Implementing pro-poor universal health coverage.

Universal health coverage (UHC)—the availability of quality, aff ordable health services for all when needed without fi nancial impoverishment—can be a vehicle for improving equity, health outcomes, and fi nancial wellbeing. It can also contribute to economic development. In its Global Health 2035 report, the Lancet Commission on Investing in Health (CIH) set forth an ambitious investment framework for transforming global health through UHC. The CIH endorsed pro-poor pathways to UHC that provide access to services and fi nancial protection to poor people from the beginning and that include people with low income in the design and development of UHC health fi nancing and service provision mechanisms. The CIH argued that pro-poor UHC off ers the most effi cient way to provide health and fi nancial protection, and proposed pathways through which pro-poor UHC could be achieved. Countries worldwide are embarking on health system reforms that move them closer to UHC, in many cases with a clear pro-poor focus. Along the way, there is a wealth of guidance on the technical aspects of UHC, such as designing health service packages and developing health fi nancing systems. However, there is very little practical guidance on how to implement these policies. Motivated by a shared interest in helping to close this gap, in July, 2015, we convened a workshop on implementation of pro-poor UHC, hosted by the CIH and held at the Rockefeller Foundation’s Bellagio Center, with additional support from the US Agency for International Development’s Health Finance and Governance Project. The following statement arises from deliberations at the workshop, which were informed by country experiences in implementation of UHC with pro-poor outcomes and empirical evidence. There is strong and increasing national and global support for UHC, for which eff ective health system development is the key foundation. Achieving UHC means assuring that health systems make available the services—prevention, promotion, treatment, rehabilitation, and palliation—that people might need to use over their lifetimes, and that these services are also of good quality, responsive, and aff ordable. WHO’s 2010 World Health Report (WHR 2010), Health Financing: The Path to Universal Coverage, was a landmark in the global movement towards UHC. The increasing support for UHC can be noted in the accumulation of important meetings, statements, resolutions, and publications since WHR 2010. Examples from the past 3 years include Global Health 2035; a special collection of 19 papers in PLOS Medicine on monitoring UHC; a 2014 World Health Assembly resolution on health intervention and technology assessment in support of UHC; the June, 2015, publication by WHO and the World Bank of the fi rst UHC global monitoring report, Tracking Universal Health Coverage; and a guide for policy makers on delivering UHC, published by the World Innovation Summit for Health. All 194 WHO member countries endorsed UHC as a guiding principle in 2011 and more than 100 are actively seeking this goal. Many are also trying to ensure that they do not move backwards as a result of recent fi nancial and economic crises. Many countries have made great progress in expanding services to reach the poor, mobilising additional domestic funding for health, reducing direct out-ofpocket payments to ensure aff ordability and fi nancial protection, and using funds more effi ciently to get more health for the money. Attention has increased to varied health system developments that need to accompany health fi nancing reforms, including service delivery models adapted to specifi c contexts, development and appropriate deployment of a health workforce, assurance of the availability of essential medicines, improvements in governance and transparency, including processes and methods for deciding what services and interventions to cover under UHC, and collection and reporting of crucial information for policy decisions. Countries have many opportunities to share their experiences and lessons on the journey to UHC—through the Joint Learning Network for UHC, the International Decision Support Initiative, the P4H Leadership for UHC Programme, the ASEAN Plus Three UHC Network Programme, the Disease Control Priorities Network, other bilateral learning and sharing platforms, and through organisations such as WHO, the World Bank, and the Regional Development Banks. Many countries, however, remain challenged by fi nancial constraints, increasing citizen demands, For more on the Joint Learning Network see http://www. jointlearningn etwork.org/