Universal Health Coverage - The Global Fund

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© The Global Fund / John Rae

Universal Health Coverage

Without universal access to quality health care, millions of people die unnecessarily every year, and preventable diseases including AIDS, tuberculosis and malaria continue to ravage families and communities. More than a billion people lack access to basic health care, and in many parts of the world, one-third of all households have to borrow money or sell assets to pay for essential health services.

Universal health coverage aims to ensure that everyone, everywhere can access quality health services without suffering financial hardship. It strives to remove barriers to health, and to improve affordability, access and quality of health systems. Universal health coverage is key to promoting equity, human security, and development and growth. With the adoption of the Sustainable Development Goals (SDGs), world leaders unanimously set the following target by 2030: 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.

With the mandate to end HIV, TB and malaria as epidemics, the Global Fund partnership makes major contributions toward universal health coverage. Investments in HIV, TB and malaria promote quality health services of all kinds, and also strengthen health systems with a powerful multiplier effect that can improve a community’s overall health status, as well as its economic and social well-being. A particular focus on removing gender- and human rights-related barriers, and on strengthening community action on health, is critical to improving access to health services for vulnerable and excluded groups. The Global Fund is a member of UHC2030, a platform that promotes collaborative work on health systems strengthening and advocates political commitment to universal health coverage.

The Global Fund contributes to universal health coverage through four strategic objectives: 1 Maximize impact against HIV, TB and malaria 2 Build resilient and sustainable systems for health 3 Promote and protect human rights and gender equality

Universal health coverage and ending HIV, TB and malaria as epidemics can only be achieved through building resilient and sustainable systems for health. These are critical to ensuring access to essential health services to all people, including those who are marginalized within societies. The Global Fund Strategy 2017-2022 reaffirms our commitment to invest vigorously in systems for health that can respond not only to HIV, TB and malaria, but yield broader health outcomes and deliver integrated, people-centered services in a sustainable, equitable and effective manner. More than one-third of Global Fund investments support the development of resilient and sustainable systems for health. Working with partners, the Global Fund takes a differentiated approach with investments that focus on a wide array of areas including: strengthening procurement and supply chains; improving data systems and data use; building stronger community responses and systems; expanding the qualified health workforce; and fostering the integration of HIV, TB and malaria services with other primary health care services so people can receive comprehensive care throughout their lives.

In Ethiopia, the government has used Global Fund grants to expand the number of community health workers. Training over 38,000 Health Extension Workers has expanded access to HIV, TB and malaria services, as well as maternal and child health services and basic screening for non-communicable diseases. The Global Fund is also increasingly supporting requests from countries to fund community-led monitoring and feedback mechanisms, which build local ownership and accountability as well as helping improve quality and accessibility of services. Efficient procurement and supply chain systems are a pillar of strong health systems and are critical to achieving universal health coverage. The Global Fund is investing to improve supply chains and pharmaceutical management, and is developing a supply chain strategy to achieve better impact. In Nigeria, the Global Fund is working with the government and partners to address structural problems, reduce costs and improve efficiency of supply chains. In Mozambique, the Global Fund is partnering with the government to refurbish provincial storage facilities in poor condition, outsource transportation to improve delivery of medicines and train warehouse employees in supply chain management.

© The Global Fund / Karin Schermbrucker


4 Mobilize increased resources

Resilient and Sustainable Systems for Health

In South Africa, in addition to providing direct support to government and nongovernmental organizations for scaling up HIV prevention and treatment for HIV and TB, the Global Fund is investing in a comprehensive package of health, education and support services for young women and girls, both in and out of schools, in priority districts.

The Global Fund’s Sustainability, Transition and Co-financing Policy aims to support countries as they move toward full domestic funding for health and responses to HIV, TB and malaria. In our 2017-2022 strategy, the Global Fund commits to work with all implementing countries to increase domestic resource mobilization for all health programs, with an emphasis on investing in programs that support key and vulnerable populations. These efforts are bearing fruit. Many low- and middle-income countries are taking up more responsibility for financing the response to HIV, TB and malaria, as well as other diseases. In the spirit of shared responsibility and global solidarity with the international community, these countries are taking the lead and investing in sectors traditionally dominated by foreign development assistance. Our co-financing requirement, for example, is boosting efforts by Viet Nam to increase self-sufficiency. The country is increasing national spending and expanding a social insurance scheme. Health improvements drove one-quarter of full income growth in developing countries between 2000 and 2011.


Lancet Commission Global Health 2035.

Equitable and Accessible Health Care The Global Fund’s work to build stronger systems for health aligns with the priorities of governments by supporting and aligning national health strategies and disease-specific national plans. In many countries, people cannot access health care, including testing and treatment, because they are unable to pay, live too far from health services, or are denied access due to discrimination or stigma, human rights- or genderrelated barriers. The Global Fund and our partners seek to knock down those barriers by investing in human rights and gender-responsive programs, by supporting greater involvement of communities in design, delivery and monitoring, and by making health services more financially sustainable. To end the epidemics and achieve global health security, countries developing national health insurance plans need to include HIV, TB and malaria within affordable coverage. In Rwanda, Global Fund partners have used grants to subsidize premiums and co-payments of health insurance for 2 million of the poorest Rwandans. Thailand provides its national health insurance to documented migrant workers and is trying to extend those services to undocumented workers.

As countries transition from Global Fund support to domestically funded health systems, partners are focusing efforts so that key populations are not left behind. Morocco is planning to increase health insurance protection for people living with HIV, and the Dominican Republic is working on the inclusion of HIV treatment in the social health insurance package. © The Global Fund / John Rae

Domestic Financing

Rwanda has used investments by development partners such as the Global Fund to build the country’s health infrastructure, developing fully integrated primary health care. Today, Rwanda serves as a model for other countries committed to far-reaching transformation of health provision. One key to Rwanda’s success is the community health management model, which places about 45,000 trained community health workers in villages across the country.

1 BILLION PEOPLE One billion people lack access to basic health care. One-third of families in Africa and Southeast Asia have to borrow money or sell assets to pay for essential health services.

© The Global Fund / Saiful Huq Omi

Focus on a Person, Not a Disease The Global Fund supports programs for prevention, treatment and care through new or existing health facilities and community delivery points that provide a range of services – not just focused on HIV, TB and malaria. The aim of integrated service delivery is to address people’s multiple health needs at different points in their lives, improving overall health outcomes and resulting in a more cost-effective and efficient approach.

Progress has also been made in the integration of HIV and TB services, in particular, breaking barriers that traditionally prevented TB patients from being tested for HIV, or HIV patients from receiving prophylaxis against TB. The Global Fund, in partnership with UNICEF and UNFPA, has also been supporting efforts to strengthen integrated service delivery platforms for maternal, newborn child and adolescent health, such as antenatal care and integrated community case management.

Villages in southeastern Bangladesh learn about malaria prevention from community health workers. Bangladesh, with the support of the Global Fund, has adopted a community-based approach, deploying thousands of community health workers who raise awareness about malaria and other diseases as well as provide diagnosis and treatment.


In Kenya, the Global Fund has integrated TB screening into the country’s antenatal care platform, which also provides treatment to prevent the transmission of HIV from mothers to their babies and addresses malaria in pregnancy. The Global Fund also recognizes and supports the role of communities in designing effective interventions, implementing and evaluating health services, and in helping reach those who may lack access to health care, particularly the most vulnerable or marginalized.

Jim Yong Kim

President, World Bank

“Achieving universal health coverage and equity in health are central to reaching the global goals to end extreme poverty by 2030 and boost shared prosperity.”

To end the epidemics and achieve global health security, countries developing national health insurance plans need to include HIV, TB and malaria within affordable coverage packages. The Global Fund is working with the World Bank on integrating HIV and TB into health insurance in Indonesia.

About the Global Fund The Global Fund is a 21st-century organization designed to accelerate the end of AIDS, tuberculosis and malaria as epidemics. As a partnership between governments, civil society, the private sector and people affected by the diseases, the Global Fund mobilizes and invests nearly US$4 billion a year to support programs run by local experts in more than 100 countries. The Global Fund’s operating costs are approximately 2 percent of grants under management, reflecting an exceptionally high degree of efficiency. By challenging barriers and embracing innovative approaches, we are working together to better serve people affected by the diseases.

December 2017 theglobalfund.org