Build back stronger universal health coverage systems after the COVID-19 pandemic: the need for better governance and linkage with universal social protection

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. [...]of this, there are inequalities in health and in access to health services in most advanced countries, as well as high out-of-pocket payments that often cause financial hardship to the poorest population groups.4 5 In high-income and, increasingly, in middle-income countries the decline in fertility rates, coupled with life expectancy increases, led to ageing populations and changes in family structures, shrinking the number of people economically active and increasing the number of people in need of support from the welfare system. Understanding of the contextual factors along with a conducive health system governance and political commitment are deemed to be among the determinants of better health and the key to improve health protection performance.14 15 Good governance is explicitly mentioned in SDG 16 that points to the need to ‘develop effective, accountable and inclusive institutions’.15 However, the relationship between governance and health is multifaceted, including broader governance environment, public policies and those specific to the health sector, and the effectiveness of institutions or organisations.16 Governance encompasses multiple aspects, such as systems of representation and engagement for citizens, accountability mechanisms, power and institutional authority, ownership, political stability, transparency and the rule of law. [...]the social and economic burden of ill health is often much larger than that related to high out of pocket payments for medical services and products.