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Build back stronger universal health coverage systems after the COVID-19 pandemic: the need for better governance and linkage with universal social protection
  1. Fabrizio Tediosi1,2,
  2. Knut Lönnroth3,
  3. Ariel Pablos-Méndez4,
  4. Mario Raviglione5
  1. 1Swiss Tropical and Public Health Institute, Basel, Switzerland
  2. 2University of Basel, Basel, Switzerland
  3. 3Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
  4. 4Columbia University Irving Medical Center, New York City, New York, USA
  5. 5Global Health Centre, University of Milan, Milano, Italy
  1. Correspondence to Dr Fabrizio Tediosi; fabrizio.tediosi{at}

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  • Moving towards and sustaining Universal Health Coverage (UHC) is critically important to build resilient health systems and to promote more inclusive and fairer societies.

  • The progressive realisation of UHC requires good governance and linkages with social protection systems.

  • UHC policies should be coordinated with social protection systems providing social safety nets and coordinated governance is required across health and social sectors.

  • This requires system-wide social and health policies breaking the boundaries of traditionally fragmented welfare systems and global health programmes.

The need for a systemic approach to complex challenges and for better understanding the relationship between population health and its economic consequences have been recognised for years as the basis towards sustainable solutions in global health. The emergence of a movement promoting Universal Health Coverage (UHC) as the ultimate means to ensuring equitable access to health for all people, raised the attention to the importance of re-imagining health systems. The COVID-19 pandemic further highlighted the importance of UHC that should be promoted with better governance and linkages to social protection systems.

UHC is key to face population health threats

UHC is the aspiration that all people will obtain access to quality health services they need while not suffering financially as a result of paying out of pocket for health care.1 UHC requires that countries expand the availability of, and effective access to, essential health services and include more people in risk pooling mechanisms, such as social or private medical insurances or tax-based prepaid systems, to reduce out of pocket payments at point of service.

The inclusion of UHC in Sustainable Development Goal 3 (SDG 3) has generated attention to coverage of essential health services, to financial protection—catastrophic or impoverishing out-of-pocket health spending—and to health system strengthening. Implicitly, it has also supported the inclusion of equity considerations into the global health agenda. Like AIDS a generation ago, UHC …

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