Global Civil Society Letter to the Inter-Agency Expert Group on SDG Indicators

23 July 2015

Dear Members of the Inter-Agency and Expert Group on SDG Indicators,

We write in response to the list of proposed priority indicators for the post-2015 development agenda dated 7 July 2015, and specifically in relation to target 3.8: “Achieve Universal Health Coverage, including financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”.

Current proposals suggest two priority indicators for target 3.8, one of service coverage and the other on financial risk protection:

  1. Coverage of tracer interventions (to be collected via household surveys and facility data);
  2. Fraction of the population protected against catastrophic/impoverishing out-of-pocket health expenditure (to be collected via household surveys).

We are pleased to see both aspects of Universal Health Coverage (UHC) reflected in the new proposal and strongly encourage you to ensure both indicators are kept within the framework. UHC means all people receiving the quality health services they need, without being exposed to financial hardship. Based on this definition, UHC has two inherent and linked concepts that must be considered together: universal service coverage and universal financial protection. Effective tracking of both components will be vital to the realisation of UHC and the SDGs. Omitting a measure of financial risk protection would be a failure to address the impoverishing effect of health spending on some of the poorest and most marginalised groups and, as such, a neglect of equity considerations.

While we welcome your efforts to streamline indicators in the framework, there is consensus in the health community that target 3.8 must be tracked using these two indicators. Without consideration of both, policy and decision-makers can neither adequately assess progress nor set appropriate policy. Neglecting one of these fundamental aspects of UHC renders the target redundant: UHC is about equality in access to affordable healthcare and measuring by one indicator alone would miss this fundamental point. Moreover, in most countries credible comparable data on both of these measures is already collected and the inclusion of both indicators would not produce an additional reporting burden.

We would be very pleased to have a more detailed discussion with you about this.

Download the letter (PDF).