Civil society engagement

Civil society is often best placed to gain access to, represent, and prioritize the most marginalized key populations. To leave no one behind, civil society is a critical voice to ensure that: people have the necessary access to equitable health services; they are informed of health policies; can input into their country’s health systems strengthening efforts.

To ensure universal health coverage and health system strengthening, reducing out of pocket expenses and achieving the aims of the SDGs, national governments and donors should take certain actions.

• National governments should progressively increase their investment in health by either moving towards allocating at least 15% of their annual budget to health, or up to 5% of their annual GDP as government health care expenditure, as contextually appropriate.  This increased budget for health should be raised through mandatory and fair pooling mechanisms (such as improving tax revenue collection, setting up social health insurance) with everyone receiving services according to their need.  These services should be free at the point of use.
• National governments should give priority to primary health care linked to essential care packages that are defined by country-level needs and priorities required to meet SDG target 3.8.1, with a concrete plan to ensure the removal of direct cash payments as an urgent measure.
• Donor governments should provide funding in alignment with countries’ plans, the aid effectiveness principles and the WHO recommendation of funding levels not below 0.1% of GNI.  This is critical in fragile and conflict-affected settings, where much of the health system is supported by foreign aid.  Donors should further support low-income countries to bridge significant finance gaps.  The international community should support countries to grow their fiscal space by tackling undermining practices like tax evasion and avoidance, and lifting harmful macro-economic policy conditions.

Civil society must be included in decision-making processes at all levels, to facilitate citizen-led monitoring of progress against outcomes towards universal health coverage, including the health budget and adherence to commitments. This includes involvement in health systems strengthening efforts at national and district level, and the provision of expanded health coverage to the poorest and most marginalized groups.  Strengthening social-led accountability is necessary to maintain the integrity of health systems, prevent corruption-related resource drain, and ensure more appropriate, acceptable and sustainable health programs.

Achieving universal health coverage depends on the availability, accessibility, and capacity of professionally trained health workers, more so at the primary care level, to deliver quality, people-centered health services.  It is critical to ensure that adequate health care financing is earmarked for training and capacity building of community and frontline health workers so that they are able to support the provision of inclusive, holistic and equitable health services, especially to those who are most marginalized.