Dear Inter-Agency and Expert Group on Sustainable Development Goal Indicators (IAEG-SDGs),
Re: Calling for the refinement of indicator 3.8.2. to ensure that Universal Health Coverage is measured in terms of both coverage and financial protection
We recognise and commend the impressive work done to date by the Intra-agency Expert Group on SDG Indicators (IAEG-SDGs) in developing a Global Indicator Framework that will measure global progress towards achieving the Sustainable Development Goals (SDGs).
We note that both ‘Review of plans for Tier III indicators’ and ‘Refinement of indicators and revisions of the indicator framework’ are on the agenda for discussion at the forthcoming IAEG-SDGs meeting in Addis Ababa in October. In addition, the current online consultation highlights 3.8.2 as a “possible indicator” to refine.
There remains unprecedented global consensus that Universal Health Coverage (Target 3.8) means everyone can access the quality health services they need without being pushed, or pushed further, into poverty. Two clear indicators are required to measure this – one for coverage (Indicator 3.8.1) and one that can measure effective financial protection (Indicator 3.8.2).
Along with all health experts, we strongly urge you to support the refinement to Indicator 3.8.2 by replacing the existing methodologically unsound indicator. The number of people covered by insurance is not an indicator of how many people are suffering financial hardship to pay for the health services they need. There is no universal meaning or definition of health insurance and numerous schemes have actually widened inequalities (e.g. voluntary insurance for only those who can pay). In addition, the current indicator runs the risk that all countries will report that 100% of their population is theoretically covered by the public system.
Existing indicator: “Number of people covered by health insurance or a public health system per 1,000 population”.
Proposed replacement: “Proposed replacement: “Proportion of the population with large household expenditures on health, as a total share of household expenditure or consumption”.
The failure to measure what matters can have devastating human consequences. We draw your attention below to two recent cases – one of a family ‘covered’ by health insurance and one of a family ‘covered’ by a public health system.
The Global Indicator Framework must measure what matters if we are to drive progress towards achieving the SDGs as well as fulfilling the ambition to ensure that no one is left behind.
We hope that you will be able to support this important refinement and replace the existing indicator.
Académico Facultad Odontología Universidad de Chile
Action for Global Health UK Network
African’ Resources Group
American Heart Association
American Leprosy Missions
Aravind Eye Care System
Association Tunisienne de Prevention Positive
Bangalore Birth Network
Brien Holden Vision Institute
Cara International Consulting Ltd.
CCM Comitato Collaborazione Medica
Center for Creative Initiatives in Health and Population
Centre for Health And Resource Management
Centre of excellence for UHC, James P. Grant School of Public Health, BRAC University
Citizen’s Voluntary Initiative for the City (CIVIC)
Coalition des OSC du Bénin pour la Couverture Universelle en Santé
Coalition for Health Promotion and Social Development (HEPS Uganda)
Commonwealth Medical Trust
COMMUNITY AND FAMILY AID FOUNDATION
Drug Action Forum – Karnataka
End Water Poverty
Federación Planificación Familiar Estatal
Federation of Medicus Mundi in Spain – Medicus Mundi Spain
For Impacts In Social health (FIS)
Forum Ong aids RS
Future Generations International (FUGI)
Gramin Social Welfare & Development Society
Health Economics Unit, University of Cape Town
Health GAP (Global Access Project)
Health Poverty Action
Helen Keller International
Help Me See
Himalayan Cataract Project
IDDC Health Task Group
Initiative for Community Development (ICD)
INITIATIVE FOR HEALTH & EQUITY IN SOCIETY
International Agency for the Prevention of Blindness
International Coalition for Trachoma Control
International Eye Foundation
International HIV/AIDS Alliance
International Planned Parenthood Federation
Justicia, Salud & Desarrollo – PHM -(Bolivia)
Kentalis International Foundation
LIGHT FOR THE WORLD
Mectizan Donation Program / Global Alliance to Eliminate Lymphatic Filariasis
Medico Friend Circle
Norwegian Association Of the Blind and Partially Sighted
Overseas Development Institute
OxYGen Foundation for Protection of Youth and Women’s rights
People’s Health Movement
Program in Global Surgery, Harvard Medical School
Sahkar Social Welfare Association
Save the Children
TASO Uganda LTD.
Terre des Hommes
The Fred Hollows Foundation
The Leprosy Mission
THET (Tropical Health and Education Trust)
Transparency International Pharmaceuticals and Healthcare programme
Tunisian Association of Positive Prevention
UHC Coalition Secretariat
University for Development Studies
Vision 2020 Australia
World Blind Union
Worldwide Hospice Palliative Care Alliance
Youth Joint Online Broadcasting Kenya (YJOBK)
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