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Submitted by Lara Brearley on

I agree - the absence of a target nullifies the lesson from the MDGs that what gets measured is more likely to get done. It also fails to respond to the danger of vertical investments that can undermine health systems, as we saw with the population and disease-specific focus of the MDGs.

The narrative of the HLP report aknowledges the importance of systems and UHC, yet the opportunity to translate this into action is missed. There needs to be a clear articulation of UHC through targets and indicators that drive equitable progress - through targets that specify gap reductions as well as aggregate progress, with disaggregated indicators.

We have been advocating for a target on both the intervention coverage and financial risk protection components of UHC. We need further discussion to establish some consensus on what these should be. Here might be a good place to start...

For financial protection, the rate and depth of impoverishment from health expenditures seem the best indicators, and an opportunity to also encourage more frequent and better quality of data. If more readily available annual estimates are wanted, then the proportion of total health expenditures that are out-of-pocket may be a more crude measure.

For coverage of interventions, ideally we'd have several tracer measures that respond to the burden and distribution of disease, to make it applicable to all contexts. If just one interventions is more politically viable, skilled birth attendance is often used as a proxy for health system strenth, but whether this is the best available measure is hotly debated. I would go further for proxies of other health system building blocks, such as the density of health workers (again this indicator could do with much improvement to truly capture whether an appropriately trained, supported, equipped and paid health worker is within reach of every person).

Let the debate begin...