Government response |
The UK Government welcomes the opportunity to respond
to this timely report from the International Development Committee
on Strengthening Health Systems in Developing Countries. The
Government appreciates the report's recognition of the UK's longstanding
good reputation for health system strengthening and of the high
quality of bilateral support provided by the UK in partner countries.
Supporting countries to strengthen their health systems
remains a top priority for DFID's health work. A strong health
system is one that delivers good quality essential services to
all people, when and where they need them. The knowledge and
the technologies already exist to prevent or treat many of the
conditions that affect poor people and prevent the MDGs from being
achieved, but weak health systems mean that many people, especially
the poorest and most marginalised people, do not get good quality
essential health care and so continue to suffer poor health.
Strong health systems are vital for making sure that
improvements in health can be sustained in the long term and for
ensuring that countries can cope with future challenges such as
population growth, ageing, the increase in non-communicable diseases
and crises such as the current Ebola epidemic.
Developments at the global level are raising the
profile of health system strengthening internationally. There
is growing consensus that countries should aspire to achieve universal
health coverage, meaning that all people can use good quality
essential health services when they need them, without the risk
of financial hardship. This requires that good quality health
facilities be in place, fully staffed with well trained and motivated
staff, with working equipment and reliable stocks of commodities,
and that the system be well managed, using good information, responsive
to people's needs and with consistent financing raised in efficient
and equitable ways. This is precisely what health systems strengthening
sets out to achieve.
DFID's future work on health systems strengthening
will need to be set within this changing international context,
including the goals that will replace the Millennium Development
Goals (MDGs), which have yet to be finalised, and the Financing
for Development agenda. Last year DFID published a Health Position
Paper, which set out the UK's public health approach to improving
health outcomes in developing countries. This approach combines
investments that achieve targeted results with investments that
strengthen broader health systems. The next step will be to develop
a framework for future work on health systems, which will be set
within the context of broader global processes and will address
measurement issues, build on the UK's existing review of support
for human resources for health and include how DFID works with
the NHS and other parts of the Government.
Response to the conclusions and recommendations
[Note that the recommendations and responses are
grouped in a different order to that in the Committee's report.]
Information and accountability
Recommendation 1: System strengthening is fundamental
to the improvement of health outcomes. It is also the route to
self-sufficiency for developing countries. We commend DFID for
its strong focus on health system strengthening in its bilateral
programmes. It is important that health outcome targets do not
have the unintended consequence of reducing this focus. We
recommend DFID review its health targets to ensure that they are
compatible with achieving its system strengthening objectives.
In individual programmes, DFID measures changes in
health system performance directly using indicators such as the
frequency of stockouts of essential drugs or the percentage of
health facilities offering appropriate emergency obstetric care.
Across DFID as a whole, however, success in health is currently
measured in terms of indicators that reflect improvement in health
outcomes, since this is the ultimate objective of all the UK's
health work, including systems strengthening.
Most of DFID's current health targets have their
end dates in 2015, in line with the MDG timeframe. The process
of agreeing new development goals and targets, and indicators
for measuring progress towards them, provides an opportunity for
DFID to review how it measures success. The increasing focus
on universal health coverage (UHC) - ensuring that all people
can use good quality essential health services when they need
them without risk of financial hardship - is helping to draw global
attention to health systems strengthening: without strong health
systems, UHC will not be achieved anywhere in the world. DFID
will ensure that global aspirations for health systems strengthening
are well reflected in its health targets from 2015 onwards.
Recommendation 4: It is impossible to know how
well DFID is delivering its health systems strengthening strategy
without knowing how much it spends or having indicators of its
performance. Nor can DFID allocate its resources efficiently in
the dark. These deficiencies are best addressed through the publication
of data to internationally agreed standards. This would ensure
comparability and enable DFID to exert influence on its partners
to improve their system strengthening work. We recommend
that DFID prioritise international agreement on measures of system
strengthening expenditure and efficacy as part of discussions
about the post-2015 development goals. We further recommend that,
once agreed, these measures form part of DFID's regular reporting.
The Government agrees with the desire to standardise
the indicators used to measure health systems performance and
to reduce the number of indicators in use. DFID is already working
actively with the World Health Organization (WHO) and others in
the international community to identify indicators that allow
an assessment of the strength and effectiveness of a health system.
These indicators will provide a measure of the efficacy of health
systems strengthening interventions. The same process will generate
indicators that can be used to assess progress towards post-2015
goals and targets, including a target on universal health coverage.
When the global set of core indicators for measuring
health results is agreed, DFID will encourage its partner countries
and organisations to draw on it when selecting indicators to monitor
progress. DFID will do the same for monitoring its own programmes.
The choice of measures for future regular reporting will therefore
be influenced by the choice of post-2015 goals, targets and indicators.
The international process to standardise and streamline
indicators of health results is not addressing the issue of measuring
health systems strengthening expenditure. The standardised definitions
and classifications for reporting on aid financing internationally
are set by the Organisation for Economic Co-operation and Development's
(OECD) Development Assistance Committee (DAC) and are not part
of the post-2015 process. Some early thinking has been done about
what would be required to develop a common framework for tracking
health systems strengthening expenditure. This would include
development of a common understanding of which activities contribute
to health systems strengthening, and hence which health expenditure
should be classified as systems strengthening, and harmonisation
of data across agencies to allow comparisons. There would also
need to be a process to change the OECD DAC expenditure purpose
codes. DFID is following these discussions and will engage with
the process as it develops.
Recommendation 13: Community services and public
health are important parts of an effective and efficient health
system. There can be a tendency, driven partly by standard health
system models, to focus on curative care in formal national systems.
We heard concerns that DFID sometimes falls into this trap. It
is too hard to assess whether this is the case. We recommend
that, in publishing the disaggregated data recommended earlier
in this Report, DFID prioritise community services and public
The Government agrees that community services and
public health - including prevention and health promotion - are
essential aspects of the health system. This extends beyond the
health sector: there are opportunities to have a significant impact
on health outcomes through support to healthy public policy and
environments, for example through water and sanitation, nutrition
and transport policy. The DFID health position paper sets out
the UK's public health approach and much of the coordination and
leadership work that DFID is valued for in partner countries is
around establishing and maintaining the links between different
parts of the system. DFID also works with Public Health England
to help share the benefits of UK experience and expertise with
The global set of core indicators on which DFID's
post-2015 reporting is likely to be based is close to finalisation
and the current draft includes indicators of public health and
community level services.
Recommendation 5: The Global Fund and GAVI have
been highly successful in improving health outcomes in some of
the poorest parts of the world. The multilateral model has advantages
in economies of scale. However, it is unacceptably difficult to
assess whether these organisations have genuinely and sufficiently
switched focus to system strengthening. The multilaterals and
their donors have a responsibility to ensure that their assistance
has the greatest possible impact. DFID has a responsibility to
UK taxpayers to ensure that their money can be followed and is
spent wisely. We recommend that DFID insist that the Global
Fund and GAVI publish better measures of system strengthening
expenditure and performance. If DFID is not satisfied
that system strengthening is being given sufficient priority by
an organisation, and that organisation does not change, DFID should
be prepared to withhold funds.
The Government agrees that the Global Fund and Gavi
should do better in measuring the impact and cost-effectiveness
of their investments in system strengthening. DFID has worked
with partners to include a Key Performance Indicator (KPI) of
health systems strengthening in the Global Fund monitoring framework.
The Fund will measure and report against this KPI to the board
annually. DFID will now work with Gavi to develop an appropriate
KPI on health systems strengthening for their new strategic period
2016-2010 for approval by the Gavi Board at their meeting in June
2015. This will also be measured and reported by Gavi on an annual
DFID uses both organisations' institutional KPIs
in its own progress monitoring frameworks. This means that their
progress on health systems strengthening is measured annually
and contributes to the DFID Annual Reviews of these organisations,
which in turn influence continued UK funding. A decision to
withhold funding to Gavi or the Global Fund would have a significant
impact in developing countries, given that both organisations
deliver life-saving interventions to millions of people. Before
making such a decision the UK would need to take into account
performance in all areas and not just on systems strengthening.
We further recommend that DFID press the Global
Fund and GAVI for programme data to be published online. Freely
accessible data will facilitate more accountability and scrutiny,
and should also be of benefit to systems strengthening research.
Both Gavi and the Global Fund already score highly
on transparency relative to other donors. In the 2014 Aid Transparency
Index Gavi was ranked fourth and the Global Fund tenth.
Both agencies publish data on their websites. The
grant portfolio section of the Global Fund's website includes
a separate page for each country, with extensive financial and
performance data on each of more than 1,000 grants it has made
to date. Some of these grants are focused entirely on health
system strengthening, while others include systems strengthening
elements. Raw data about the Fund's grant portfolio can also
be accessed via the website.
Gavi also publishes data on health systems strengthening
expenditure and progress by country and by grant on its website.
Recommendation 6: Other donors do not share DFID's
responsibilities to UK taxpayers. Private donors such as the Gates
Foundation are rightly free to set their own priorities. However,
health development is invariably a complex team effort. Transparency
about expenditure and performance is imperative for these arrangements
to work well. We recommend that DFID work harder to encourage
its partners to make more data on their health systems strengthening
work freely available. Accepting our recommendation
that it publish more disaggregated statistics of the expenditure
and performance of its own programmes would set a good example
and make this task easier.
DFID models good behaviour on transparency. Under
the government's transparency commitment, information is published
each month about DFID's expenditure and projects. All business
cases, annual reviews, project completion reviews and evaluations
are published on the Development Tracker. DFID also has an open
and enhanced access policy for research and evaluation. It has
identified a leading data repository and is moving forward arrangements
for submitting datasets with them. Once this is finalised, DFID
will then require all researchers to make their data open access
via this repository.
This high level of transparency has received international
recognition: DFID was ranked second out of 68 donor organisations
in the 2014 Aid Transparency Index. DFID will continue to set
a good example to its partners on transparency and to encourage
them to follow this example.
Strategies and working with the NHS
The responses to recommendations 18, 11 and
17 are combined below
Recommendation 18: DFID's own health systems strengthening
work is world-leading. But that is not enough; DFID must be an
active and vocal systems champion, driving the international agenda
by experience and example, pressing other donors to prioritise
systems strengthening and exercising its influence on the boards
of multilaterals to ensure that they have genuine systems focus
at strategic level. As it is, DFID, and its ministers in particular,
are insufficiently vocal. This is a particular concern in the
increasing number of countries where DFID does not have a bilateral
programme. We recommend that DFID publish a clear health
strategy, including measures of performance, setting out the rationale
for system strengthening, how it intends to strengthen systems
in its own work and what it expects from its international partners.
Recommendation 11: Doctors, nurses and other health
professionals are at the centre of any well-functioning health
system. We are concerned that DFID does not know how much it spends
on human resources for health and or have means of monitoring
its performance. We recommend that DFID's review of its
approach to human resources for health extends to an ambitious
strategy which would set an example of best practice to international
Recommendation 17: Demand for NHS staff does not
end with doctors and nurses. Though often criticised at home,
the NHS is held in high international regard and many countries
would greatly benefit from the assistance of those expert in managing
and financing such a successful health system. In turn, NHS managers
would benefit from tackling familiar problems in unfamiliar settings.
This is a challenge to traditional development models and DFID
must be sufficiently agile to adapt to changing and increasingly
complex needs. NICE International is a successful example of how
NHS expertise can benefit overseas systems, and leverage funds
from other donors in the process. We recommend that DFID
establish a clear strategy for how UK government should work in
partnership with the NHS to support overseas health systems.
In August 2013 DFID published its Health Position
Paper: Delivering Health Results. This paper sets out how DFID
works to improve health outcomes in developing countries including
DFID's public health approach, which combines investments that
achieve targeted results with investments that strengthen broader
Building on this paper, the UK's work to date on
human resources for health and broader processes including the
development and agreement of post-2015 goals, targets and indicators,
DFID will develop a framework for its work on health systems strengthening,
which will set out areas of focus for work in developing countries
and globally. The framework will encompass the global processes
underway in the shift from the MDGs to the new development goals
and will consider the implications for measurement of progress
towards universal health coverage. It will also include DFID's
approach to working with the NHS and other UK government and non-government
Recommendation 10: The staffing of the UK health
sector should not be at the expense of health systems in developing
countries. We recommend DFID work with the Department of
Health to review its approach to the UK recruitment of health
workers from overseas. This review should consider options for
compensating source country systems, promoting training schemes
that involve a temporary stay in the UK, and strengthening local
programmes to enable more medical training to take place in country.
The Department of Health (DH) and DFID will continue
to work together to review their approach to the UK recruitment
of health workers from overseas.
In moving towards reducing the gap in healthcare
workers DH endorses the WHO Global Code of Practice on the International
Recruitment of Health Personnel and implements it through the
UK Code of Practice for international recruitment. DH works closely
with DFID on reviewing the definitive list of developing countries
which should not be targeted for recruitment of healthcare professionals.
DH also continues to work with DFID, the lead department,
to support the Health Partnership Scheme (HPS). The scheme aims
to improve health outcomes in low-income countries through effective
transfer of health services skills, in ways that also benefit
the UK public health sector. It provides opportunities for British
nurses, doctors and health workers to play a crucial role in the
UK's effort to reduce maternal and child deaths in the world's
In addition, the DH and DFID continue to recognise
the value of the Medical Training Initiative (MTI) and its importance
in the way that the health sector supports the Government's international
development objectives with doctors returning to their countries
and applying the skills and knowledge developed during their time
in the UK. Doctors benefiting from MTI training take back with
them knowledge of practice, procedure, networks and UK expertise
which deliver significant tangible benefits to the UK economy.
DFID will also continue to look at ways of supporting
local medical training in its partner countries in order to promote
retention of health workers. The UK already provides some support.
HPS, for example, has contributed to health worker training including
curriculum development in 26 countries using the skills of UK
health professionals. Similarly, the 'Making it Happen' Partnership
between the Royal College of Obstetricians and Gynaecologists
and the Liverpool School of Tropical Medicine is training health
professionals in Emergency Obstetric and Neonatal Care to reduce
maternal and newborn mortality and morbidity in 11 countries in
sub-Saharan Africa and South Asia. Decisions about any new funding
will depend on future budgets and operational plans.
Recommendation 15: Volunteering overseas by UK
medical staff can be highly advantageous for developing health
systems. Through the personal and professional development of
individuals, the sharing of best practice and the building of
global contacts, it can also be of great benefit to the NHS. Existing
volunteering schemes, though often successful, are small-scale
and fragmented. The Health Partnership Scheme is highly effective,
but its funding is a drop in the ocean. Volunteering schemes need
coordination, structure and scaling up.
DH recognises the numerous benefits in overseas volunteering
by UK health professionals to contribute effectively to global
health development through the Medical Training Initiative and
the DFID-led Health Partnership Scheme.
DH has set up a working party to provide information
to support potential volunteers in the NHS to take up volunteering
positions. Membership of the working party includes DFID, the
Tropical Health Education Trust, the British Medical Association,
the Nursing Midwifery Council, NHS Employers and charities that
This group is looking at issues surrounding accreditation
and continuing professional development and other barriers to
volunteering. It will also examine the barriers and constraints
that affect employers with a view to identifying best practice
and exemplar activity within the service. A tool is being developed
to help employees provide evidence of the benefits from volunteering
and, in particular, how skills/knowledge gained will benefit the
Recommendation 16: NHS staff should be supported
in seeking to apply their skills where need is greatest. We recommend
that the new NHS framework for volunteering establishes a formal
structure to facilitate the participation of many more medical
professionals, including through extended sabbaticals, and makes
clear that volunteering overseas is valued and consistent with
career progression. DFID should provide the necessary funds to
support these more ambitious schemes. We further recommend that
DFID investigates means of supporting those who volunteer, including
continuing NHS pension contributions and paying down student loans.
In response to the recent Ebola outbreak in West
Africa, the Chief Medical Officer recently wrote to NHS staff
encouraging them to volunteer to help in Sierra Leone. Over 650
NHS frontline staff and 130 Public Health England staff have volunteered
to go out to Sierra Leone to help in the UK's efforts on the ground.
DH will work with DFID, NHS England, the devolved
administrations and the NHS International Health group to explore
the feasibility of establishing a formal structure to support
volunteering. The framework acknowledges the work of the DH-led
volunteering overseas group on developing a tool to help employees
provide evidence of the benefits from volunteering and, in particular,
how skills/knowledge gained will benefit the NHS.
The DH volunteering group also acknowledged that
volunteers returning from overseas face a much reduced pension.
The working group has worked to maintain the continuity of contributory
membership of the NHS Pensions Scheme for those volunteers working
on projects in the Health Partnership Scheme. DH is exploring
how it can help other volunteers.
Recommendations focused at country level
Recommendation 2: Despite some significant moves
in the right direction, we are not convinced that DFID's main
international partners give the development of health systems
the same priority as DFID does. To some extent, this is understandable;
multilaterals such as the Global Fund and GAVI were set up to
tackle particular diseases, tasks they have performed with great
distinction. But DFID now has fewer bilateral programmes and relies
on multilaterals to manage an ever-greater proportion of its expenditure,
often without in-country representatives. We recommend that
DFID conduct a detailed assessment, by country, of the extent
to which existing funding arrangements enable its health systems
strengthening objectives to be met.
In all the countries in which DFID has a health programme
its investments are already based on an assessment of needs and
funding gaps, taking into account the activities of other partners,
both domestic and international. The process of developing a
business case for a new investment requires that such an assessment
be carried out and the annual review process provides an opportunity
to revisit it. In countries which both have UK bilateral programmes
and are recipients of Gavi and GFATM funds, DFID staff work to
ensure complementarity, with each organisation working to its
comparative advantage and engaging closely to achieve the best
DFID is also stepping up its efforts to ensure that
funding channelled through Gavi and the Global Fund supports the
UK's objectives at country level. A framework is being developed
to better monitor the effectiveness of global funds in country.
As part of this, DFID's Global Funds Department will work with
country-based health advisers to receive regular feedback, including
on health systems strengthening, which will be used to inform
DFID's annual reviews of its investments through Gavi and the
Global Fund and the UK's positions in these organisations' Boards
In future the proposed DFID health systems strengthening
framework will help to provide a stronger basis for monitoring
of the UK's overall impact on health systems at country level.
Recommendation 3: DFID expresses continued support
for the International Health Partnership (IHP+), but it is not
providing the impetus for increased coordination it did in the
past. We recommend DFID reaffirm its commitment to IHP+
by publishing on an annual basis the steps it is taking to implement,
and encourage its international partners to adopt, IHP+ principles
and recommended behaviours
The IHP+ core team is funded until 2015. DFID will
continue to adopt IHP+ principles and behaviours, and will encourage
its international partners to do so. This will include both advocacy
at country level and continuing senior-level participation in
the work of the group of global health agency leaders, whose purpose
is to accelerate progress on and implementation of the agreed
principles of the IHP+.
Recommendation 8: The lack of progress by many
African governments on the health expenditure commitment in the
2001 Abuja declaration is very worrying. It suggests a culture
of reliance on aid that is irreconcilable with ultimate self-reliance.
DFID aid should never be a blank cheque. We recommend that,
as well as making the positive case for expenditure on health
systems, DFID work with developing country governments to agree
medium-term aid plans based on concordance with the Abuja target
and fund accordingly, taking a tough line with governments which
are unwilling to take responsibility for the long-term health
of their own populations. We also recommend that DFID make better
use of local parliamentarians and medical professionals as advocates
for prioritising expenditure on health systems over other demands.
The majority of financing for health in most countries
already comes from domestic sources, including government revenues
and individuals' own pockets. As countries' economies grow, they
will have an opportunity to invest more in health if they choose
to do so. They will also begin to graduate from funding sources
such as the Global Fund and Gavi.
Challenges in future health financing include persuading
governments that health is a good investment. Better health care
is known to be one of the things people value most highly, but
not all governments are incentivized to ensure it is provided.
It needs to be part of the social contract between a government
and its people.
Future financing for health is being discussed widely,
with a focus on non-aid sources such as more domestic resource
mobilization and attracting more financing from private investors
through impact investing and Development Impact Bonds. DFID will
work more on all of these areas in future.
DFID continues to actively make the case for investment
in health systems and to invest in evidence to strengthen this
case, including the work of the 2013 Commission on Investing in
Heath. DFID will use the opportunity of developing its new research
priorities and the proposed performance framework for health systems
strengthening to look again at the evidence and identify remaining
The most effective agents of change for DFID to work
with to raise the priority governments give to health will differ
from country to country. A thorough political economy analysis
is needed to help identify them. In some countries, working more
with Parliamentarians and medical professionals as advocates for
greater health expenditure may be effective; in others using agents
such as civil society and the media to hold government to account
for financing health may be more influential.
Recommendation 14: DFID rightly identifies factors
ranging from superstition and mistrust of formal health systems
to discrimination and violence against women and girls as obstacles
to improving healthcare. We recommend that DFID press its
international partners, including national governments, to tackle
unacceptable cultural barriers to access to health services.
The Government promotes the development of inclusive
health systems. Much of DFID's work is targeted at identifying
and tackling inequities in access to health for the poorest and
most marginalised, including women and girls, disabled people
and ethnic minorities. It is clear that the poorest and most
marginalised suffer most: they are not only more exposed to health
risks but also less able to take preventive measures and less
likely to have access to services. They are more likely to be
ill, less likely to receive care and more likely to die or suffer
long term disability.
The UK Government has shown international leadership
on family planning, HIV, nutrition, female genital mutilation
and early and forced child marriage, all of which require dismantling
cultural barriers. The UK's view is that deep-seated cultural
barriers that prevent people from accessing services are best
overcome by empowering people in the communities concerned. That
is why, for example, DFID is supporting an Africa-led movement
to end female genital mutilation and child, early and forced marriage
in a generation.
The growing international focus on universal health
coverage is helping to attract attention to a range of barriers
to access, including cultural barriers. Without tackling these
barriers, countries will not be able to achieve UHC.
Research and evidence
Recommendation 7: Understanding what works is
an important part of effective and efficient intervention in health
systems. At the moment, too little is known. DFID has a large
research budget and allocating more of it to health systems is
likely to be good value for money. We recommend that DFID
increase funding for health system strengthening research.
DFID has a strong history of supporting health systems
research and is seen as a leading funder in the field. The Human
Development team in DFID's Research and Evidence Division is currently
developing future research priorities to provide evidence that
will support the achievement of the post-2015 development goals.
This process will involve a range of activities, including an
expert roundtable event and both internal and external consultations,
to be held in 2015. The exercise will identify DFID's future
global health research priorities, which will determine how best
to continue DFID's significant investments in health systems research
and its component pillars, including human resources for health.
The Committee's recommendations will be taken into account in
Recommendation 12: Community health workers can
be an important part of a developing health system. They provide
flexibility and enable programmes to be scaled-up very quickly.
However, they should not be seen as an easy remedy for all health
system problems, nor as a substitute for properly trained and
specialist health professionals. As in other areas, DFID would
benefit from sounder monitoring and a better evidence base in
assessing the role to be played by community health workers in
The Government agrees that community health workers
can play an important role in health systems but that this role
should be carefully defined and evidence-based. DFID is already
contributing to expanding the evidence base, including by funding
a multi-country study of the cost-effectiveness of community health
workers in different settings and by supporting the REACHOUT research
programme consortium, which focuses on the role of close to community
health workers. DFID will look at additional research needs as
part of developing its new research strategy and its approach
to human resources for health.
Recommendation 9: Health systems governance and
finance are complex political issues. The outcomes of intervention
in these areas tend to be uncertain and expenditure on them can
be harder to sell to electorates, donors and developing country
governments. DFID's international partners, given their narrower
objectives, are also less likely to be involved. However, health
systems governance and finance are vital to properly functioning
and ultimately self-sustaining health systems. DFID must lead
the way on strengthening them, including making the case for such
interventions to sceptics at home and abroad.
The UK Government is now increasingly focussed on
tackling the underlying causes of poverty by supporting strong
and inclusive economic, social and political institutions to establish
what the Prime Minister has termed 'the golden thread' of development.
Basic service delivery is often one of the most significant ways
in which citizens come into contact with the state. Visible inequity
in access to basic services and/or visible corruption can undermine
citizens' perceptions of the state, with potentially negative
effects for state-building and the wider social contract between
a government and its people.
Poor governance - such as weak public financial management
or procurement processes or the absence of transparency &
accountability - can result in corrupt or wasteful practices.
Where this results in less money or less efficient use of limited
financial resources for service delivery, it leads to slower progress
in improving health outcomes.
DFID already supports the strengthening of domestic
health financing systems through both bilateral and centrally-managed
programmes, including support to WHO, NICE International and the
Commission on Investing in Health, which demonstrated the links
between better health and higher productivity. DFID health advisers
also make an important contribution to governance and financing
by participating actively in policy dialogue at country level.
Recommendation 19: We recommend DFID continue
to press for universal health coverage as a prominent feature
of a single post-2015 development goal for health. Universal
health coverage cannot be attained without a properly functioning
health system. Its incorporation in post-2015 goals would add
considerable impetus to health system strengthening efforts. Given
DFID's systems expertise and the unrivalled experience of the
NHS, this would put the UK in a position of even greater influence
and responsibility. Should universal health coverage be targeted,
DFID must be willing to grasp the opportunity it provides and
demonstrate genuine world leadership on health system strengthening.
The UK has supported the inclusion of a universal
health coverage target under an outcome-focused post-2015 health
goal. It will continue to do so as discussions progress.
Moving more rapidly towards UHC requires strengthening
the health system (including both public and private sectors)
to ensure that good quality essential health services are provided
and are used by everyone. It requires work on both the supply
side to increase provision and the demand side to remove barriers
to access, particularly for the poor. The inclusion of UHC as
a post-2015 target will ensure that health systems indicators
are defined, agreed and monitored.
The Government agrees that long experience with the
NHS gives the UK a particular comparative advantage in supporting
other countries to progress more rapidly towards UHC.
The NHS has much to offer to other countries and
the UK is already sharing its experience in a number of ways.
For example, DFID and DH share the expertise of NHS staff through
schemes such as the Health Partnership Scheme, which enables NHS
clinicians, technicians and other professionals to work with counterparts
in developing countries, for mutual benefit. DFID is also investing
in NICE International, which enables other countries to learn
from the UK's experience of making hard choices about which services
to fund and developing guidelines to deliver health services that
offer good quality and value for money. DFID will continue to
explore options so that the experience of the NHS can benefit
1 Since the Committee's report was published, GAVI
has changed its name to Gavi, the Vaccines Alliance. Back