17th International Dialogue

Universal Health Coverage (UHC) – ensuring that every person has access to quality, affordable health services without the risk of financial hardship – has emerged as a dominant framework in global health. Through the inclusion of UHC in the Sustainable Development Goals (SDGs, target 3.8), this trend has been further reinforced.

According to the 2019 UHC Global Monitoring Report, at least half of the world’s population cannot access essential health services. This also holds true for those services specific to sexual and reproductive health (SRH). Because of the lack of social and financial protection in many countries, many people remain unable to afford services ranging from contraception to safe delivery.

The relationship between UHC and SRHR is mutual: Universal access to quality SRH services cannot be achieved without structural efforts to minimise financial barriers and expand coverage. Equally, achieving UHC is impossible without particular consideration of SRH and its central importance to
large numbers of people in all countries – especially women and adolescents.

While the rise of UHC is often seen as a great – and possibly unique – opportunity to further SRHR, many of these hopes remain unrealised. The interpretation and implementation of UHC differs from country to country: to date, most countries have included limited aspects of a comprehensive SRH package in their national UHC frameworks. While some SRH services, such as maternal and antenatal health services, are commonly included in basic health packages, national health schemes aiming at UHC often leave out other essential elements of SRH such as access to contraceptives: In 2014, more than US$ 1.2 billion was spent on contraceptive supplies across 135 low and middle-income countries (LMICs). The share of out-of-pocket expenditure for contraceptive supplies was 82 per cent, while donor funding and domestic government expenditure covered 10 per cent and 8 per cent respectively.

In addition, steps towards UHC have not automatically resulted in greater equity. Those groups with the largest needs for SRH services – women, adolescents or sexual minorities – remain more likely to be left out of schemes aiming to achieve UHC. Moreover, the inclusion of services in national UHC frameworks does not guarantee their accessibility, availability and quality, as many structural barriers persist. Finally, it appears that despite the broad vision of UHC within the Agenda 2030, efforts at country level often remain truncated by an overly narrow focus on the health sector and bias towards clinical and curative services. This limits the utility of UHC as a vehicle to drive a comprehensive SRHR agenda, which in large parts depends on multisectoral action, health promotion and prevention.

The 17th International Dialogue on Population and Sustainable Development will be moderated by Katrin Erlingsen and Ute Lange.