WHO’s largest platforms for international cooperation on universal health coverage (UHC) and primary health care (PHC). It comprises a broad mix of health experts working hand in hand to promote UHC and PHC by fostering policy dialogue on strategic planning and health systems governance, developing health financing strategies and supporting their implementation, and enabling effective development cooperation in countries.

Our aim is to strengthen country capacities and reinforce the leadership of the Ministry of Health in building resilient and effective health systems in a sustainable manner. We bridge the gap between global commitments and country implementation on the ground.

Since its inception in 2011, the UHC Partnership has expanded ...

2022 Progress report on the Global Action Plan for Healthy Lives and Well-being for All. Stronger collaboration for an equitable and resilient recovery towards the health-related Sustainable Development Goals – Incentivizing collaboration

As COVID-19 continued to dominate global health over the last year, the direct and indirect impact of the pandemic has led progress against the health-related SDGs to fall even further behind.  At the same time, crises such as armed conflict, increasing food insecurity, political and economic instability and the growing impact of climate change threaten to derail recovery from the pandemic.

A key way to respond to and ensure an equitable and resilient recovery from COVID-19 is for multilateral agencies to collaborate even more closely in providing effective and efficient joint support to countries, which is the foundation of the Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP).

SDG3 GAP is helping to promote synergies among its signatory agencies’ pandemic-specific responses and longer-term work to accelerate progress towards the SDGs by creating an improvement platform for collaboration on health among key actors in the multilateral system.

Global Competency and Outcomes Framework for Universal Health Coverage

The goal of this Global Competency and Outcomes Framework for UHC is to advance improvements in health and progress towards UHC through aligning health worker education approaches with population health needs and health system demands. More specifically, the primary objective of this document is to provide guidance for the specification of pre-service and in-service competency-based education outcomes for health workers, which in turn inform the development of relevant curricula, learning activities and assessment approaches. Its main target audience is health workforce educators, but it can be of relevance also for licensing and regulatory authorities and health service and facility managers. With this framework, WHO sets out its recommended approach to competency-based health worker education outcomes; in so doing, it also provides conceptual and terminological clarity.

The Global Competency and Outcomes Framework for Universal Health Coverage identifies the health worker competencies towards the achievement of UHC organized within six domains: people-centredness ...

An assertive, practical, and substantive agenda to catalyse meaningful change

The Lancet Global Health Commission on financing primary health care combines a shared vision with practical guidance on how to align health financing with overall reform strategies that place primary care service delivery at the core. The Commission reinforces key messages that WHO has put forward on health financing reforms to enable progress towards universal health coverage. It then extends these by application to primary care as a critical service delivery element for the progressive realisation of UHC.

WHO's guidance on health financing is crystallised into a framework for regular country assessment to inform policy dialogue. The alignment of the Commission with this guidance is clear, as reflected in the table. While the decision to limit the operational definition of primary health care to service delivery platforms was made for the purposes of the Commission, certain key financing issues merit further attention. We point to these towards the end ...

The Lancet Global Health Commission on financing primary health care: putting people at the centre

Community-oriented primary care for National Health Insurance in South Africa

This is a report on Chiawelo Community Practice (CCP) in Ward 11, Soweto, South Africa, a community-oriented primary care (COPC) model for National Health Insurance (NHI) in South Africa, developed by a family physician.

A shift to capitation contracting for primary health care (PHC) under NHI will carry risk for providers – both public and private, especially higher number of patient visits. Health promotion and disease prevention, especially using a COPC model, will be important. Leading the implementation of COPC is an important role for family physicians in Africa, but global implementation of COPC is challenged. Cuba and Brazil have implemented COPC with panels of 600 and 3500, respectively.

The family physician in this report has developed community practice as a model with four drivers using a complex adaptive system lens: population engagement with community health workers (CHWs), a clinic re-oriented to its community, stakeholder engagement and targeted health promotion. A ...

Benefit design: the perspective from health financing policy

Given the central importance of public financing to make progress towards universal health coverage (UHC), government policy on benefit design, including both service entitlements and conditions of access, significantly influences health system performance. Benefit design considers how all public funds are used and should be based on evidence and developed through a systematic process involving key stakeholders. Reducing uncertainty over entitlements and conditions of access, in particular co-payments, both reduces barriers to accessing services and improves financial protection. Finally, aligning benefit design with a range of health financing policies, as well as service with delivery objectives, provides a powerful way through which policy makers can drive positive change in their health systems.

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Introducing The Lancet Global Health Commission on financing primary health care: putting people at the centre

Tell the real story of universal health coverage

UHC2030 is asking for contributions to a multi-stakeholder review called 'The State of UHC Commitment'. As part of this monitoring, UHC2030 would like to tell the stories of people in your country.

Telling people’s stories can help governments and people around the world understand what UHC can mean to people. We are asking you to submit a story because we believe you have a story to tell about a positive and/or negative experience with accessing health care, with the quality of the care you got, or with paying for your care.

Submit your story here before 31 October 2021

 

How do I create my story? Click here for instructions

Enhancing the quality of health services – introduction to a new planning guide for implementers

Planning for quality is required at the national, district and facility-levels to enhance quality of care, and drive efforts towards universal health coverage. WHO recently launched Quality Health Services: a planning guide to support key actions required to improve the quality of health services for the entire population, recognizing the unique pathway for each country. The planning guide focuses on actions required at the national, district and facility levels to enhance quality of health services, providing guidance on implementing key activities at each of these three levels. It is intended to support those working at all levels of the health system translate intention into results, delivering an impact on the quality of services for people across the world.

This 60-minute session will provide an overview of the WHO Quality Health Services: a planning guide, discussing how it can be applied to improve the quality of care across the health system.

State of Commitment to Universal Health Coverage

The State of commitment to universal health coverage (UHC) provides a multi-stakeholder consolidated view on the state of progress being made towards UHC at country and global levels.

The review is political, country-focused and action-oriented in nature and complements the more technical and global UHC monitoring report focusing on UHC indicators on service coverage and financial protection.

The State of UHC Commitment  follows the UHC Political Declaration’s Key Targets, Commitments and Follow-up Actions and support national accountability and advocacy processes to ensure political leaders are held accountable for their UHC commitments.

The synthesis report summarises the state of UHC commitment at both the country and global level. In 2020, the report focuses on how the world has coped to date with the extraordinary challenges posed by the COVID-19 pandemic. It shares short stories from people’s lived experiences, demonstrating the reality of UHC on the ground.

Read more 

State ...

Primary Health Care for Universal Health Coverage

The PHC for UHC webinar will present the 2020 achievements of the Regional Joint Workplan 2020-2021 for East Mediterranean Region Global Action Plan Accelerators 1 partners. The achievements are products of the joint collaboration between the World Health Organization (WHO) Regional Office for the Eastern Mediterranean (EMRO) and United Nations partners, including United Nations Programme on HIV/AIDS (UNAIDS), United Nations Population Fund (UNFPA), United Nations High Commissioner for Refugees (UNHCR), United Nations Children's Fund (UNICEF) and the World Organization of Family Doctors (WONCA) in the East Mediterranean Region.

Primary health care: transforming vision into action

Marking the two-year anniversary of the Declaration of Astana, this event, hosted by WHO, UNICEF and the Ministry of Health of Kazakhstan, brings together national experiences from across the globe to launch the operational framework and discuss its relevance for strengthening PHC both in the COVID-19 pandemic context and as part of building better.

 Agenda:

11:00 – 12:00 Ministerial Plenary Session (streamed in the six UN languages)

• Welcome & opening remarks - H.E. Alexey Tsoi, Minister of Healthcare of Kazakstan
• WHO Remarks - Dr Tedros Adhanom Ghebreyesus, Director-General, WHO
• UNICEF Remarks - Dr Henrietta Fore, Executive Director
• Presentation of PHC Operational Framework - Dr Suraya Dalil, Director, Special Programme on PHC
• Ministerial Panel – moderator: Dr Hans Kluge, WHO Regional Director for Europe
• Featuring Ministers of Health
• Reflections on two years since the Declaration of Astana - Zsuzsanna Jakab, Deputy Director-General, WHO

Participants will be able to join one of five roundtable discussions focusing on ...

Communities, universal health coverage and primary health care

Universal health coverage (UHC) depends on a strong primary health-care system. To be successful, primary health care must be expanded at community and household levels as much of the world’s population still lacks access to health facilities for basic services. Abundant evidence shows that community-based interventions are effective for improving health-care utilization and outcomes when integrated with facility-based services. Community involvement is the cornerstone of local, equitable and integrated primary health care.

Integrated Health Service Delivery Networks (IHSDN) based on primary health care (PHC)

Integrated Health Service Delivery Networks (IHSDN) based on primary health care (PHC) are the most promising solution for health systems to satisfy the health needs of the population and to address access, efficiency, quality and equity challenges faced by health systems of the world. PHCs essential attributes (people and family centred care, comprehensiveness, continuity, longitudinality) position this approach as one of the key strategies for countries to meet the aspiration of achieving universal health coverage.

Creating care networks has been a common thread running through Latin America and the Caribbean health policy agendas. In terms of actually putting the IHSDN model in action, there is a wide range of interpretations and experiences, with designs, scales, organizational methods, and maturity levels that vary within and between countries.

Health Network in Action, a publication from the Inter-American Development Bank, shares evidence of the progress made in forming and launching IHSDN in Latin ...

Time to get our act together on UHC and health emergencies

UHC2030 will launch a discussion paper to consolidate our vision for resilient health systems, and priority actions for both emergency preparedness and UHC goals. With this, we aim to bring partners together around common messages on public health actions as ‘step zero’ of UHC, so health systems better support health security and UHC. This builds on the recent statement from UHC2030 co-chairs which called on world leaders to remember their UHC commitments as they respond to COVID-19.

Ilona Kickbusch, Chair of the International Advisory Board of the Global Health Centre, will moderate a panel discussion with senior leaders from WHO, World Bank, OECD and respondents from academia and civil society. This event proposes to stimulate discussion with stakeholders from across the UHC movement and beyond, immediately after the World Health Assembly, in order to leverage the momentum around the discussions among ministers of health.

The event is jointly organised by ...

Covid-19 and the Need for Health Care Reform

The Covid-19 pandemic has brought into sharp focus the need for health care reforms that promote universal access to affordable care. lthough all aspects of U.S. health care will face incredible challenges in the coming months, the patchwork way we govern and pay for health care is unraveling in this time of crisis, leaving millions of people vulnerable and requiring swift, coordinated political action to ensure access to affordable care.Our policies on health and health care, both during this pandemic and in the future, should reflect this reality, and we should not let the lessons of this crisis pass us by.

Celebrating the 4th anniversary of the approval of the WHO Framework on integrated and people-centred health services: progress and opportunities ahead

This month marks the fourth anniversary of the approval of the Framework on integrated people-centred health services (IPCHS) and its accompanying resolution WHA69.24 (2016) on “Strengthening integrated people-centred health services” by the World Health Assembly. In May 2016, Member States showed exceptional support to these global commitments and requested WHO to help them implement, adapt, and operationalize this Framework. However, this was not the first time WHO recognized the relevance of health services being managed and delivered so that people, who are active participants of health systems, receive a continuum of care according to their needs throughout the life course. Other previous WHO global and regional commitments, including “People-centred health care: a policy framework” produced by the Western Pacific Region in 2007, the “World health report 2008 on primary health care: now more than ever”, and resolution WHA62.12 (2009) on Primary health care, including health system strengthening, had ...

WHO Guideline: recommendations on digital interventions for health system strengthening

The key aim of this guideline is to present recommendations based on a critical evaluation of the evidence on emerging digital health interventions that are contributing to health system improvements, based on an assessment of the benefits, harms, acceptability, feasibility, resource use and equity considerations. For the purposes of this version of the guideline, the recommendations examine the extent to which digital health interventions, primarily available via mobile devices, are able to address health system challenges along the pathway to UHC. By reviewing the evidence of different digital interventions against comparative options, as well as assessing the risks, this guideline aims to equip health policy-makers and other stakeholders with recommendations and implementation considerations for making informed investments into digital health interventions.

Community perceptions of universal health coverage in eight districts of the Northern and Volta regions of Ghana

Ever since Ghana embraced the 1978 Alma-Ata Declaration, it has consigned priority to achieving ‘Health for All.’ The Community-based Health Planning and Services (CHPS) Initiative was established to close gaps in geographic access to services and health equity. CHPS is Ghana’s flagship Universal Health Coverage (UHC) Initiative and will soon completely cover the country with community-located services.

This paper aims to identify community perceptions of gaps in CHPS maternal and child health services that detract from its UHC goals and to elicit advice on how the contribution of CHPS to UHC can be improved.

Primary Health Care That Works: The Costa Rican Experience

Long considered a paragon among low- and middle-income countries in its provision of primary health care, Costa Rica reformed its primary health care system in 1994 using a model that, despite its success, has been generally understudied: basic integrated health care teams. This case study provides a detailed description of Costa Rica’s innovative implementation of four critical service delivery reforms and explains how those reforms supported the provision of the four essential functions of primary health care: first-contact access, coordination, continuity, and comprehensiveness. As countries around the world pursue high-quality universal health coverage to attain the Sustainable Development Goals, Costa Rica’s experiences provide valuable lessons about both the types of primary health care reforms needed and potential mechanisms through which these reforms can be successfully implemented.

Building a Thriving Primary Health Care System: The story of Costa Rica

Situated in Central America, Costa Rica’s 4.9 million citizens have access to one of the most effective primary health care systems in the world. The country’s unique, team-based model of primary care service delivery successfully combines preventive and curative care to provide comprehensive primary health care to nearly all Costa Rican citizens. This case study examines the process by which Costa Rica developed its laudable primary health care system, fully describes the functioning of the system through both clinical and patient perspectives, and elucidates key lessons about primary health care delivery that can be learned from the Costa Rican experience.

High Quality Primary Health Care in Action: The Story of Costa Rica

Costa Rica’s primary health care system is supported by robust integrated care teams that provide comprehensive, coordinated, continuous, and person-centered care to empaneled populations. As a result, health outcomes in Costa Rica are consistently strong and improving.

Comprehensive Primary Health Care Reform in Costa Rica

In the past, Costa Rica was characterized by a duplicative and fragmented public primary healthcare system. In 1994, the country initiated a sweeping reform of the health system, including primary health care. Bureaucratic reorganization of the Ministry of Health (MOH) and the Social Security Agency (CCSS) led to the integration of all healthcare delivery under the CCSS, from public health activities to tertiary care. Comprehensive multidisciplinary primary healthcare teams (EBAIS)—comprised of a doctor, nurse assistant, community health worker, and data specialist—were created to care for approximately 5,000 patients each. A system of geographic empanelment was implemented to assign every Costa Rican to one of the newly-formed EBAIS teams. Finally, quality assurance mechanisms were initiated and promoted data collection and feedback central as a central function of the EBAIS teams. The first EBAIS team was established in 1995 and by 2002, there were 818 active teams throughout the ...

Consultation on the Handbook on Social Participation for UHC for civil society

UHC2030, WHO and the UHC Partnership have launched a consultation for civil society to provide substantial feedback on the contents of the Handbook on Social Participation for UHC. The ‘Handbook on Social Participation for UHC’ will provide specific best practice guidance to policymakers on how to effectively and meaningfully engage with populations, civil society and communities for policy- and decision-making.

The Handbook is in an advanced stage of development and your views would be useful to shape the final document. Currently, you can comment on the overview of five of the chapters through a survey until February 2020.

See more information about the handbook and an overview presentation.

Political struggles for a universal health system in Brazil: successes and limits in the reduction of inequalities

Brazil is a populous high/middle-income country, characterized by deep economic and social inequalities. Like most other Latin American nations, Brazil constructed a health system that included, on the one hand, public health programs and, on the other, social insurance healthcare for those working in the formal sector. This study analyzes the political struggles surrounding the implementation of a universal health system from the mid-1980s to the present, and their effects on selected health indicators, focusing on the relevant international and national contexts, political agendas, government orientations and actors.

Primary Health Care: The Engine to Universal Health Coverage

The Global Conference on Primary Health Care hosted in Astana, Kazakhstan, in October 2018, renewed the core principles included in Alma Ata Declaration in 1978, emphasizing the essential role of primary health care (PHC) around the world. The Declaration of Astana focused on primary health care to ensure that everyone everywhere is able to achieve a good standard of health.

On 23 September 2019, the United Nations General Assembly held a high-level meeting on universal health coverage.  This meeting, held under the theme “Universal Health Coverage: Moving Together to Build a Healthier World,” identifies primary health care as the route to universal health coverage (UHC).

UHC shouldn´t be a luxury that only high-income countries can afford. However, it needs some levers that must be strengthened everywhere. One of the most important ways to achieve UHC is to prioritize PHC as a crucial strategy in health systems. PHC is the ...

A qualitative appraisal of stakeholders’ perspectives of a community-based primary health care program in rural Ghana

The Ghana Community-based Health Planning and Services (CHPS) initiative is a national strategy for improving access to primary health care services for underserved communities. Following a successful trial in the North Eastern part of the country, CHPS was adopted as Ghana’s flagship programme for achieving the Universal Health Coverage. Recent empirical evidence suggests, however, that scale-up of CHPS has not necessarily replicated the successes of the pilot study. This study examines the community’s perspective of the performance of CHPS and how the scale up could potentially align with the original experimental study.

Integrated care for older people (ICOPE) implementation framework: guidance for systems and services

Alongside supporting community-level services, the Integrated Care for Older People (ICOPE) approach helps broader health and social care systems effectively respond to the diverse and complex needs of older people. The ICOPE Implementation Framework provides guidance for policy makers and programme managers to concretely assess and measure the capacity of services and systems to deliver integrated care at the community level.

The ICOPE Implementation Framework provides a score card to help assess the overall capacity of health and social care services and systems to deliver integrated care in community settings and support the development of ICOPE implementation action plans. There are 19 actions needed to implement ICOPE on the services level (meso) and systems level (macro). The scoring process provides an evidence-based means of highlighting areas for improvement as well as establishing concrete measures of future improvements.

Approval of political resolution on Universal Health Coverage in UN High-Level meeting

World leaders came together for the United Nations High Level Meeting (HLM) on Universal Health Coverage (UHC): Moving Together to Build a Healthier World, held at the UN General Assembly in New York, on Monday, 23 September 2019. This was the first time the UN had called for a HLM devoted to UHC and the encounter provided an unprecedented opportunity to mobilize the global community and secure political commitment from Heads of State and Government to accelerate progress toward achieving UHC by 2030. As a result UN Member States have adopted the most comprehensive set of health commitments ever adopted at this level, the political declaration on UHC. Among other key attributes, the declaration recognizes the need for health systems to be integrated and people-centred, with primary health care being the cornerstone of a sustainable health system for UHC and health-related SDGs.

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Access the political declaration here.

UN High-Level Meeting on universal health coverage

On 23 September 2019, the United Nations General Assembly will hold a high-level meeting on universal health coverage (UHC). This meeting, held under the theme Universal Health Coverage: Moving Together to Build a Healthier World, aims to accelerate progress towards UHC, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

The meeting will result in a political declaration on universal health coverage endorsed by Heads of State. Among other key attributes, the declaration recognizes the need for health systems to be integrated and people-centred, with primary health care being the cornerstone of a sustainable health system for UHC and health-related SDGs.

Strengthening national health research systems in the WHO African Region – progress towards universal health coverage

Health challenges and health systems set-ups differ, warranting contextualised healthcare interventions to move towards universal health coverage. As such, there is emphasis on generation of contextualized evidence to solve local challenges. However, weak research capacity and inadequate resources remain an impendiment to quality research in the African region. WHO African Region (WHO AFRO) facilitated the adoption of a regional strategy for strengthening national health research systems (NHRS) in 2015. This article assessed the progress in strengthening NHRS among the 47 member states of the WHO AFRO.

Community health extension program of Ethiopia, 2003–2018: successes and challenges toward universal coverage for primary healthcare services

The Alma-Ata Declaration of 1978 identified primary health care (PHC) as the key approach to the attainment of the goal of “Health for All”. The PHC approach tackles the main health problems in the community through the provision of essential health services. The implementation of the PHC approach relies on health workers, including community health workers (CHWs) Ethiopia has been implementing a community health extension program (HEP) since 2003. The aim of this studya was to assess the successes and challenges of the HEP over time, and develop a framework that may assist the implementation of the program toward universal primary healthcare services

Does rural health system reform aimed at improving access to primary health care affect hospitalization rates? An interrupted time series analysis of national policy reforms in Iran

Primary health care reforms are often proposed for their efficiency outcomes (i.e. reduction in costs and use of hospitals) as well as their impact on improving health outcomes. The aim of this study was to evaluate the effects of rural health insurance and family physician reforms on hospitalization rates in Iran and it demonstrated that in populations with unmet needs, such reforms are likely to substantially increase hospitalization rates. This is an important consideration for successful design and implementation of interventions aimed at achieving universal health coverage in low- and middle-income countries.

Future of Digital Health Systems in the European Region

The WHO Symposium on the Future of Digital Health Systems in the European Region will bring together evidence and experience to show how governments and organizations can adopt digital health to reduce inequalities and improve the health and well-being of populations.

The Symposium will help policy-makers prepare for the digitalization of health systems by sharing country experiences of:

• - How digital health and emerging innovations are being used to strengthen national health systems
• - Digital health activities currently underway
• - How digital technologies can empower individuals and health-care workers.

Towards universal health coverage and sustainable financing in Afghanistan: progress and challenges

Afghanistan has made impressive progress in introducing primary health care across the country over the last fifteen years. In the face of the diverse challenges ranging from persistent insecurity, conservative social norms, weak public financing, and reducing donor aid, Afghanistan is arguably among one of the most challenging contexts to achieve universal health coverage (UHC). Therefore, it is important to consider additional avenues towards UHC while building on the progress in coverage and financing of primary health care to date.
The right to health is considered a fundamental human right and UHC has gained prominence globally as a goal for countries in the Sustainable Development Goals (SDGs). UHC is defined by the World Health Organization (WHO) as: “access to key promotive, preventive, curative and rehabilitative health
interventions for all at an affordable cost, thereby achieving equity in access.

Universal health coverage necessitates a system approach: an analysis of Community-based Health Planning and Services (CHPS) initiative in Ghana

The 9th Global conference on health promotion (Shanghai 2016) reaffirmed the role of primary health care (PHC) in achieving the 2030 Sustainable Development Agenda. Gaining much international recognition, the community-based health planning and services (CHPS) initiative is considered one of the pragmatic strategy in delivering on the promise of universal health coverage (UHC) through the PHC strategy, in Ghana. Yet, certain key factors threaten its successes – renewing the relevance of this study to present the barriers to and facilitators of the initiative. According to their findings, CHPS contribution particularly in bridging geographical access to health cannot be demeaned. Nevertheless, the full functioning of the initiative is limited by factors centered on the following themes: health governance and leadership, provision of services of quality, financial risk protection strategies targeting public health, information and care continuity, and the right mix of trained health professionals of even distribution across communities. Addressing the challenges ...

Community health workers and accountability: reflections from an international “think-in”

Community health workers (CHWs) are frequently put forward as a remedy for lack of health system capacity, including challenges associated with health service coverage and with low community engagement in the health system, and expected to enhance or embody health system accountability. During a ‘think in’, held in June of 2017, a diverse group of practitioners and researchers discussed the topic of CHWs and their possible roles in a larger “accountability ecosystem.” While CHWs are often conceptualized as cogs in a mechanistic health delivery system, at the end of the day, CHWs are people embedded in families, communities, and the health system. CHWs’ social position and professional role influence how they are treated and trusted by the health sector and by community members, as well as when, where, and how they can exercise agency and promote accountability. To that end, this study put forward several propositions for further conceptual development ...

Equity in access to care in the era of health system reforms in Turkey

The aim of this study was to evaluate access to healthcare from an equity perspective on the way toward Universal Health Coverage in Turkey. In order to  The country representative data from 2006 to 2013 Turkey Income and Living Conditions Surveys were analyzed. Private household residents aged fifteen and older were asked for self-reported unmet need for medical care in the past twelve months. 

Health system innovations: adapting to rapid change

A fundamental challenge for health systems is the need to adapt to changes in the patterns of health service need, scientific and technological developments, and the economic and institutional contexts within which providers of health services are embedded. This is especially true of many low and middle-income countries, where the pace of multiple and interconnected changes is breath-taking. 

A Critical Analysis of Purchasing Arrangements in Kenya: The Case of the National Hospital Insurance Fund

Purchasing refers to the process by which pooled funds are paid to providers in order to deliver a set of health care interventions. Very little is known about purchasing arrangements in low-and middle- income countries, and certainly not in Kenya. This study aimed to critically analyse purchasing arrangements in Kenya, using the National Hospitals Insurance Fund as a case study. 

Challenges and achievements in integrated care: different health and social care providers working together. Successful projects that show that this is the way

The Catalan health system is a public healthcare system, funded by taxes, with universal coverage and public healthcare services portfolio. There´s a mixed healthcare providers network. Delivery of integrated health and social care witha a shift to a patient-centered model is one of the main challenges of our public system. this artcile share three experiences of different models developed to improve integration of social and healthcare services, to guarantee the continuum of care and to achieve quality health and social care outcomes. 

Lessons from Brazil: on the difficulties of building a universal health care system

A number of developing countries that are often referred to as emerging economies have turned their attention to addressing their public health issues in more comprehensive and systematic ways. While the trajectory of this particular initiative and similar ones elsewhere is yet to be determined, the aim of this piece is to draw some lessons from an emerging economy that, for contingent historical and political reasons, started building a universal public health care system earlier: Brazil. The key argument offered from the Brazilian experience is that building a robust public health care system based on the principles of universality and equity is a challenge of a political economy nature and one that ought to be met at multiple levels simultaneously. 

A systematic review of strategies to increase access to health services among children in low and middle income countries

Universal Health Coverage is widely endorsed as the pivotal goal in global health, however substantial barriers to accessing health services for children in low and middle-income countries exist. Failure to access healthcare is an important contributor to child mortality in these settings. Demand side interventions included: educational programmes, text messages, and financial or other incentives. Interventions that delivered services at or closer to home and text messages were in general associated with a significant improvement in relevant outcomes.

There are some intervention areas that seem to show encouraging trends including text message reminders and delivery of services at or close to home.

Strengthening universal health coverage through role delineation in the Solomon Islands

To achieve effective coverage of services, Role Delineation Policy (RDP) was developed following extensive consultation. The RDP defines service delivery packages for six levels of health facilities: rural health centres, area and urban health centres, general hospitals and the national referral hospital; successful advocacy led to inclusion of Universal Health Coverage in the National Development Plan, and to Role Delineation being the central unifying feature of the National Health Strategic Plan, 2016-2020, based on initial implementation experiences, the RDP was revised and will be sequentially will be implemented in rural provinces commencing in 2017.

Defining and standardizing primary care in Georgia

Government reforms aiming to establish universal health care, increase state involvement in the health system and strengthen regulation have been introduced; articulating a clear government vision ensured a strong foundation on which to build reforms; learning from previous experiences and seeking expertise from international partners helped the initiative avoid potential difficulties; inclusion of stakeholders in the design process helped build local consensus for change; following the strategy development process, detailed plans were drawn up to guide proposed reforms.

No universal health coverage without primary health care

Correspondance

Universal health coverage is currently the aspiration of many countries worldwide. We commend Michael Reich and colleagues for analysing lessons learned from different country experiences, but we believe there is a crucial element neglected within the ongoing universal health coverage debate.

Health-care system development requires more than financing and human resource considerations. Although essential, these components must be integrated into an overall framework for organising and delivering care that best meets population needs. Primary health care provides such a framework, builds the backbone of an effective health-care system, and can improve health, reduce growth in costs, and lower inequality^. Strong orientation towards primary health care and its core principles (often outlined as first contact, continuous, comprehensive, and coordinated care) is shown to be stable over time and was often incorporated in the early days of many health-care systems that have a strong primary health-care orientation today. This observed stability ...

Director-General’s Opening address to the 69th World Health Assembly

Dr. Margaret Chan’s opening address for the 69th World Health Assembly holding from the 23rd to the 28th of May 2016, in Geneva, called for celebration of the stunning health achievements to date, but warned that health challenges have grown far more numerous and complex.

The speech spanned across the various areas of focus of the WHO. As such, the global strategy on people-centred and integrated health services also featured:

“[…] Innovations help, but ambitious goals are feasible and affordable only if we cut out waste and inefficiency.

We do so through integrated, people-centred care that spans the life course, from pre-conception through ageing, and brings prevention to the fore. The target for universal health coverage moves us in that direction.

UHC is the target that underpins all others. It is the ultimate expression of fairness that leaves no one behind. It also has the best chance of meetings people ...

State humanitarian verticalism versus universal health coverage: a century of French international health assistance revisited

The French contribution to global public health over the past two centuries has been marked by a fundamental tension between two approaches: State-provided universal free health care and what we propose to call State humanitarian verticalism. Both approaches have historical roots in French colonialism and have led to successes and failures that continue until the present day. In this paper, the second in The Lancet's Series on France, we look at how this tension has evolved. During the French colonial period (1890s to 1950s), the Indigenous Medical Assistance structure was supposed to bring metropolitan France's model of universal and free public health care to the colonies, and French State imperial humanitarianism crystallised in vertical programmes inspired by Louis Pasteur, while vying with early private humanitarian activism in health represented by Albert Schweitzer. From decolonisation to the end of the Cold War (1960-99), French assistance to newly independent states ...

Multi-country purchasing study

The international research consortium RESYST (Resilient & responsive Health Systems) has examined healthcare purchasing functions in some low and middle-income countries to identify factors that influence the ability of healthcare purchasers and other key actors to take strategic actions. The countries included in the study are: Kenya, India, Nigeria, South Africa, Tanzania, Thailand and Vietnam.

From a universal health coverage perspective, this research project focus on purchasing of services from healthcare providers. This core function of healthcare financing must be designed and undertaken strategically to promote quality, efficiency, equity and responsiveness in health service provision and, in doing so, purchasing facilitate progress towards universal health coverage.

The research examined the relationships between purchasers and other groups of actors involved in purchasing mechanisms, including the government, healthcare providers and citizens, so as to understand the various components of strategic purchasing and the organizational environment within which it operates.

The study makes some ...

Can service integration work for universal health coverage? Evidence from around the globe

Universal health coverage (UHC) is at the heart of the new 2030 Agenda for SustainableDevelopment. Health service integration is seen by World Health Organization as an essen-tial requirement to achieve UHC. However, to date the debate on service integration hasfocused on perceived benefits rather than empirical impact. We conducted a global reviewin a systematic manner searching for empirical outcomes of service integration experimentsin UHC countries and those on the path to UHC. Sixty-seven articles and reports were found.We grouped results into a unique integration typology with six categories – medical stafffrom different disciplines; patients and medical staff; care package for one medical condi-tion; care package for two or more medical conditions; specialist stand-alone services withGP services; community locations. We showed that it is possible to integrate services indifferent human development contexts delivering positive outcomes for patients and clin-icians without incurring additional costs. However, the improved outcomes shown wereincremental rather than ...

Global Learning Laboratory for Quality Universal Health Coverage

Welcome to the Community of Practice for the WHO Global Learning Laboratory (GLL) for Quality Universal Health Coverage (UHC). The GLL is deeply rooted in the five interwoven strategies of the Integrated People Centred Health Services Framework—engaging and empowering people and communities; strengthening governance and accountability; reorienting health services; strengthening coordination of care and creating an enabling environment. The GLL recognizes the key role of people-centred health services in order to achieve the Sustainable Development Goals (SDGs) and UHC.

The GLL highlights the need to focus care on the needs and preferences of people. To this end, the GLL aims to create a safe space to share lessons, experiences and ideas; challenge those ideas and spark innovation on quality within the content of UHC. The GLL is organized around three areas. First, national quality policy and strategy (NQPS) in order to drive quality across all levels of the health ...

IHF 40th World Hospital Congress

The IHF 40th World Hospital Congress will be held 31 October – 3 November 2016 in Durban, South Africa with the theme: Addressing the Challenge of Patient-centered Care and Safety.

The World Hospital Congress of the International Hospital Federation (IHF) is a unique global forum that brings together key drivers of national and international policy, management, financial trends and solutions in healthcare management and service delivery. Through this forum multidisciplinary exchange of knowledge, expertise and experiences are facilitated, together with dialogue on best practices in leadership in hospital and healthcare management and delivery of services.

For further information please click here: IHF 40th World Hospital Congress

Universal Health Coverage’s evolving location in the post-2015 development agenda: Key informant perspectives within multilateral and related agencies during the first phase of post-2015 negotiations

In 2001, technocrats from four multilateral organizations selected the Millennium Development Goals mainly from the previous decade of United Nations (UN) summits and conferences. Few accounts are available of that significant yet cloistered synthesis process: none contemporaneous. In contrast, this study examines health’s evolving location in the first-phase of the next iteration of global development goal negotiation for the post-2015 era, through the synchronous perspectives of representatives of key multilateral and related organizations. As part of the Go4Health Project, in-depth interviews were conducted in mid-2013 with 57 professionals working on health and the post-2015 agenda within multilaterals and related agencies. Using discourse analysis, this article reports the results and analysis of a Universal Health Coverage (UHC) theme: contextualizing UHC’s positioning within the post-2015 agenda-setting process immediately after the Global Thematic Consultation on Health and High-Level Panel of Eminent Persons on the Post-2015 Development Agenda (High-Level Panel) released their ...

Achieving Effective Universal Health Coverage And Diagonal Approaches To Care For Chronic Illnesses

Health systems in low- and middle-income countries were designed to provide episodic care for acute conditions. However, the burden of disease has shifted to be overwhelmingly dominated by chronic conditions and illnesses that require health systems to function in an integrated manner across a spectrum of disease stages from prevention to palliation. Low- and middle-income countries are also aiming to ensure health care access for all through universal health coverage. This article proposes a framework of effective universal health coverage intended to meet the challenge of chronic illnesses. It outlines strategies to strengthen health systems through a “diagonal approach.” We argue that the core challenge to health systems is chronicity of illness that requires ongoing and long-term health care. The example of breast cancer within the broader context of health system reform in Mexico is presented to illustrate effective universal health coverage along the chronic disease continuum and across health ...

Health-system reform and universal health coverage in Latin America

Starting in the late 1980s, many Latin American countries began social sector reforms to alleviate poverty, reduce socioeconomic inequalities, improve health outcomes, and provide financial risk protection. In particular, starting in the 1990s, reforms aimed at strengthening health systems to reduce inequalities in health access and outcomes focused on expansion of universal health coverage, especially for poor citizens. In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries studied, government financing enabled the introduction of supply-side interventions to expand insurance coverage for uninsured citizens—with defined and enlarged benefits packages—and to scale up delivery of health services. Countries such as Brazil and Cuba introduced tax-financed universal health systems. These changes were combined with demand-side interventions aimed at alleviating poverty (targeting many social determinants of health) and ...

Going Universal: How 24 countries are implementing universal health coverage reforms from the bottom up

This World Bank Group book is an overview of how 24 developing countries have embarked on the long journey to Universal Health Coverage (UHC). This Universal Health Coverage Study Series (UNICO) offers knowledge and operational tools to help countries tackle UHC in ways that are fiscally sustainable and that enhance equity and efficiency, by providing examples and lessons learnt from the UNICO countries (individual case studies may be accessed at http://www.worldbank.org/en/topic/health/publication/universal-health-coverage-study-series). In these countries, which together represent one third of the world’s population, efforts to achieve UHC have mainly focused on fiscal expansion, accountability, and community health workers. The study finds that most of these countries, except for success stories such as Costa Rica and Thailand, are still struggling with establishing functional integrated care networks. However, the report recommends that developing countries should continue to empower their primary sector as gatekeepers ...

World health report 2013: research for universal health coverage.

Overview Universal health coverage ensures everyone has access to the health services they need without suffering financial hardship as a result. In December 2012, a UN resolution was passed encouraging governments to move towards providing universal access to affordable and quality health care services. As countries move towards it, common challenges are emerging -- challenges to which research can help provide answers. The World health report: research for universal health coverage focuses on the importance of research in advancing progress towards universal health coverage. In addition, it identifies the benefits of increased investment in health research by low- and middle-income countries using case studies from around the world, and proposes ways to further strengthen this type of research.