Three steps to universal health coverage

Healthy citizens and community-led responses will form the strongest foundations for universal health coverage, writes Michel Sidibé, minister of health and social affairs of the Republic of Mali

The G20 is to be commended for its leadership and commitment to the 2030 Agenda for Sustainable Development. But it is time to ask: are we on track? World leaders committed to leaving no one behind, yet are they? The call of United Nations secretary-general António Guterres to “inject a sense of urgency” in implementing the 2030 Agenda for Sustainable Development confirms what we all fear – we are lagging in realising our ambitious plans for people and planet. I am convinced that the fastest route is to start with healthy citizens.

In recent years, G20 and G7 summits have elevated health as a political issue, a central plank of health diplomacy and a critical element to foster human capital. The first-ever meeting of G20 ministers of health in Berlin in 2017 underscored the G20’s commitment to health with calls for greater investments in human resources as well as addressing anti-microbial resistance and emergency preparedness.

As 100 million people fall below the poverty line every year due to catastrophic health expenditures, the global community is rallying behind universal health coverage – as a means for all people to access high-quality and affordable services. I commend the G20 for leading this charge. Let’s go a few steps further at the Osaka Summit.

Japan, and in particular Prime Minister Shinzo Abe, has long been a champion of universal health coverage, at home, in partner countries as well as through its health diplomacy efforts. Further to its central role in the adoption of the universal health coverage target in 2030 Agenda, Japan hosted the UHC Forum in 2017 and pledged $2.9 billion to universal health coverage in developing countries. I salute the resolve of Prime Minister Abe to shift the G20 discourse on health – rightly seeing it as a global public good that is essential to inclusive growth.

Nonetheless, ambitious words may turn into empty promises if not accompanied by measurable targets focused on results for people. One of the lessons from the Millennium Development Goals is that targets provide a driving force to galvanise action, build political ownership, bring partners together and guide service providers. Ultimately, targets lay the foundations of national and global accountability. As executive director of UNAIDS, I saw this firsthand with the power of the 90-90-90 treatment targets. And as newly appointed minister of health for Mali, I will take a results-oriented approach.
If we are serious about eliminating health disparities, it behooves the G20 and the G7 to set clear, equity-focused targets across universal health coverage, along with robust accountability mechanisms that include independent monitoring. Japan already kicked us off in 2017, when calling for one billion more people to enjoy access to basic health services by 2023. Yet to achieve a universal health coverage system that truly leaves no one behind, I urge the G20 and G7 to adopt people-centred, rights-based and gender-transformative approaches in implementing universal health coverage. I see three ways the G20 and its partners can do so.

Community-led responses must be the foundation of universal health coverage

As we move from millions to billions, we need to support new models of community service delivery. We know from the AIDS response the essential role played by communities in delivering services that deliver health outcomes. I call on the G20 and the G7 to strengthen the capacity and professionalisation of community health workers and to do so in the context of promoting gender equality and decent paid work.

Inclusive governance for universal health coverage must be defended and advanced

When building the organisational arrangements of a universal health coverage system, we need to ensure multi-stakeholder stewardship. I call on the G20 and the G7 to promote inclusive governance with meaningful engagement of communities and civil society as demand creators, campaigners, innovators, experts, implementers and auditors, from the clinic to the highest policymaking table.

Human rights and gender-equality must be at the heart of universal health coverage

I believe universal health coverage provides a unique opportunity to ensure equitable access to health for all, but only if health facilities are free of stigma and discrimination and services are free at the point of care. I call on G20 leaders to do more to foster legal and policy environments that unleash the potential of civil society to contribute to universal health coverage.

This generation of G20 and G7 leaders has demonstrated their forward-looking thinking by raising the salience of investing in human capital. Their combined influence and resources, if channelled towards measurable, people-centred outcomes, hold the key to democratising the life chances of billions of people around the globe, from vulnerable and marginalised communities to ageing populations. I encourage both the G20 and the G7 to seize this opportunity.