Letter from participants of the G7 Civil Society Taskforce which met in Rome (1-2 February 2016) to members of the G7 Health Experts Working Group meeting in Tokyo (18-19 February 2016)

1. Letter from participants of the G7 Civil Society Taskforce which met in Rome (1-2
February 2016) to members of the G7 Health Experts Working Group meeting in
Tokyo (18-19 February 2016).
Dear Members of the G7 Health Experts Working Group
We need a commitment at Ise-Shima to a truly transformative agenda for health and sustainable
development
The G7 has a long tradition of supporting health. The 2016 Summit under Japan’s leadership, the
first following the adoption of the 2030 Agenda for Sustainable Development, has the potential to
be a transformative G7, starting a new commitment to Universal Health Coverage (UHC) whilst
increasing momentum on existing priorities such as the Global Fund.
We and the undersigned organisations support three priority areas:
Universal Health Coverage for 2030 Sustainable Development
The era of the MDGs has reached an end. There is finally an historic commitment under the SDG
Framework to Universal Health Coverage. As an ambitious target for health system strengthening, a
G7 endorsement of the principles of UHC will be powerful catalyst for ensuring equity and the right
to health for all. Stopping the daily scandal of unnecessary mortality and poor health, coping with
infectious disease outbreaks and reducing antimicrobial resistance all require universal health
services which are accessible to all, adequately funded and staffed.
We call on the G7 to:
1. Endorse the principles of UHC: that everyone has the right to health without facing financial
hardship.
2. Assert that UHC must not discriminate against any social groups or leave anyone behind,
bringing the poorest and marginalised into coverage urgently. Closing equity gaps is
imperative to the success of the SDGs.
3. Confirm that UHC requires a move from the injustice of out-of-pocket payments to
increased domestic resources. The G7 should endorse greater fiscal space for countries to
raise fair taxes and increase public spending, including through the IMF and World Bank.
4. Even with increased domestic resources, there is a $27 billion annual gap for the poorest
countries for UHC. G7 countries should contribute 0.1% of GNI to health, as part of 0.7% to

2. ODA and ensure that their aid is aligned to support national health plans, coordinated
through the International Health Partnership+ and the Roadmap for Health System
Strengthening.
5. Support a new Global Partnership or Alliance for UHC which can drive global momentum
and ensure all actors are playing their part. Governments, the UN, civil society and the
private sector need to refocus, harmonise and align their policies and contributions towards
UHC.
6. Support greater UHC accountability to ensure sufficient monitoring and commitment.
Prevention and Responses to Global Health Threats
Building UHC is the priority so that health systems will be far better equipped to stop outbreaks
before they become national disasters. However, countries which cannot cope with infectious
disease outbreaks need fast and effective international help. While we support better and more
coordinated responses, we also raise the following concerns about the Pandemic Emergency
Financing Facility:
1. Prevention is better than response. Helping countries build strong systems for UHC must not be
a lower priority than responding. Defining “health security” narrowly as pandemic preparedness
undermines the importance of a health system that saves lives and protects livelihoods every
single day. Health security means ensuring no one goes bankrupt when they get sick.
2. Any global funding mechanism must not present private sector insurance as a magic solution.
Companies will make an overall profit from insurance which can only come from public money
that should be funding public services.
3. Qualifying for payouts will be complicated and companies will always seek to avoid payouts.
There may also be a perverse incentive to declare outbreaks, impacting on fragile economies.
4. Countries with weaker health systems may be expected to pay higher premiums and receive
lower payouts; those countries most in need may benefit least from the PEF.
5. All multilateral institutions on global health crisis, including PEF, should ensure full involvement
of civil society in its governance, implementation and evaluation.
6. The reform of WHO and supporting its role in coordinating global health responses should not
be undermined by other actors.
Increased aid for health to end ongoing global health crises
G7 actions have helped to save lives and to start to turn around global health problems including
major epidemics through the Global Fund to Fight AIDS, TB & Malaria, child and maternal mortality
through the Muskoka Initiative, nutrition and polio. The 2030 Agenda for Sustainable Development
is ambitious about ending health threats. To achieve this, greater investment is necessary, always
supporting comprehensive health systems.
1. The G7 should lead the process of the fifth replenishment of the Global Fund to ensure it is
fully-funded Global Fund, whilst making sure its new strategy (2017-2022) for resilient health
systems supports UHC
2. G7 countries should extend their political and financial commitments to accelerate progress
towards eradication of polio and planning of the transfer of polio assets towards health systems
to contribute to UHC.

3. 3. Continue and increase investments in Research and Development for poverty-related and
neglected conditions and infectious diseases and support manufacturing of treatments,
vaccines and diagnostics in low and middle-income countries.
4. Ensure a strong commitment for the coming Nutrition for Growth Summit in Rio: the World
Health Assembly nutrition targets and the SDG health targets can only be reached through
increased focus and new financial commitments to nutrition.
5. Support the Global Strategy for Women, Children and Adolescents’ Health and ensure that
essential SRMNCAH services at primary care level are the first priority of UHC, including Sexual
& Reproductive Health & Rights.
6. Recognise and reinforce the importance of the social and gender determinants of health by also
mainstreaming gender into national health strategies.
We wish you a successful meeting and will work with you for a transformative G7 commitment to
health.
Signed by:

4. AARP
ACT - Alliance for the Control of Tobacco Use and Health Promotion
Action for Global Health
ACTION Global Health Advocacy Partnership
Action Medeor E.V.
ADD International
Adivasi Adhikar Samiti, India
ADRA Germany
Advance Family Planning, Johns Hopkins Bloomberg School of Public Health
Advocacy, Research, Training and Services (ARTS) Foundation
African Agency for Integrated Development (AAID)
AFRIHEALTH Optonet Association (CSOs Network)
Aga Khan University
Age International
AIDOS Italian Association for Women in Development
ALEJO Community Support Project
Alliance for Surgery and Anesthesia Presence
Alliance of Young Nurse Leaders and Advocates International, Inc.
Allied World Healthcare
Alternative SantÉ Cameroun
Alzheimer's Disease International
American Cancer Society
American Heart Association
American Leprosy Missions
Anesvad
Aravind Eye Care System
AS - Center for the Empowerment Youth of people who are living with HIV and AIDS, Serbia
Asia Arsenic Network
Asociación Mexicana de Vacunología
Association d'Entraide Médico-Sociale AEMS-ASBL
Association for Academic Surgery
Association of Anaesthetists of Great Britain & Ireland
Association Tunisienne de Prévention Positive
ASTRA Network
AUCI (Associazione Universitaria per la Cooperazione Internazionale)
Austrian Leprosy Relief Association
AVERT
Awaka Go Forward International
Balance Promoción para el Desarrollo y Juventud A.C.
Better Place International
Blood Patients' Protection Council(BPPC), Kerala, India
BRAC
Brien Holden Vision Institute
British Foundation for International Reconstructive Surgical Training
CAFOD
Catholics for AIDS Prevention and Support (CAPS)
CBM
CBM Germany
CBR Asia Pacific Network & ASHA Pakistan
CCDT
CCM Comitato Collaborazione Medica
Center for Advocacy and Research (CFAR)
Centre for Global Surgery
Centre for Health Policy, School of Public Health, University of the Witwatersrand, South Africa
Centre for Sustainable Development and Education in Africa
Centre of Excellence for Universal Health Coverage, James P Grant School of Public Health, BRAC University,
Bangladeshh.
CHARM
Christian Aid
CICODEV Africa
Civil Society Organisations Forum on HIV and AIDS (FOCDHA), Serbia
Coalition des OSC du Bénin pour la Couverture Universelle en Santé
Coalition 15%

5. Coalition for Health Promotion and Social Development (HEPS Uganda)
Columbia University
Commonwealth Medical Trust (Commat)
Community and Family Foundation Ghana
Comprehensive Health and Education Forum (CHEF) International
Comprehensive Health and Education Forum (CHEF), International, Islamabad
Construsion Ensemble Le Monde
Concern Health Education Project -Ghana
Corporación Kimirina
Curatio International Foundation
Development Policy Solutions
Diamedica UK Ltd
Disability Partnership Finland
Double Positive Foundation
Drug Action Forum - Karnataka
DSW (Deutsche Stiftung Weltbevoelkerung)
Ecokarma
Elizabeth Glaser Pediatric AIDS Foundation
EngenderHealth
Episcopal Church of South Sudan & Sudan Department of Education and Training
Equilibres & Populations
Espolea A.C.
European Network on Independent Living
Eyes of the World Foundation ( Ulls del món)
Faculty of Medicine, Suez Canal University, Ismailia, EGYPT
Fast Rural Development Program
Federacion Planificacion Familiar Estatal
Federal Medical Center Yenagoa, Bayelsa State, Nigeria
Fondation Joseph The Worker/ Structure Lazarienne
For Impacts in Social Health (FIS)
Freshwater Action Network Mexico
Friends in Health: DPRK
Fundacion Arcoiris. Mexico
Fundación Mexicana para la Salud
G4 Alliance
GASOC ( global anaesthetic surgery and obstetric collaboration)
GCAP Italy
General Trade Union of Workers in Health Services and Pharmaceutical Industries in Jordan
Global Campaign for Education
Global Health Advocates France
Global Health International Advisors GHIA
Global Network of People Living with HIV
Global Paediatric Surgery Network
Global Pediatric Surgical Technology and Education Project
Global Social Observatory
Green Cameroon
HANDICAP INTERNATIONAL
Harvard University Program in Global Surgery and Social Change
HEAL Africa
Health Access and Integrated Development Initiative
Health Economics Unit, University of Cape Town
Health For All Coalition Sierra Leone
Health Partners International
Health Poverty Action
Health Volunteers Overseas
HealthNet TPO
Healthwatch Forum UP
Helen Keller International
HelpAge International
HePDO (Health Promotion and Development Organisation)
HERA TRUST
HHRD Pakistan
HIV i-Base

6. HIV Justice Network
Housing Works, Inc.
Howard University College of Medicine
Hwlp Me See
Hwupenyu Health and Wellbeing project
Icahn School of Medicine at Mount Sinai
ICWAP
ILEP
Incentives for Global Health
India HIV/AIDS Alliance
Indus Hospital
Initiative for Community Development
Initiative for Health and Equity in Society
Initiative for Rural Empowerment (IRE)
International Agency for Prevention of Blindness
International Anesthesia Education Forum
International Children's Palliative Care Network
International Community of Women
International Council of Ophthalmology
International Diabetes Federation
International Disability Alliance
International Eye Foundation
International Federation of Surgical Colleges
International HIV/AIDS Alliance
International Planned Parenthood Federation
IntraHealth International
Irish Family Planning Association (IFPA)
IWC Barbados
Jamaica Community of Positive Women
Jan Swasthya Abhiyan - Mumbai
Jan Swasthya Abhiyan ( Peoples Health Movement-India)
Japanese Organization for International Cooperation in Family Planning (JOICFP)
Jeevik
Jharkhand Science Forum
Johns Hopkins University
JOICFP
JONGO Farmers Nigeria
Karnataka Janaarogya Chaluvali
Kenya AIDS NGOs Consortium - KANCO
Kenya Legal & Ethical Issues Network on HIV/AIDS (KELIN)
Korean American Medical Association
Light for the World International
Liliane Foundation
Liverpool School of Tropical Medicine
Malaria Consortium
Management Sciences for Health
May Dugan Center
Medact
Medical College of Georgia/University of Georgia Medical Partnership
MEDICI Centre, Western University
Medico Friend Circle
Medicos del mundo España
Medicus Mundi España
Medicus Mundi International - Network Health for All
Medsin-UK
Mending Kids
Mercy Ships
Motivation
Multiple Foundation Trust
Muslim Family Counselling Services
NCD Alliance
NEPHAK

7. Network of 'Southern Africa Parliamentarians on HIV/AIDS, & Community Engagement on Prevention of Communicable
Diseases, and Health Rights Advocacy (SA-PACEDIST)
Nigeria Network of NGOs
Nigerian Society of Anaesthetists
Norwegian Association of Disabled
Norwegian association of the blind and partially sighted
Operación Sonrisa Nicaragua
Operation Eyesight
Operation Smile, Inc.
Orbis International
ORES Tanzania
Organisation pour la Prévention de la Cécité (OPC)
Osservatorio Italiano sull'Azione Globale contro l'AIDS
Oxfam International
Pan African Positive Women's Coalition-Zimbabwe
Pan-African Academy of Christian Surgeons
Pathfinder Outreach Ministries-Ghana
Patients' Rights Organization in Kosovo - PRAK
People's Health Movement
Peoples Training And research Centre
Plan UK
Plate Forme des Organisations de la Societe Civile pour le soutien à la Santé/vaccination
PLENITUD Foundation
Porridge and Rice
Positive Women
Positive Women Inc. New Zealand
Positive-Generation
Prayas
Preah Kossamak Hospital
Primary Trauma Care Foundation
Princess of Africa Foundation
Program in Global Surgery and Social Change - Harvard Medical School
Progressio
Public Health Foundation of Bangladesh
Public Health Foundation of India
Research and Development Division, Ghana Health Service
Restless Development
RESULTS Australia
RESULTS Canada
RESULTS UK
ReSurge International
RFSU
Royal College of Surgeons in Ireland
RTI International
Rutgers
Sahkar Social Welfare Association
Salamander Trust
Save the Children
Save the Children Italy
Schistosomiasis Control Initiative Imperial College London
Secours aux Lépreux - Leprosy Relief Canada
Sécretariat Permanent des Organisations Non Gouvernementales (SPONG)
Selfless
SEM (Sudan Evangelical Mission)
Sensoa (Belgium)
Seres (con) viver com o VIH
Seva Foundation
Sightsavers
Smile Train
Sociedad Dominicana de Pediatria
Society for Community Health Awareness, Research and Action (SOCHARA)
Sophia Forum
SOS Children's Villages

8. South African Disability Alliance
STEP Organization Pakistan
STOPAIDS
Surgerymatters
Surgical Society of Zambia
Surgicon Foundation
Sustainable Development Solutions Network (SDSN)
Tanzania Diabetes Association
Terre des Hommes
The Fred Hollows Foundation
The G4 Alliance
The Global Surgical Consortium
The Graça Machel Trust
The Hunger Project
The International Coalition for Trachoma Control
The International Community of Women Living with HIV
The Leprosy Mission International
The Rockefeller Foundation
The Well Project
THET
THET (The Tropical Health & Education Trust)
Tororo forum for people living with HIV networks
Traditional Healers and Traditional Medicine Foundation (Thetramed Foundation)
Training and Research Support Centre
Treasureland Health Builders Initiative
Uganda Network of Young People Living with HIV&AIDS (UNYPA)
Union des ONG du Togo(UONGTO)
University of Melbourne, Melbourne School of Population and Global Health
University of Michgan
University of Sheffield
University of the Witwatersrand
University of Utah, Center for Global Surgery
University of Vermont College of Medicine
Väestöliitto
Vasavya Mahila Mandali
Vision 2020 Australia
VSO International
Wada Na Todo Abhiyan
WaterAid America
WaterAid Australia
WaterAid India
WaterAid UK
WECARe plus
Wemos
Women Deliver
Women's Hope Association
World Heart Federation
World Vision
Worldwide Hospice Palliative Care Alliance
Wote YouthDevelopment Projects
Youth Joint Online Broadcasting Kenyta
Youth Stop AIDS
Zambia Asthma Association
Zambia Heart and Stroke Foundation
Challenge the debate on health care financing and delivery www.globalhealthcheck.org
It's time for the #IAEG to measure what matters. No one should go bankrupt when they get sick. #HealthForAll
It's time for the #IAEG to measure what matters. Let's have an indicator that works for #UHC:
Tell @UNStats: Insurance is no assurance. Must track financial protection!

9.
There is unprecedented global consensus that Universal Health Coverage (SDG Target 3.8) means
everyone can access the quality health services they need without being pushed or pushed further into
poverty. It requires two indicators to capture coverage (3.8.1) and financial protection (3.8.2).
Recent changes to indicator 3.8.2 mean that we will not be able to measure how many people are suffering
financial hardship to pay for the health services they need.
At the upcoming meeting of the Inter-Agency Expert Group (IAEG) in Mexico, we urge all members to revise
the Universal Health Coverage indicator 3.8.2.
• From “number of people covered by health insurance or a public health system per 1,000 population”
• To “lack of coverage by a form of financial protection.”
There is no one-size-fits-all approach to UHC and countries at all income levels are taking different paths.
But the principle of access to health without financial hardship is fundamental and must be measured. The
current indicator does not measure what matters. And it risks promoting just one mechanism—insurance—
without tracking the impact of paying for health on the individual.
CURRENT INDICATOR (as of 19th
February):
“Number of people covered by health insurance or
a public health system per 1000 population.”
× “Access to a public system or insurance” is
neither a measure nor a guarantee of financial
protection.
× Does not measure financial costs.
× Does not meaningfully distinguish between
countries; would measure 100% efficacy in all
countries with any public health system.
× Household spending can increase, and financial
protection can be reduced, despite coverage by
insurance or a public health system
× No accepted universal meaning or definition and
so won’t allow for cross-country comparisons.
× Does not allow data disaggregation,
undermining SDG priority to leave no one
behind.
× Not policy-neutral. Risks promoting one
potential route to UHC—insurance—above
others. This is not the job of the IAEG or the
SDGs.
RECOMMENDED INDICATOR:
“Lack of coverage by a form of financial
protection”*
ü Relevant to the target: Directly measures the
financial impact on households to meet the
costs of health services.
ü Methodologically sound: Methodologies dating
back to the 1990s, refined over a 3-years of
extensive and inclusive consultations involving
expert academics and international agencies.
ü Internationally agreed: Standard definition
which is scientifically robust and policy neutral.
ü Data available: Information is readily available
from routine household surveys conducted by
national statistical offices (e.g. Budget Surveys,
Income and Expenditure Surveys, Living
Standards Measurement Surveys)
ü Amenable to disaggregation
*This should be measured by calculating the proportion
of the population with large household expenditure on
health, as a total share of household expenditure or
income (e.g. greater than 25%)
MEASURING UNIVERSAL HEALTH COVERAGE
Recommendations from Civil Society on Indicator 3.8.2
CURRENT INDICATOR vs. RECOMMENDED INDICATOR

10. MEASURE WHAT MATTERS.
Countries around the world have demonstrated that “the number of people covered
by health insurance or a public health system” is not fit for purpose as a measure of
financial protection.
• KOREA covered 100% population with health insurance in 1989 but individuals paid
65% of all health costs and faced huge financial risk for hospitalization or chronic
illness. Coverage has since remained at 100% while payments have fallen.
• UK and AZERBAIJAN both have a public system – 100% coverage, but out of pocket
payments are less than 10% in the UK and more than 70% in Azerbaijan.
• CHINA expanded its rural insurance scheme during the 2000s, but high patient co-
payments increased financial hardship, in the early days.
• In VIETNAM, nearly 60% of the population was enrolled in health insurance in 2010,
but continued to face financial risk due to no cap on co-payments for members.
• NIGERIA has a huge informal population. Investments in health insurance have not
expanded health access among the poor. Health indicators remain among the
worst in Africa despite its relatively larger economy.
These examples show that having a public health system or insurance mechanism
doesn’t guarantee better financial protection, and that changes in financial
protection often do not correlate with changes in insurance coverage.
631 INDIVIDUALS—including Atul
Gawande, Michael J. Klag and Edna
Ismail—signed a letter to the Inter-
Agency and Expert Group in February
2016 calling for robust measurement of
financial risk protection. Leaders like
Graça Machel and Anne Mills have
also come forward to add their support.
300+ ORGANIZATIONS around the
world—including The Rockefeller
Foundation, Oxfam, Save the Children,
the Graça Machel Trust, the London
School of Hygiene and Tropical
Medicine—agree that the current
indicator is not fit for purpose, and call
for this to be revised.
COUNTRY EXAMPLES
HUGE SUPPORT TO REVISE INDICATOR 3.8.2
Questions?
Contact Anna Marriot (AMarriot@oxfam.org.uk), Beck Smith
(B.Smith@savethechildren.org.uk) or Abigail Rowlands (Abigail.Rowlands@plan-uk.org)