Health systems strengthening, universal health coverage, health security and resilience

Health system strengthening comprises the means (the policy instruments), while universal health coverage is a way of framing the objectives of policy. Without this distinction, there is a risk that instruments of reform become the objective, with the perception that “the problem” to be solved is the absence or presence of a particular policy instrument. When this occurs, policy dialogue shifts quickly away from where it needs to be – getting to consensus about the nature and causes of underperformance relative to universal health coverage goals – to what is often an ideologically polarized debate about the inherent merits or flaws of particular reform instruments. In health financing, for example, this has been observed in the debate on social or community-based health insurance, performance-based financing and user fees. Similarly, simply calling something a “universal health coverage reform” does not convey any meaning as to the actual content of what is being planned or implemented.