Why universal health coverage is crucial for an effective AIDS response

Last updated on: 27 February 2024

What is universal health coverage?

The concept of universal health coverage or UHC goes back to the World Health Organization’s (WHO) Constitution of 1948 declaring health a fundamental human right. It means that all people receive the quality, essential health services, they need, without falling into poverty because of health expenses. UHC can be broken down into three dimensions:

Who is covered? We need to make sure this includes marginalised communities such as children, LGBT, people living with diseases, people who use drugs, sex workers and young women and girls affected by HIV.
What is covered? It should include the full range of health priorities and good quality health services including HIV prevention, treatment and care.
How is it covered? It should be financed as much as possible through greater public financing for healthcare, including through social health insurance contributions, and general government revenues (tax financing). Out-of-pocket spending should be reduced as accessing health care should not be dependent on the ability to pay.

UHC a priority across the globe

UHC has become a key global health priority at global level and in an increasing number of countries ever since the 2012 United Nations Resolution on UHC and the adoption of the Sustainable Development Goals (SDGs).

Many countries across the world, at all levels of development, are embracing UHC as the right thing to do for their citizens, providing an integrated approach to health.

In most countries, except for very low-income countries, UHC will be mostly funded through domestic resources, without or with very limited external donor support. This means increasing pressure on health budgets and scarce resources being spread across a wide variety of health priorities.

What does the transition to UHC and domestic funding mean for HIV/AIDS?

Each country will have to make important decisions on how HIV services will be funded and how the availability, affordability, and quality of HIV treatment is guaranteed. Different options will be considered, including the inclusion of HIV treatment in national health insurance schemes, the use of specialised government funds, or a specific tax to cover HIV-related health costs.

However, UHC must not just be about treatment and medicines. Its success also depends on the delivery of all other interventions that are critical for good health, in particular prevention and other non-medical interventions, such as awareness-raising, advocacy, treatment adherence support or linking key populations to friendly health services. Many of these interventions are delivered outside of health systems by local civil society and community actors, which are mainly funded through external donors. The question is what will happen when donors leave, and governments are not able or willing to support civil society or communities in the delivery of these critical activities.

We must get serious about reducing the barriers that key populations and other marginalised, stigmatised and excluded groups face accessing life-saving HIV and other health services due to persistent stigma, discrimination, criminalisation and human rights violations against them. There will be no UHC without the elimination of discriminatory laws and policies and consistent efforts to decriminalise HIV transmission, sex work, drug use, or same-sex relationships.

Finally, we must push for active and meaningful involvement of civil society in UHC based on the principle “nothing about us without us”, which has guided the AIDS response for four decades. Civil society and communities have a critical role to play in advocacy, research, service delivery and in holding governments to account, especially when it comes to the rights of the most marginalised people in society.

What does UHC mean for Aidsfonds?

UHC is critical for achieving Aidsfonds’ strategic goals. The UHC train is moving forward, and it has placed the AIDS response in a broader health context. We will not achieve a world without AIDS and STIs without jumping on board the fast-moving train and influence its direction to make sure it delivers to the communities we work with. We want a UHC that is equitable and rights-based, includes comprehensive and good quality HIV services and is meeting first and foremost the needs of key populations and other marginalised and excluded groups.

In our international programmes, we support and equip local civil society partners, activists and communities in the countries we work in to actively engage with the UHC agenda at country, regional and global level. This support includes capacity-building on UHC advocacy, conducting research on the integration of HIV into UHC, and supporting community engagement in global and country-level debates on UHC. Ensuring UHC truly builds on the lessons learned, and the successes of the AIDS response in the past decades will be instrumental for achieving the end of AIDS and the right to health for all.

“By pushing for active involvement in UHC at a country level, civil society can bring the learnings of the past four decades of the HIV response to help shape a vision for rights-based, person-centred UHC that, if implemented, leaves no one behind.” Mark Vermeulen, Director Aidsfonds

Action we took towards an inclusive UHC

To accelerate our international actions, we supported the high-level event ’Making Universal Health Coverage Work for Key, Vulnerable and Underserved Populations’ which took place on May 7th 2019 in Geneva, Switzerland. This event, hosted by the French government, was geared towards strengthening the Global Fund’s role within UHC.
Together with Frontline AIDS and the London School of Hygiene and Tropical Medicine new research was conducted to reveal opportunities and major areas of concern as countries move towards UHC, while at the same time transitioning from international to domestic funding for HIV programmes. In the report experiences from Indonesia, Kenya, Uganda and Ukraine are shared.

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