Universal health coverage and community engagement

Achieving universal health coverage (UHC) and the sustainable development goals (SDGs) requires health systems to shift from an almost exclusively vertical, top-down and curative paradigm to one that places people at the centre of health services. Here we reflect on how efforts towards UHC could offer an opportunity to address those aspects within health systems that continue to hinder efforts to meaningfully engage with patients, their families and local communities. The backbone of these efforts should be a health workforce that is skilled in engagement, responsive to local context and to the needs and expectations of those using their services. The complexity of health issues in today’s globalized world challenges the fragmented and often isolated practices in both contemporary medicine and public health in much of the world.1 For example, managing chronic diseases and multimorbidities and responding to outbreaks of infectious diseases challenges health systems, as they require collaborative action at different levels of the system and across multiple stakeholders, sectors and countries. Diverse disciplines, professions and institutions should work together to find more sustainable and locally owned solutions and practices to address fundamental issues, such as equity and the social determinants of health.2 With UHC as a major goal for health reform in many countries and a priority for the World Health Organization (WHO), there is an opportunity to focus on how such high-level consensus can be translated into meaningful action.3 Therefore, it is timely to consider the emerging role of non-traditional areas for health systems, such as community engagement, within UHC, in particular how community engagement can shape the delivery of quality health services that are safe, effective, efficient, equitable, people centred and that integrate care.4 UHC and community engagement