Strengthening Health Systems to Achieve Universal Health Coverage: A glance at donors’ and the 3Gs’ support for better essential services for women, children and adolescents

Weak health systems in many low- and middle-income countries (LMICs) mean many people have no access to essential health services. The children and adults most impacted by inequalities and discrimination often face the biggest barriers. Even before the COVID-19 pandemic, most LMICs were not on track to achieve Sustainable Development Goal 3 (“Ensure healthy lives and promote well-being for all at all ages”) by 2030. The World Health Organization (WHO) estimates that less than half of the world’s population (33 %–49 %) was covered by essential health services in 2017. Every year, 100 million people are pushed into extreme poverty because of out-of-pocket spending on health.

The COVID-19 pandemic has exacerbated these vulnerabilities and reversed progress on many health outcomes. Health systems strengthening (HSS) is fundamental to achieving SDG 3 and making UHC a reality for all people. Building strong, equitable and inclusive health systems in LMICs is a precondition to improving access to good-quality health services, ending preventable deaths of newborn babies, children and mothers, and improving pandemic preparedness and response globally. In particular, there is need to strengthen primary health care (PHC) structures.

This report assesses the HSS support of three global health initiatives (GHIs): Gavi, the Vaccine Alliance (Gavi), the Global Financing Facility for Women, Children and Adolescents (GFF), and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). This report then discusses the financial and policy support to the 3Gs and to HSS more broadly of five government donors: Canada, Germany, Japan, the United Kingdom (UK), and the United States of America (USA). The final section of the report summarises the main findings and makes policy recommendations to donor countries and the three GHIs.