Rallying For UHC (I): Refining the UHC Message for Post-2015 Success

Rallying For UHC (I): Refining the UHC Message for Post-2015 Success

{Photo credit: Pan American Health Organization}Photo credit: Pan American Health Organization

As the United Nations General Assembly kicks off general debate on the post-2015 development agenda this week, advocates of a universal health coverage (UHC) target are rallying other organizations to build and showcase support around UHC. These efforts include high-profile events on Monday and Tuesday, both hosted by the Rockefeller Foundation with partner support. On Wednesday, Johnson & Johnson hosts an event on the key role of frontline health workers to efforts like these. 

In a three-part series, MSH bloggers expand on the themes raised by these events and consider the road ahead for UHC in post-2015 discussions. Readers can participate through their organizations—which can sign on to a joint letter to UN Member States supporting a post-2015 UHC target—or as individuals: by urging their organizations to sign the joint letter, adding comments on this blog post, or on Twitter with the hashtag.  

Advocates for universal health coverage (UHC) have been inclined to claim recently that there’s a global consensus around UHC. To be sure, many key stakeholders have rallied around UHC’s importance, especially for developing countries. These stakeholders are global, both in the sense that they span the globe—from Amsterdam to Lagos, Manila to Santiago—and that they include multilateral UHC champions like the World Bank and World Health Organization (WHO). Signatories to the December 2012 UN resolution endorsing UHC were geographically, economically and politically diverse. 

But for civil society advocates, the feeling around UHC is still far from unanimous. UHC has been a divisive issue within NGO coalitions in the U.S., Europe and elsewhere. MSH and several other NGOs—Save the Children and Oxfam the largest among them—have fully backed the international move towards UHC. Many, however, have taken notice but no position on UHC. How could NGOs be lukewarm while a longtime health and development practitioner like Jim Kim is passionately arguing, “We must be the generation that delivers universal health coverage”?

Here are a few sticking points we’ve observed:

Talking financing vs. health and wellbeing

In recent years, the main intellectual drivers of the UHC agenda have been World Bank and WHO, both of which discussed UHC primarily in terms of financing reforms. The most influential technical work in today’s UHC movement, like WHO’s 2010 World Health Report and the Rockefeller Foundation’s Catalyzing Change, have focused on financing.

These health financing reports were necessary technical contributions. But few health NGOs work on health financing per se. Even fewer talk publicly about it. The civil society world, tasked with representing the underserved populations who lack a global public voice, is concerned with making people’s lives better. To draw greater support from civil society, UHC can’t just be about risk pooling, prepaid funds and service delivery reorganization. It’s got to be about the mom in Nigeria who can’t get malaria care for her daughter because, of the two clinics she can get to, one is too expensive and the other is stocked out. 

A more people-focused approach to UHC will improve UHC’s chances, not just among NGOs but in the UN process. For both NGOs and UN delegations, the post-2015 agenda has got a specific set of goals: not just improving lives, but specifically improving equity and eliminating extreme poverty. The UN Secretary General’s recent recommendation that the post-2015 framework include “universal health coverage, access and affordability” offers a clue as to the direction of UHC dialogue over the next two years. 

A new report from Rockefeller, Save the Children, UNICEF and WHO, UHC: A Commitment to Close the Gap (PDF) takes the discussion in the right direction. The report, launched at a high-powered event last night featuring WHO Director General Margaret Chan and other UHC heavy hitters, includes the key finding is that improving healthcare access in an equitable way—that is, focusing on rolling out services to poorer groups—generates a better return on healthcare investment than simply aiming to increase coverage overall. The report is still relatively technical and aimed at a savvy audience. But it brings the conversation closer to making life better, especially for the worst-off around the world. That’s what NGOs care about.


Although UHC is a powerful goal, UHC advocates can become so enamored with the potential of UHC that they forget to mention all the work it takes to make UHC programs successful. Adopting a UHC goal is a major step—perhaps even a landmark step—but it’s not unreasonable to question whether countries can deliver. 

Last night’s report launch event hit two important notes: first, the need to highlight countries which have successfully built around this vision, including the experiences of Thailand and Japan, whose UN missions co-sponsored the event. Second, the argument for smart design and continuous monitoring of health systems working towards UHC: for UHC to succeed as a post-2015 goal, it must be clear that we know how to make it work. The most common objection we’ve heard to a UHC goal is that while it sounds great, it’s too vague, unmeasurable, or won’t make a difference to how countries operate post-2015. “UHC: A Commitment to Close the Gap” emphasizes that a UHC goal comes with a body of literature—still evolving, to be sure—which can guide implementation and evaluate progress and outcomes. 

Shifting priorities

Since UHC efforts change how money is spent, they’ll affect life for NGOs on the ground and civil society constituents. Some advocates are understandably concerned about how things will change, and perhaps still more are concerned about U.S. government support (or lack thereof). But others are simply looking for opportunities to join a coalition. See our next post in this series for more on this.