Universal Health Coverage Day 2015: Accountability for UHC to Leave No One Behind

Universal Health Coverage Day 2015: Accountability for UHC to Leave No One Behind

{Photo credit: Warren Zelman}Photo credit: Warren Zelman

December 12 marks the second annual global Universal Health Coverage (UHC) Day, and what a year it has been.

Through legal reform and new programs, many countries — like Burkina Faso and Iran — have made important progress on the path to UHC. The Sustainable Development Goals (SDGs) announced in September reinforced the world's commitment to UHC; the third SDG calls for "good health and well-being" and includes a target of achieving universal health coverage.

Now that goals and targets have been set, indicators to track progress are being agreed upon, and we must focus on the implementation, monitoring and accountability of these goals. Accountability — encompassing the interconnected functions of monitoring, review, and remedial action — is imperative to guiding implementation and accelerating progress across the SDGs.

Today we are launching a public consultation on accountability for UHC, calling for feedback on an options paper with proposals for key components of an accountability framework. We welcome your expertise, experience, and ideas to develop this thinking.

Join our efforts to strengthen accountability for UHC

UHC is fundamental to the right to health, which governments are obliged to fulfill. It is an inherently political agenda, pertaining to the redistribution of resources in society. And it is countries' policy choices made along the path to UHC that will determine whether those most in need will benefit first from efforts to expand coverage.

While there is no blueprint for how countries should progress towards UHC, implementation should be consistent with guiding principles — such as progressive universalism, shared responsibility, and participatory decision-making — in order to advance the right to health and fulfill the promise to leave no one behind. Accountability mechanisms throughout implementation are crucial to ensuring adherence to these principles and to prompt course correction when necessary.

UHC can also provide a more integrated and coherent framework for accountability across the health goal, encouraging integrated, people-centred approaches. This is why Management Sciences for Health is working to strengthen accountability mechanisms for UHC at local, national, regional and global levels, with the support of the Rockefeller Foundation.

In recent months, we have been conducting informal consultations on the topic of accountability for UHC. We organized a brainstorming meeting with key stakeholders in New York during the UN General Assembly, co-hosted by the Rockefeller Foundation, WHO, the World Bank, USAID, the government of Japan, and Save the Children. Meeting participants agreed on next steps, which included the development of an options paper for wider consideration. We have also facilitated discussions at related events, including at a WHO and World Bank meeting on the measurement of UHC, and at a meeting to discuss harmonizing civil society advocacy on health systems strengthening and the health goal in the SDGs.

Let's work together to prevent UHC from becoming yet another silo and a failed promise to the world's most vulnerable populations. With strong systems for accountability, we hope to celebrate equitable and accelerated progress next UHC Day and in the years to come.


Achieving Universal Health Coverage (UHC) is an overwhelming task, yet worth pursuing, as a lot can be done and should be done, within the tight budgets available for spending with governments of developing nations. While the UHC strategies would be shaped by structural and cultural uniqueness of a country, some strategies and best practices apply universally, e.g. promoting generic medicines. The WHO report - Health Systems Financing for Universal Coverage, 2010, has provided the guidelines to this effect. It mentions four pathways through which countries can raise resources for health domestically - increasing efficiency in revenue collection, re-prioritizing government budgets, innovative financing and developmental assistance for health. The report also mentions ten leading causes of inefficiencies that are a barrier to achieving UHC. These causes could serve as components for accountability framework for governments. While the components of the framework could be standardized, the strategies could be country specific. Another point to consider is, accountability should be addressed at all levels - Governments, private institutions, non-profits, and community based structures. This would need specific tools for each type of stakeholder in the accountability framework - government, private, non-profits. Further, the frameworks would not be effective unless there are institutions to monitor, reinforce and build capacity of organizations to be compliant to this framework. The third aspect that is often neglected is evaluating the progress and outcomes of the strategies employed for UHC. Sometimes such evaluations are influenced by political pressures to give distorted findings, and could undermine the efforts put in UHC. So accountability framework should also include key performance indicators, that can be objectively verified and data on the same is easily available. For e.g. out-of pocket spending as percent of total health spending. Finally, ensuring accountability in private sector is more complex in comparison to the government. A lot depends on the regulatory framework of the country. Accountability in the private should be thought of differently, as it may need different strategies. One worth mentioning strategy is India's - Corporate Social Responsibility (CSR) law - that mandates industries and business to invest a certain percentage of their profits in developmental activities.

Add new comment