Blog - universal health coverage: towards strong accountability and community-engagement

Blog - universal health coverage: towards strong accountability and community-engagement

Blog by Marielle Hart, Head of Policy US 

Next week, the first ever UN High Level Meeting on universal health coverage (UHC) will be held. A momentous occasion as it will result in the adoption of a Political Declaration and a set of commitments, which will guide UN Member States in years to come on their road towards the realisation of UHC and the right to health. For Aidsfonds, the UHC HLM gives us the opportunity to support our partners in their calls to their governments to include marginalised and key populations in their statements. To further support their cause we will also be calling for stronger accountability and community engagement in the implementation of UHC.

What UHC can learn from the AIDS response

At Aidsfonds, we have engaged with the UHC agenda since the start of the development of the Sustainable Development Goals (SDGs). We have been concerned about the implications of the UHC agenda for the sustainability of the HIV response. In our research with the London School of Hygiene and Tropical Medicine on the opportunities and challenges of the integration of HIV into UHC, we observed:

  1. A decrease in donor support for health, in particular in middle income countries
  2. An increase in pressure on domestic health budgets
  3. Insufficient or non-existent emphasis on the rights and needs of vulnerable populations, in particular key populations
  4. A lack of support for and investment in the community-led response to health
  5. A lack of accountability frameworks and inclusive civil society engagement mechanisms for UHC.


In other words: all elements that made the AIDS response effective, are so far insufficiently included in national UHC plans.



What we have learned from the AIDS response is that being able to keep governments accountable is crucial for policies to be effective. A strong and agreed accountability framework to translate the political declaration into action can be a game changer for UHC. Without it, the HLM will surmount to empty promises and no mechanisms in p;ace to hold governments accountable for their implementation of UHC.


The demand for accountability by civil society and affected communities has long been a critical component of the HIV and AIDS response, and its basis for success.


It has resulted in the setting of global targets to which governments can be held accountable. In addition, the HIV and AIDS response has been at the forefront of social accountability in health. The Greater Involvement of People Living with HIV/AIDS (GIPA) principles have revolutionised global health by realising their right to participate in decision-making processes that affect their lives.

Opportunity for stronger accountability

The Political Declaration on UHC does not include an accountability framework. Specific targets focus on service coverage alone, but this is far beyond from what is needed. However, the Political Declaration for UHC does include important commitments that need to be translated into an accountability framework.


The next step now is to work together on global and national accountability frameworks to guide the implementation and hold government responsible.


All of us involved in the AIDS, TB and other communicable diseases responses have the responsibility to pro-actively shape the UHC agenda in the coming years. We need to demonstrate how accountability frameworks and the inclusion of communities and civil society in policy-processes in health will lead to better and stronger outcomes.

The implementation of UHC is already happening in many countries where civil society faces growing conservatism, criminalisation and stigmatisation of marginalised communities and the withdrawal of donors.

At Aidsfonds, we will continue to support communities to play their role effectively as agents of change, ensuring space and support for civil society both as partners in the design and delivery of UHC and as advocates and watchdogs.

But we need the support of all stakeholders, including governments. A stronger accountability for UHC, engaging all stakeholders leads to better health outcomes and thus is in the interest of us all.

Marielle Hart, originally from the Netherlands, represents Aidsfonds in the U.S. as Head of Policy. Based in Washington D.C, she advocates for a strong HIV response by the U.S. Government in Washington and the United Nations in New York. She strives to make HIV and the needs and rights of people living and affected by HIV a key priority at the global policy level, especially in the broader universal health coverage agenda and the sustainable development goals framework. Marielle also supports country partners their advocacy on these critical global priorities.

Marielle Hart
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