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Advancing Health Systems for All in the SDG Era

The Alma Ata vision of ‘Health for All’ remains as compelling today as it was in 1978, as reflected in goal 3 of the Sustainable Development Goals (SDGs). But the world has changed in forty years. Despite improved health outcomes, there remain extraordinary challenges for health equity and social inclusion, such as demographic and disease transitions, conflicts and their subsequent migrations, pluralistic health systems and markets, and climate change. Political systems still marginalize those most in need. Yet there are new opportunities for health systems to achieve universal coverage.

The Fifth Global Symposium will advance conversations and collaborations on new ways of financing health; delivering services; and engaging the health workforce, new social and political alliances, and new applications of technologies to promote health for all.

The SDGs as a stimulus for renewed multisectoral action

During a period in which global advances are threatened by climate change, faltering aid commitments, and tightening of borders, the SDGs remind us that human progress relies on multisectoral action. There is a need for health systems to look beyond the provision of care, and act on the complex social, political, environmental and economic determinants of health. Such multisectoral action will be essential to address such diverse challenges as emerging infections, chronic conditions, and the mass movement of people. But such progress requires new ways of working across disease programs and across sectors, and new mechanisms of governance to support this. How can our approach to health systems help us work across sectors to achieve shared goals of social development?

Polemic and pragmatism: engaging the private sector in moving towards universal health coverage

The Alma Ata vision was premised mostly on the idea of publicly funded health systems providing health care for all. Little thought was given to the role of private sector providers (both not-for-profit and for-profit). Yet, forty years later, billions of people continue to seek care from the private sector, which is highly heterogeneous, often weakly regulated and poorly linked to the rest of the health system. And the private sector is evolving quickly, in response to the gaps left by the public sector and the opportunities for trade and investment. There is significant opposition to the role of the private sector in providing healthcare; yet the private sector can be a source of innovation, additional resources and services that are more responsive to the needs of health service users. How best should the movement for universal health coverage consider the role of the private sector in delivering and financing health care?

Leaving no one behind: health systems that deliver for all

Health systems not only provide access to essential services, but also form the backbone of social protection. This was part of the vision for the UK National Health Service, celebrating its 70th anniversary in 2018; and more broadly for universal health coverage which emphasises both financial protection and service coverage. Yet many slip through the health system safety net. These include those affected by conflict and humanitarian crisis; migrants whose entitlements to coverage are not assured; and those who because of their gender, ethnicity, religion, sexual orientation, or other characteristics, are excluded. Financing of services for these marginalized populations is precarious – because of economic austerity and budget cuts; poor integration with the rest of health system financing; or dependence on external sources. And service delivery often relies on a poorly coordinated patchwork of public, NGO and private providers. How can health systems be mobilized to form the backbone of social protection for vulnerable groups?

Community health systems – where community needs are located, but often the invisible level of health systems

Alma Ata emphasized the importance of health services close to where people live, and of community participation. Forty years later, health systems are struggling with changes in society and communities brought about by urbanization and other demographic changes, and efforts to strengthen health systems often ignore the role of communities. Issues such as community mobilization, civil society engagement and the appropriate role of community health workers remain as relevant now as in 1978 – fundamental to effective primary care, but also to tackling both the burgeoning demands of chronic diseases as well as the renewed threats of pandemic infectious diseases. Community-led and participatory governance is also important not just to achieve immediate health outcomes, but also in strengthening health systems and their accountability to the populations they serve. How should health systems engage communities to achieve universal coverage?