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Health Systems Strengthening for UHC

A priority for German Development Cooperation

The challenge

Access to healthcare is a human right. Yet, more than of the world’s population currently does not have full coverage of essential health services. About 90 million people are being pushed into extreme poverty (having to live on less than US$1.90 a day) each year because they have to pay for health care or are unable to work due to illness. In 2005, all member states of the World Health Organization (WHO) subscribed to the goal of Universal Health Coverage (UHC) – ensuring that all people have access to healthcare without suffering financial hardship paying for it.

‘Universal health coverage (UHC) means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship’ (WHO, 2019).

Ensuring financial protection for all is a complex and lengthy undertaking that raises numerous systemic – and redistributive – questions about how a state intends to guarantee and promote a basic human right of its citizens. Supporting partner countries in this endeavour is one of the priorities of German Development Cooperation in health and social protection.

How does Germany contribute?

UHC is an important part of Sustainable Development Goal 3 on ensuring healthy lives and well-being for all people of all ages. For its realisation health systems strengthening efforts at national and global levels must be optimally coordinated. Germany contributes to these efforts and promotes a comprehensive approach to health systems strengthening that is aligned with national priorities. It provides its support at three levels:

  1. At the global level, Germany contributes to coordinated global health system strengthening efforts 
  2. At the multilateral level, it strengthens and actively contributes to UHC networks
  3. At partner country level, it supports governments on their paths towards UHC 

Contributing to coordinated global health system strengthening efforts

During the 2019 UN High Level Meeting on UHC under the motto “Moving Together to Build a Healthier World”, UHC 2030, the global partnership for strengthening health systems and UHC, consolidated a set of key asks from the UHC movement. These key asks, which Germany fully supports, will guide the critical reforms on the road to UHC.

Angela Merkel and Margaret Chan
Angela Merkel and Margaret Chan

Germany’s support for health systems strengthening for UHC started several years earlier: ‘We want to change our world. And we can,’ said German Chancellor Angela Merkel speaking at the UN Summit in 2015. Together with the then WHO Director General, Dr Margaret Chan, she launched the global initiative ‘Healthy Systems – Healthy Lives’ aimed at developing  a ‘Joint Vision’ on what is needed to establish stronger health systems around the world. Under the umbrella of UHC 2030, in 2016/17, more than 200 health actors from governments, NGOs, multilateral organisations and private foundations contributed to a consultation process on the Joint Vision Paper, ‘Healthy systems for universal health coverage – a joint vision for healthy lives’. Read more…

Germany recognises the importance of UHC2030 as largest global multi-stakeholder partnership for health system strengthening for UHC. It supports the partnership as Steering Group member and through technical and financial support for its strategic initiatives. Read more…

Early in 2018, Angela Merkel, Ghana’s president, Nana Akufo-Addo, and Norway’s prime minister, Erna Solberg, recognised: greater impetus was needed to ensure that health-related Sustainable Development Goals could be reached. They wrote a joint letter to the Director General of WHO,  requesting that he lead the development of a ‘Global Action Plan for Health and Wellbeing for All’. Read more…

Strengthening and actively participating in UHC networks

Germany is one of the founding members of the P4H Network, the global network for health financing. It finances and organises the secondment of so-called P4H country focal points to P4H member countries who support, directly from the ground, processes in the area of health financing for UHC by contributing to the development of needed capacities and assisting the government in coordinating national and international stakeholders. Read more…

Making UHC a reality in individual countries requires effective leadership able to rise above bureaucratic, social and other obstacles by aligning divergent, often conflicting, interests among key players. This is why Germany, in cooperation with the World Bank, has developed and continues to support the L4UHC leadership course. L4UHC is a year-long programme which aims to accelerate the UHC process among participating countries, helping to build effective and sustainable partnerships. Experienced coaches and resource personnel share experiences on leadership and change theory, as well as UHC-related technical expertise.

Supporting countries on their paths towards UHC

Two of Germany’s partner countries that have taken big strides towards UHC by extending social health protection to hundreds of millions of people in a matter of years are India and Indonesia. In both of them, Germany supported UHC-related efforts right from the very beginning.

Bernd Rürup and Indonesia’s Mari Elka Pangestu consulting on reforms of Indonesia’s social protection system.
Bernd Rürup and Indonesia’s Mari Elka Pangestu consulting on reforms of Indonesia’s social protection system.

Each country took a different approach: while India has focused its efforts on extending social health protection to the poor as part of its ‘inclusive growth’ strategy, Indonesia conceived of health protection as part of the government’s comprehensive social protection mandate and therefore launched a single-payer national health insurance for the entire Indonesian population.

In both countries, legal frameworks needed to be crafted and administrative procedures drafted, vast amounts of data had to be analysed and management structures set up – all to ensure the functionality and operational viability of the new national schemes to serve up to half a billion users. Through its bilateral projects, German development cooperation has helped to facilitate the necessary change processes, building on Germany’s longstanding expertise and experiences in the field of social health protection.

As of March 2020

© World Health Summit
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