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  • In September countries agreed to the

    2019-05-31

    In September, 2015, 193 countries agreed to the ambitious Sustainable Development Goals (SDGs). SDG 3, for “healthy lives and wellbeing”, includes targets for universal health coverage (UHC). Some international commentators have raised questions about whether many of the SDGs are feasible and affordable. Targets related to health have good metrics to assess progress, and there is a good track record of achieving many of the previous ambitious goals. So, health is a good place to start assessments of feasibility and affordability. The Article by Karin Stenberg and colleagues in represents a milestone in the implementation of this ambitious SDG agenda. It provides not only the estimated level of financing that will be required for the health SDGs to be reached, but also a global picture of how this target might be achieved. In this Comment, we discuss how their analysis could be of use to countries, and some of the implications for the global health community. The health-systems research and policy communities have made substantial progress since the same WHO group attempted to cost achievement of the health Millennium Development Goals, at a time when the evidence strontium chloride for investment in health systems was weak. Now, the case for investing in health systems is stronger and generally more accepted. The ability to describe and compare health systems across countries has also much improved. The model used by Stenberg and colleagues includes services across sectors, with different service delivery platforms and scenarios to consider what is feasible with different levels of political commitment and resource envelopes. The funding requirements as presented in Stenberg and colleagues\' analysis provide countries with a soft target for minimum spending levels for health as they move towards UHC. As countries increase their data quality and capacity to do country-specific costing and impact studies, these targets can be complemented with more robust locally determined resource-needs estimates of what is required to reach national SDG-related targets (where they exist). Ministries of health could also use these data to negotiate for additional domestic resources by highlighting the effect that increased health spending has on life expectancy, healthy life-years, and financial empowerment of households. Stenberg and colleagues\' analysis can act as a benchmark to track health spending, in combination with locally led resource tracking. It also allows countries to compare their spending with that of higher-income countries, to plan how health spending will need to evolve in the long term. The estimates emerging from the analysis provide compelling arguments that investments in health need to focus not only on direct service delivery but also on overall health-systems strengthening. Strong health systems will be central to achievement of SDG 3. Stenberg and colleagues\' data can facilitate building cross-country consensus on why health-systems strengthening is so essential, but country-specific studies will be required to understand where countries should focus their investments—eg, human resources, infrastructure, data systems. The Article provides a stark reminder that many countries need substantial additional investments in health to meet SDG 3. As countries continue to grow economically, those that transition to middle-income status will probably reach the UHC target, assuming that they have the right policies in place and the political commitment to raise resources domestically. Investments in research and new technology have also been emphasised as important in longer-term projections for improving global health. By contrast, low-income countries will continue to need international financial assistance to reach UHC goals. To sustain this level of financing, the global public health community will need a sophisticated set of messages tailored to different audiences that clearly show the benefits in terms of human rights, economic development, and global health security.