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Universal Health Coverage: Engage Civil Society and Communities to Keep the Promise

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Universal Health Coverage day Universal Health Coverage day

For the past five years, the world has come together every December 12 to rally around the idea that everyone, everywhere should have access to quality, affordable health care, without suffering financial hardship. This International Universal Health Coverage Day (UHC Day), the message to leaders is straightforward: “Keep the promise.” The promise to advance UHC by 2030 is embedded in the Sustainable Development Agenda, and most recently, the Political Declaration on the United Nations High-Level Meeting on Universal Health Coverage. The Civil Society Engagement Mechanism for UHC2030 (CSEM) – which exists to raise civil society voices in the International Partnership for UHC2030 (UHC2030) to ensure UHC policies are inclusive and equitable – reiterates this message. To effectively advocate for leaders to "Keep the Promise," we must explore how the promise has been broken.

On the eve of the UN High-Level Meeting on UHC in September 2019, the World Health Organization launched the Primary Health Care on the Road to Universal Health Coverage: 2019 Monitoring Report, a biennial report to track global progress on UHC. The CSEM produced the Reflections of the Civil Society Engagement Mechanism for UHC2030 on the Primary Health Care on the Road to Universal Health Coverage 2019 Monitoring Report, launched alongside the UHC monitoring report. The message emerging from these reflections is clear: the biggest failure of the UHC promise is not protecting hundreds of millions of people from financial hardship, and consistently pushing people further into poverty.

The UHC Monitoring Report provides a useful picture of the progress of UHC globally. However, the CSEM reflections identify a gaping hole in the monitoring of UHC. The report fails to identify those people who are most often left behind and does not go further still to identify the increased burden on already vulnerable groups as well as the strong likelihood that they will forgo their healthcare needs entirely. Current monitoring processes leave the most vulnerable populations out: household surveys and facility data are unlikely to capture data from these populations as the most vulnerable people are often stigmatized, imprisoned, marginalized and undocumented. The report only provides a partial picture of financial hardship due to health care costs. The financial protection indicators do not account for often high non-medical costs that can often become a barrier, or for the people who are living in so much poverty that they cannot even afford to pay for healthcare.

To redress these and other gaps, the CSEM recommends that leaders actively uphold the SDG-enshrined principle of leaving no one behind, intensify efforts to accelerate population coverage expansion in lower-middle-income-countries where 1.9 to 2.4 billion people are still without service coverage, and in low-income-countries where coverage remains far below the global average. Every effort must be made to cut out-of-pocket expenditure. Engagement of civil society, people, and communities, including in the process of collecting, collating, validating, and analyzing country data to assist accuracy and comprehensiveness, is paramount to the success of all these efforts.

The findings of the UHC report intensify the CSEM’s commitment to calling for meaningful inclusion and engagement of civil society in all processes of building UHC. The report reveals widespread continuation of inequity and inequality in the availability and accessibility of essential health services and increasingly catastrophic healthcare costs. Over 930 million people had to spend more than 10% of their household budget on healthcare, and 210 million people crossed the 25% threshold. The situation is deteriorating among vulnerable, low-income groups and in low-income countries where the need and disease burden is much higher.

The CSEM welcomes the opportunity to bring civil society and community perspectives on the report through UHC2030 and encourages the strengthening of such partnership efforts. The engagement of civil society and vulnerable populations in the entire process of monitoring UHC at country and local levels is key. The CSEM calls for stronger partnerships between government, UN agencies, the World Bank, civil society, people, and the communities; without the implementation of this critical success factor, leaders will not be able to keep the promise of UHC by 2030. As a result, millions of people will remain without essential health services and continue to live in increasing poverty due to high healthcare costs.



Civil Society Engagement Mechanism Secretariat, hosted by Management Sciences for Health



Communications Officer, CSEM Secretariat, Management Sciences for Health


Executive Director, Center for Support Community Development Initiatives|Advisory Group Member, CSEM


Director, Primary Health Care Initiative, PAI|Advisory Group Member, CSEM

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