Define the Problem
Successful advocacy strategies start with a good analysis of the problem and where pressure must be applied to deliver change.
Depending on your country context, there can be a wide range of problems for UHC advocacy to address. It is necessary to know what your government is already doing including the scope of health-related policies and programs, expected outcomes and the real impact on communities’ access to quality health services. Evidence-based advocacy is important to frame compelling solutions for policymakers.
Tool 1: UHC Research Template
Use a research template such as the one below to gather the essential information you will need to build your advocacy strategy. Download Tool 1: UHC Research Template
Questions to Ask
Does your country have UHC legislation?
TIP! Your country may use the term ‘health reforms’ rather than UHC
Does your country have a national health policy or strategic plan?
What period does it cover?
Is it publicly available?
Where to Find the Answer
See also National Health Strategic Plans
- Ministry of Health
- Ministry of Social Welfare
- Parliament/National Assembly
- Ministry of Finance
- Ministry of Health
- Parliament/National Assembly
Note Your Answers
If you find it difficult to get information from your Ministry of Health, ask a member of parliament (MP) to find out for you.
Where to Go for Information
This is a good place to start to find out where your country is on the road to UHC. Each country profile contains over 30 indicators and statistics reflecting progress toward UHC targets.
HOW TO USE THE UHC2030 DATA PORTAL (Download PDF)
This database provides a list of all the national policy documents relevant to health by country, with dates and timelines.
The UHC Partnership is focused on strengthening policy dialogue on health systems strengthening as part of delivering UHC. It has profiles of 115 countries with key indicators and details of progress on policy projects.
The Global Health Observatory (GHO) is WHO’s portal providing access to data and analyses for monitoring the global health situation. It provides critical data and analyses for key health themes and direct access to the full database.
This report provides a multi-stakeholder view on the state of progress towards UHC at country and global levels. It is less technical, more country-focused and action-oriented than the global UHC monitoring report.
Africa Scorecard on Domestic Financing for Health. African Union, 2019 (Also available in French)
This is a very useful tool that monitors government domestic health spending performance against global and regional health financing benchmarks and enables countries to compare their performance with each other.
Tool 2: Advocacy Asks Matrix
The next step is to find out how your country is doing in terms of the Advocacy Asks outlined in Part 2 with Tool 2: Advocacy Asks Matrix. Most of this information will be available in the documents and resources in the UHC Template. However, you may need to meet with policy-makers and parliamentarians to discover more.
Questions to Think About
How does your government define ‘universal coverage’?
Target: 100% of the population
How is UHC being measured?
Do health plans and policies identify which populations are currently left behind and have insufficient access to health services?Do these plans and policies explicitly target those populations most in need?
Are health data disaggregated by sex, age, gender identity, race, ethnicity, income, disability and migratory status to accurately identify who is being left behind?
How does your government define marginalized and vulnerable groups?
Does this definition include people who use drugs, sex workers, prisoners, migrants etc.?
Do health insurance schemes cover these groups? If not, why not?
Are there laws and policy frameworks that explicitly support vulnerable groups to access health services?
Are there quotas or earmarked services?
Do health policies and plans address the social and environmental determinants of health?
What is the current percentage of the health budget in relation to the overall government budget? Over the past few years, has there been any increase?
Target: 15% (Abuja Declaration)
What is the current percentage of annual GDP spent on health? Over the past few years, has it progressively increased?
Target: At least 5%
What proportion of health funding comes from external donors
Do donor governments provide funding in alignment with countries’ plans, the aid effectiveness principles and the WHO recommendation that funding levels are not below 0.1% of GNI?
Does the government still rely on patient fees/ out-of-pocket (OOP) payments to fund the health system?
Do UHC plans include specific action points to abolish patient fees/ OOP payments?
What steps have been taken to phase out patient fees/OOP payments?
Do UHC plans include specific action to address tax evasion and avoidance?
What steps have been taken to address tax evasion and avoidance?
If the government is not increasing its spending on health services, what is preventing this?
Is civil society engaged at all stages of UHC decision-making, from design and budgeting through to implementation, monitoring and evaluation?
At the national level, are there opportunities for people, civil society organizations, and the private sector in your country to be engaged in planning, budgeting, monitoring and evaluating the health sector?
At the community level, are communities engaged in local-level health planning, budgeting and accountability processes, and are there feedback mechanisms for communities to assess the quality of services provided by local authorities?
What steps have been taken to ensure the voices of the most marginalized and vulnerable communities are included and heard?
Are country health plans and policies accompanied by a health care financing strategy supported by the MoF?
This guarantees the resources to implement the national health plans and policies and cements the role of civil society in holding governments to account for what they have promised to deliver.
Are CSOs engaged in expanding health services to reach marginalized and vulnerable groups?
Are community-led monitoring approaches recognized and valued?
Are civil society accountability mechanisms included in UHC implementation plans?
Are there sufficient numbers of health-care workers in the health care system?
Do health workers have decent working conditions and levels of pay?
Does health policy acknowledge that women make up 70% of the health workforce but only 25% of senior roles?
Do health workers receive training on how to support the health needs of marginalized and vulnerable groups?
Are training and capacity-building for both government and community health workers earmarked and adequately funded by the government?
Do UHC policies, plans, and reports include a focus on investing in the health workforce?
Note Your Answers
Tool 2 will help you select 2–3 priority areas to focus your UHC advocacy efforts. These will depend on your organization or network’s strengths and existing capacity. Examples could include: calling on the government to deliver on stated UHC priorities and commitments, demanding a seat for civil society at the decision-making table, or a longer-term objective to push for greater equity in insurance schemes.
Review the UHC Cube to see where can you push for change. Frame your advocacy ‘ask’ within the three dimensions: population (who is covered), services (what is covered) and financial protection (what costs do people have to pay).
Global-level example: Securing US commitment to the Global Fund
In 2019, the United States Government proposed to slash funding for the Global Fund—a vital source of support for health systems in many low-income countries. A national coalition of US-based NGOs and networks pulled together to mobilize their combined strengths and resources. One of these organizations—RESULTS International—provided training, tools and resources to volunteers who led local advocacy efforts to influence their federal Senators and members of the House of Representatives in nearly every US state.
Key tactics included grassroots lobbying and media outreach. Volunteers published 220 media pieces in local newspapers to build support for the funding and held over 400 meetings with Congressional staff across the country to express the importance of maintaining this funding. This was reinforced by 175 face-to-face meetings with Congress. Through this grassroots lobbying and follow-up, volunteers engaged over 250 Senators and Members of the House to sign letters publicly stating their support.
To strengthen this action, RESULTS staff supported volunteers to host two Expert Media Tours. RESULTS International partners came to the US to meet with reporters and editorial boards of local newspapers to share their expertise and stories related to HIV and TB, resulting in powerful media stories. Volunteers also arranged community outreach events around this tour. As a result, two bipartisan (cross-party) resolutions were passed in the Senate and House that rejected the proposed cuts and stated Congress’s financial support to the Global Fund. Subsequently, Congress committed to contributing US$4.68 billion over the next three years to the Global Fund.
Source: RESULTS, USA