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The was published by the World Health Organization and the World Bank in 2015. It found that more than 400 million people lacked at least one of seven essential health services like family planning or immunization, and that many people who did access services faced significant financial hardship because of the costs involved. Access to these essential services is critical to improving people¡¯s quality of life, economic productivity, and to reducing premature deaths.

In the same year, the World Bank and Government of Australia created the Advance Universal Health Coverage (Advance UHC) trust fund, a long-term partnership designed to support countries to:

¡¤       establish a credible evidence base for decision making and provide technical assistance that supports health reforms.

¡¤       unlock investments that improve the coverage and quality of health services.

¡¤       promote knowledge exchange activities so countries can share experiences and insights.

Prioritizing the Pacific and developing East Asia countries, including Cambodia, Indonesia, Laos, Myanmar, Philippines, and Viet Nam, Advance UHC successfully brought together additional development partners including Gavi¡ªthe Vaccine Alliance, the Global Fund, and the Gates Foundation, united behind the goal of health care for all. Between 2015 and 2024, the Advance UHC partnership contributed to mobilizing an estimated US$7.7 billion of new health sector investments, and continues to provide strategic support, bringing essential health services within reach of the people who need them most.

A credible evidence base for decision making

Indonesia over recent years has been implementing a aimed at providing good quality health care to 277 million people. It¡¯s a complex and ambitious undertaking, requiring strategic, evidence-based investments.

¡°Analytics are critical for developing better policies and building institutions,¡± says Kunta Nugraha, Secretary General of Indonesia¡¯s Ministry of Health. ¡°They inform the health transformation agenda in Indonesia and enable better utilization of the huge data we have.¡±

In 2016, a , supported by Advance UHC, helped Indonesia¡¯s health ministry explore short- and long-term financing strategies that could accelerate progress towards UHC. The assessment¡¯s recommendations included changes to Indonesia¡¯s national health insurance, Jaminan Kesehatan Nasional (JKN), a scheme which was only two years old at the time.

¡°The analytics helped us design and leverage subsequent multi-billion-dollar reform projects that are underway now,¡± continues Kunta Nugraha. ¡°We very much value the ongoing technical assistance that helps with the success of these projects.¡±

Nearly a decade later, Indonesia¡¯s JKN has enrolled over 98 percent of the population, and the government is three years into implementing a US$400 million results-based project to continue improving the quality of care, efficiency of spending, and support new policy formulation. Also underway is a new US$1.5 billion Health Systems Strengthening Project, as part of a US$4 billion co-financing with the Asian Infrastructure Investment Bank, the Asian Development Bank and the Islamic Development Bank, to increase the availability of medical and laboratory equipment in public health facilities and improve the utilization of public health services, and a US$300 million project to improve the coverage, quality and efficiency of the country¡¯s .   

The Government of Indonesia¡¯s investment in health (in US dollars per capita) has grown by 26 percent between 2019 and 2022 to directly advance the Health Sector Transformation Agenda.

Investments that improve access to health services

Beyond technical assistance and analytics, Advance UHC has also provided US$21 million in co-financing to help countries innovate and invest in programs that improve access to quality health services.  

In the northern provinces of the Lao PDR, a higher proportion of children under 5 years old were found to have stunted growth and low maternal and child health immunization coverage compared to national averages, while antenatal and postnatal care rates were low. A Gender Action Assessment led by the government, identified local cultural practices that led to early marriage, teenage pregnancy, and maternal and child health risks. In response, a Gender and Equity Innovation Fund (GEIF) has been set up to help Health Centers and District Health Offices deliver local initiatives that address challenges in achieving gender equity. Since 2021, three rounds of funding have been awarded to proposals in four provinces¡ªPhongsaly, Oudomxay, Huaphan and Xieng Khuang. The initiatives focus on addressing language barriers that make it difficult to raise awareness about sexual and reproductive health, maternal health, safe childbirth, and proper nutrition.  Since work began, in two villages in Kham District, safe childbirth deliveries at Health Centers doubled between 2021 and 2022 and the number of home deliveries decreased by 79%.  

¡°The GEIF has strengthened the relationship between community stakeholders and promoted maternal and child health,¡± says Dr Daoduangchanh Boulommavong, Deputy Director of the Cabinet Office at the Lao Ministry of Health. ¡°Schools, communities, village leaders, various women¡¯s organizations, and youth development groups have helped disseminate translated information, expanding awareness to remote areas. We are seeing an increase in demand for and use of services at health centers and district health offices.¡±

The Cambodia Nutrition Project provides another example. Support since 2021 has enabled the national government to reform health and nutrition systems, giving local authorities more say over management and delivery of services in their commune/sangkats and villages. Aligned with Cambodia¡¯s decentralization policies, the project supports the delivery of higher quality services across nine provinces. 

¡°We have seen improvements in the availability, accessibility, affordability, and quality of health and nutrition services,¡± says Dr Sophonneary Prak, Cambodia Nutrition Project Director at the Ministry of Health. ¡°We have also been able to develop national maternal and child health and nutrition guidance documents, tools, training modules, coaching packages, implementation guidelines, educational videos, and many other nutrition related materials.¡±

Promoting knowledge sharing

Knowledge exchange improves decision making, promotes innovation, and generates cycles of continuous improvement. With Advance UHC support, health policymakers have been able to take advantage of a range of opportunities for sharing information at national, regional, and international levels.      

In Papua New Guinea, a comprehensive public financial management toolkit has been developed to better equip Provincial Health Authorities with the necessary guidelines, equipment and knowledge to effectively manage their financial systems. As part of this initiative, staff from the Department of Finance are training and mentoring staff from the National Department of Health and four Provincial Health Authorities, enhancing their financial planning, budgeting, accounting, reporting and auditing processes.

¡°It has been really beneficial for our provincial health staff to have the opportunity to engage with and learn from their colleagues in the finance ministry,¡± says Pala Vanuga, Acting Deputy Secretary, Corporate Services, with the National Department of Health. ¡°Establishing this partnership has been a significant step towards stronger governance within the health sector and will help improve our ability to provide services to those who most need it in our communities.¡±

Building on previous health financing initiatives across the region, the Asia & Pacific Health Financing Forum was established in 2022 as a platform for connecting policymakers so they can explore sustainable financing solutions that improve health outcomes.

¡°One of the important opportunities of these [health financing] forums is to learn from other island countries,¡± says Pelesala Kaleia, Deputy Secretary, Ministry of Health and Social Welfare in Tuvalu. ¡°Listening to what other countries are saying, we can understand the differences and hear about some of the successful approaches that they have made to improve their health sector.¡±  

The Advance UHC partnership also supports the , a global community of practitioners and policymakers who regularly engage in practitioner-to-practitioner learning to co-develop knowledge products and form collaboratives that find practical solutions to shared health challenges across 40 countries globally.

¡°The Joint Learning Network is a very innovative approach,¡± says Ghufron Mukti, co-convenor of the JLN¡¯s Global Steering Group and President Director of BPJS Health Indonesia, the country's Social Security Agency for Health. ¡°It brings countries, donors and technical experts together to use their hands-on knowledge and experience to work together to develop action-oriented resources through knowledge products that can be applied or adapted to reaching UHC. Together we can win the challenges."

One of its newest thematic priorities is looking at climate-smart health systems.

¡°The climate-smart health system collaborative models the kind of global partnerships necessary to scale up climate-health action,¡± says Lusiana Biumaiwai, Senior Health Inspector with Fiji¡¯s Ministry of Health. ¡°It currently draws on the experience of 21 countries, including Fiji, that are committed to generating and sharing knowledge that will inform evidence-based investments in sustainable health systems.¡±

In addition to country focused knowledge and analytics, Advance UHC has supported several high-profile big picture regional studies and reports that have influenced national, regional and global dialogue. This includes the Double Shock to Double Recovery series which most recently highlighted the fact that  sluggish economic recoveries, combined with an increase in debt servicing due to pandemic-era increases in borrowing, are constraining the ability of many countries to undertake public investments in health.

The future

Advance UHC has successfully built partnerships for health across the region and supported countries through a turbulent decade, one which included the worst global pandemic in a century. More investment is needed to ensure the East Asia and Pacific region is ready for future pandemics and Advance UHC plays a key role in advocacy and hands on technical support to access global resources.  Recently, technical assistance was provided that supported two Pacific countries¡ªFiji and Samoa with successful applications to the Pandemic Fund. The financing will enable much-needed investments to strengthen disease surveillance and early warning systems, upgrade laboratories, and build the One Health workforce.

The report found that the world is off track to make significant progress towards UHC by 2030. In this difficult context, Advance UHC will continue to support priority countries with strategic health reforms that improve access to quality health care. There is demand for sustainable health financing and enhancing integrated primary health care systems, so they are better prepared for tackling the challenges of aging populations, growing double burden of non-communicable diseases and infectious diseases, and mental health issues.

Digital health solutions hold great promise, particularly for Pacific Island countries with widely dispersed populations, but investment in technology, infrastructure, and training will be needed before their benefits can be fully felt. A focus on digitally enabled primary health care reforms is critical to accelerating progress towards UHC and a healthier and more prosperous region.