18 June 2021

A letter to The Lancet from Ms Gabriela Cueva and Dr Justin Koonin

A call to action on UHC commitments from UHC2030 Co-chairs

Global health is at an extraordinary moment. The COVID-19 pandemic has exposed all the inequities that prevent achieving health for all. At the same time, the pandemic has given countries the opportunity to rebuild health systems differently, and the determination to ensure that bridges are built across geographies and sectors in doing so. This task will only be successful if everyone—communities and civil society, governments, multilateral organisations, philanthropists, and the private sector—does their part.

To end this crisis and build a healthier future, the world should act urgently in three linked areas: equitable access to COVID-19 tools, preparedness for future emergencies, and universal health coverage (UHC). To this end, we call on global leaders to mobilise political will, commit additional financing, and take collective action, and we note several unprecedented opportunities for the G7, G20, and UN to show their resolve to secure political commitment and action for stronger global governance and investment in stronger health systems.1

Although it is quite clear that UHC is an urgent priority to end the current global health crisis, the question and reality is this: are countries stepping up to the challenge of taking action on their UHC commitments?

As newly elected co-chairs of UHC2030, we are committed in driving this global multistakeholder collaboration forwards to reach its maximum potential. However, we are strongly aware that global initiatives must be closely linked and engaged with both national and local circumstances in order to be effective. We will endeavour to work with all our partners to help to turn political commitments to UHC into action on the ground and focus on linkages and interaction with implementation processes at the national level, which involve review by the legislative and executive branches of government.

On Sept 23, 2019, world leaders endorsed the most ambitious and comprehensive political declaration on health in history.2 Their commitment to UHC was loud and clear. But are governments taking action towards meeting these commitments?

To try to answer this question and support national accountability and advocacy processes, UHC2030 produced the first review documenting the state of commitment to UHC at the end of 2020.3 It provides a multistakeholder consolidated view on the state of progress being made towards UHC at country and global levels.

The review includes a set of political messages for national leaders as well as an online dashboard of country profiles, which show snapshots of the state of UHC commitment in 193 UN member states. The country profiles will be updated to help national stakeholders assess the latest status of UHC commitments in their countries and to track progress in translating them into action, so that they can hold their political leaders accountable for their UHC commitments. What does the review show? The current state of UHC presents huge challenges. Findings show that in many counties, poor and vulnerable groups are being further left behind, and inequities are widening due to the COVID-19 crisis. The COVID-19 pandemic is also exposing and exacerbating weaknesses in health systems, showing that many governments neglected to invest in health, social safety nets, and emergency preparedness when it really mattered: before a crisis struck.

Even countries with stronger health systems could have been better prepared for this emergency. There is still much to be done to ensure adequate support to front-line health workers, to meaningfully engage all stakeholders in decision making, and to ensure gender-equitable responses. Furthermore, many countries have not adopted measurable national targets, and public awareness of governments’ commitments remains limited. This situation must change. We call on all leaders and stakeholders across society to take urgent action for health systems that protect everyone—now.

The COVID-19 pandemic shows the imperative for governments to step up investments in core health systems functions that are fundamental to protecting and promoting health and wellbeing, including common goods for health, such as surveillance and risk communication, and the need to strengthen primary health care as the cornerstone of people centred integrated service delivery.4 Hard-won gains in essential service coverage must also be sustained and scaled up.

We urge all partners of UHC2030 to use our review's political messages and ask national political leaders in all 193 UN member states to take action on universal health coverage. Specifically, we call on all national political leaders to:

  • prioritise UHC to tackle and recover from the COVID-19 pandemic,
  • stop public anxiety, and rebuild trust in government and political leaders;
  • address the systemic inequities that are widening with COVID-19 by creating stronger social and financial safety nets and prioritising equity;
  • expand and strengthen UHC legislation and regulations, set clear targets, and communicate better;
  • support, protect, and care for health workers, and innovate to improve and maintain quality during emergencies;
  • invest in public health and primary health care as a joint effort of health and finance ministers, and local governments;
  • build partnerships through genuine civil society engagement;
  • empower women, who are proving to be highly effective leaders in health emergencies; and
  • give UHC principles more weight in every crisis response and build emergency preparedness into all health system reforms.

Now more than ever everyone needs to come together to ensure coherent action and to build trust and accountability by widening participation in health governance at all levels.

We are co-chairs of UHC2030. We declare no competing interests.

Reprinted with permission. See original article here.


  1. Cuevas Barron G., Koonin J, As Sy E, et al. :Joint statement by UHC2030 co-chairs and the UHC Movement Political Advisory Panel.
    https://www.uhc2030.org/blog-news-events/uhc2030-news/dear-global-leaders-now-is-the-time-to-invest-in-better-global-governance-and-stronger-country-health-systems-for-everyone-555482. Date: May 21, 2021. Date accessed: May 21, 2021
  2. UN. Political declaration of the high-level meeting on universal health coverage. Universal health coverage: moving together to build a healthier world. https://undocs.org/en/A/RES/74/2. Date: Oct 18, 2019. Date accessed: March 19, 2021

  3. UHC2030. State of commitment to universal health coverage: synthesis, 2020. https://www.uhc2030.org/blog-news-events/uhc2030-news/state-of-commitment-to-universal-health-coverage-synthesis-2020-555434 Date: Dec 2, 2020. Date accessed: March 19, 2021

  4. UHC2030. Time to get our act together on UHC and health emergencies. New discussion paper from UHC2030. https://www.uhc2030.org/blog-news-events/uhc2030-news/time-to-get-our-act-together-on-health-emergencies-and-uhc-555361 Date: May 29, 2020. Date accessed: March 19, 2021

    Photo credit: Copyright © 2021 FG Trade/Getty Images

More UHC2030 News


UHC2030 is excited to welcome several new and distinguished...


The UHC Movement Political Panel calls on Member States to...