16 November 2016

Advocacy is successful to influence IAEG-SDG decision

SDG Indicator 3.8.2 refinement agreed

On 14-18 November 2016, The IAEG-SDGs members met in Geneva and agreed to revise the wording and definition of the 3.8.2 indicator to "Proportion of population with large household expenditures on heath as a share of total household expenditure or income". This final refinement proposal will be submitted to the 48th UN Statistical Commission in March 2017 for formal approval. 

This decision is an outcome of hard work by development agencies, civil society organisations and researchers who have advocated strongly for this change. 


Sustainable Development Goal 3 is to ensure healthy lives and promote well-being for all. Within this broad Goal 3, there are 13 targets and the eighth target is about progress towards universal health coverage (UHC). This target is of particular relevance to the International Health Partnership for UHC 2030.

Target 3.8 of SDG 3 is: 'to achieve universal health coverage, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all. 

A question of concern is how we can measure how far countries are making progress towards this target and ultimately reaching it?  The target is about the multi-dimensional nature of universal health coverage, and indicators are needed to monitor each dimension. For example, indicator 3.8.1 concerns the coverage of essential health services and indicator 3.8.2 involves the proportion of the population not financially protected.

The formulation of indicator 3.8.2 previously developed by IAEG-SDG and agreed to, as a practical starting point at the 47th session of the UN Statistical Commission in March 2016, was the 'number of people covered by health insurance or a public health system per 1000 population''. 

However, many considered that the formulation was not a valid measure of financial protection. Devex News published an article How should we measure access to health care? after the 47thCommission. During high-level week at the 71st UN General Assembly on 22 September 2016, Dr Gro Harlem Brundtland, the former Director-General of WHO and the deputy chair of the Elders claimed

“The indicator to be adopted by the UN Inter-Agency and Expert Group for Target 3.8 must address the issue of financial protection coverage, rather than looking at the number of people covered by health insurance. Insurance is not a measure or guarantee of financial risk protection. We are concerned that this kind of indicator for UHC could undermine measuring real progress.”

Following the 47th Statistical Commission decision 47/101 (e) requesting 'the Inter-Agency and Expert Group to take into account the specific proposals for refinements of the indicators made by Member States during the discussion'', the IAEG-SDGs conducted an open consultation on possible refinements for a limited set of indicators in the global indicator framework for the SDGs. 

A proposed refinement of indicator 3.8.2 was 'Proportion of the population with large household expenditures (e.g. greater than 25%) on health as a share of total household expenditure or income', reflecting World Health Organisation (WHO) and the World Bank Group’s proposal.

Notably, 70% of responses were positive on refined indicator 3.8.2 and 95% of recommendations from those in favour were to adopt the refined indicator with 65% of supports as 'instead of' rather than 'in addition to' the 3.8.2 indicator. Besides, over 90 civil society organisations and 351 health researchers and academics also signed up letters to urge IAEG-SDGs members to make a right decision based on the open consultation. 

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