What’s Next: Country-Level Action for Universal Health Coverage and How to Ensure Universal Access to Sexual and Reproductive Health and Rights

Universal health coverage (UHC) is the overarching health priority in the Sustainable Development Goal (SDG) era. The September 2019 United Nations High-Level Meeting on UHC and its forthcoming declaration will lay the groundwork for progressive action toward health for all.

Beyond September’s milestone, though, we know that tangible action and measurable progress toward achieving true UHC will happen at the country level and over the next decade. This requires bold leadership as governments across the world chart a new direction and unveil sweeping national health reforms to ensure their people have access to the quality health care services they need, spanning preventive through palliative care. Accessing those services is balanced with financial protection to ensure people are not pushed into poverty by realizing their right to health care—the real promise of UHC.

Across sub-Saharan Africa and Asia, we are witnessing governments rapidly introducing health financing policy reforms, with health insurance models as the crux, framed as a means to achieve UHC. We know this directly correlates with the “ensuring financial risk protection” portion of the UHC SDG, because providing financial risk protection means protecting people from impoverishing out-of-pocket expenses at the point of care, where many make impossible choices between their health and competing financial realities. Alleviating this burden requires governments creating strong, nationwide systems of pre-paid, pooled funds, distributed to pay for services and commodities in advance—or what we know commonly as health insurance schemes.

Zambia is poised to introduce its first major national health insurance scheme toward UHC this year, and Uganda is set to follow suit, with a recently introduced National Health Insurance Bill in Parliament. Kenya and India launched a UHC pilot scheme and the world’s largest public health insurance scheme, respectively, in the past year and will adapt their policies and programs as they prepare for scale-up through the sub-national level in the coming year. After failing to include family planning in its landmark health reform that introduced its national health insurance scheme, Ghana is piloting a family planning reimbursement scheme since last year, with plans to scale it up nationwide by next year. Additionally, as Burkina Faso and Ethiopia prepare for early stage health financing policy change, including social and community-based health insurance reforms, there are opportunities to learn from the ever-growing cohort.

In this movement, we see an unprecedented opportunity to ensure that emerging UHC-oriented policies are designed to deliver quality services for women and girls. As governments redesign their entire health systems to achieve UHC by 2030, the global community must ensure that these policies and programs are rights-based, increase access—including availability, affordability, acceptability and quality—to sexual and reproductive health (SRH) services and commodities, and bolster sustainable domestic financing for sexual and reproductive health and rights (SRHR).

As governments introduce health financing reforms as one of the first major steps in designing a revitalized health sector to achieve UHC by 2030, the financing policy decisions being made right now will impact the affordability, availability, acceptability, quality and equity of SRH service provision, including family planning (FP), over the next decade and beyond. The way these policies are designed matters for women and girls. As countries create systems to provide financial protection, policymakers’ decisions will determine the nationwide health benefits package. This dictates the particular FP methods and SRH services that are available, and the costs covered through government financing, which determines out-of-pocket costs women, girls and their families must pay. Additionally, these decisions impact the providers and facilities that are selected, and the way they are reimbursed through government financing, which determines where women and girls can access care and whether they can expect quality SRH services.

With this urgent motivation, PAI is launching a multi-year evidence-based advocacy initiative to support  civil society organizations (CSOs) as they advocate for SRHR access as a priority within emerging UHC policies. By employing our innovative partnership model, policy analysis and advocacy expertise, we aim to support SRHR CSO engagement in country-level UHC financing policy processes across seven countries (Zambia, Uganda, Kenya, India, Ghana, Burkina Faso and Ethiopia) where UHC financing reforms are progressing rapidly and work is most urgently needed.

Civil society champions play an instrumental role in these efforts as constructive partners to government-led efforts. Together with country partners, we are first targeting our efforts on health financing reforms for UHC to increase women and girls’ access to SRH services, but we know the road ahead requires a multifaceted front. In addition to financing, we know achieving UHC and ensuring universal access to SRHR requires major country-level policy and programmatic changes across complementary parts of the health system, including the health workforce, supplies, service delivery, governance and information systems, and we are ready to meet the challenge with country-tailored and locally-driven solutions.

To truly realize the 2030 vision of no one left behind, we must carry this current UHC momentum forward with an equal commitment to accountability and ensure governments deliver universal access to SRHR for women and girls for the next decade and beyond.