69th World Health Assembly: MSH and The Rockefeller Foundation Release Report on Options for an Accountability Framework for Universal Health Coverage

{Photo credit: Carmen Urdaneta/MSH}Photo credit: Carmen Urdaneta/MSH

It is encouraging how much the world is focused on achieving universal health coverage, and the Sustainable Development Goals only add to that momentum. While much courageous leadership and thoughtful work have led to amazing progress toward UHC in many countries, there is still much to be done for all people have access to the quality, affordable health services they need. 

On the eve of the 69th World Health Assembly, MSH and The Rockefeller Foundation release this progress report on the work of many organizations to develop concrete measurements of UHC progress – for both access to basic care and its affordability to all. If we are to meet the SDG UHC target by 2030, we need commonly agreed measures to aid us in charting progress country by country, to celebrate success, to make adjustments when we fall short, and to hold ourselves – all of us – accountable for achieving SDG 3.8. And UHC progress, as we know, facilitates the achievement of the other SDG health targets. This report helps point the way forward to completing this important work.

This report summarizes the responses received through a public consultation on the UHC Accountability Options Paper that took place between December 2015 and February 2016. This was part of a Management Sciences for Health project to strengthen accountability for UHC, supported by The Rockefeller Foundation and implemented with partners. Approximately 100 people participated in the consultation (online and at events held in Montreux and Bangkok) from all regions and a wide range of constituencies.

There was consensus among the respondents on the importance of strengthening multi-stakeholder accountability for UHC and the timeliness of this initiative as we are at the start of the SDG implementation period. The feedback received confirmed support for the proposals in the Options Paper and the UHC 2030 Alliance/Partnership (herein referred to as ‘UHC 2030’) as the global mechanism to drive this agenda. Respondents acknowledged the political nature of accountability for UHC and emphasised multi-stakeholder participation as key to any approach pursued. 

The following recommendations were identified:

UHC accountability framework

  • A more systematic mapping and deeper review of accountability initiatives under the MDGs to analyse what has been effective, what hasn’t and why, as well as how to build on and leverage these experiences and efforts for health systems and UHC across SDG3.
  • Country-specific consultations to identify gaps and opportunities to strengthen multi-stakeholder accountability for UHC across the functions of monitoring, review and action.
  • Securing reference to accountability in intergovernmental resolutions including the WHA resolution on the SDGs, specifying obligations of Member States.
  • Better definition of ‘non-compliance’ when it comes to UHC implementation, and specification of opportunities for policy guidance.
  • Exploration of the human rights and legislative mechanisms that can be leveraged for UHC accountability.

UHC 2030

  • A commitment to the mandate to strengthen accountability with sufficient human and financial resources to support implementation of the accountability framework.
  • A review of existing models for multi-stakeholder governance (such as the ILO, Global Fund and PMNCH Boards), to inform the design of the UHC 2030 Steering Committee.
  • A consultative process to inform a collective proposal for the CSO consortium under the umbrella of the UHC 2030.
  • Sufficient donor investment in the UHC 2030 to operationalise the accountability framework, including capacity strengthening of civil society, parliamentarians, media and other stakeholders, to effectively engage at country level.

Independent Accountability

  • Expansion of the mandate of the IAP for Every Woman Every Child to the whole of SDG3, and a corresponding restructure.

The proposed next steps are listed below:

  • Update and finalize the UHC accountability framework, incorporating the feedback received and addressing the questions raised in collaboration with the UHC 2030 stakeholders.
  • Translate the framework into a costed action plan as part of the overall UHC 2030 workplan.
  • Continue to advocate to secure political commitment to accountability and UHC and to inform the design and support for the UHC 2030. 

Read the full report