Leaving No-One Behind in Universal Health Coverage

Published on 3 February 2021

Understanding and addressing exclusion in the context of the COVID-19 pandemic  

This session is designed to meet the needs of health and social development advisers and those from the wider health network and from other cadres with an interest in health, equity and justice. ​​​​​​​

Why this session now?

The impacts of COVID-19 have been harshest for existing marginalized and excluded groups; although new vulnerabilities have also emerged, and drivers of exclusion have intensified. The impact of COVID-19 on health seeking experiences, opportunities and outcomes is wide reaching with implications for models and understanding of Leaving No One Behind and Universal Health Coverage. To reach the Sustainable Development Goals, policy makers and funding agencies need to consider and confront a number of issues to be discussed in this session, including:

How can we best understand and categorise drivers of exclusion with regard to health systems? How has COVID-19 affected this?

What definitions and models of LNOB are there? How can these be adapted to meet different country and local contexts, for example urban settings and fragile, conflict affected and shock prone areas?

How can we promote equity in progressing towards UHC, including in response to health system shocks such as COVID-19? What existing frameworks and approaches are available, and what are their strengths and weaknesses?

​​​​Learning objectives

  1. Be clear on key definitions, concepts, principles in “Leaving no one behind” (LNB) and “Universal Health Coverage” (UHC)
  2. Be able to identify key frameworks and approaches to LNB in progressing towards UHC and how these have been challenged by COVID-19
  3. Have greater awareness of drivers of exclusion and equity consideration in different contexts (e.g. urban) and on different areas of concern (e.g. adolescent health).
  4. Be more comfortable engaging with key stakeholders in dialogue on equity, LNB and UHC  ​​​​​​​

Hear from our experts

Hear more from Dr Lilian Otiso here where she reflects on gender and health system policy ; gender; disability; changing gender norms and engaging with policy makers and the use of evidence. (5 mins) ​​​​​​​​​​​​​​

Hear more from Professor Sabina Rashid on What Does Lockdown Mean for South Asian Communities? (10 mins). Sabina discusses the reality of lockdown, poverty, precarity, stigma and fear on the experience and health of people living in informal settlements/slums in Bangladesh. ​​​​​​​​​​​​​​

Supporting Resources


  1. Leaving no-one behind – UNSDG operational guide for U.N teams – interim Draft March 2019, United Nations Sustainable Development Group 2019. Available at: https://unsdg.un.org/resources/leaving-no-one-behind-unsdg-operational-guide-un-country-teams-interim-draft. Pages 7-10 (3 pages).
  2. World Bank. 2020. Poverty and Shared Prosperity 2020:Reversals of Fortune. Washington, DC: World Bank. doi: 10.1596/978-1-4648-1602-4. License: Creative Commons Attribution CC BY 3.0 IGO. Available at: https://www.worldbank.org/en/publication/poverty-and-shared-prosperity. Overview: pages 1-19 (18 pages).
  3. World Health Organisation. 2017. Reforming Health Service Delivery for UHC. WHO/HIS/SDS/2017.9. Available at: https://apps.who.int/iris/bitstream/handle/10665/255311/WHO-HIS-SDS-2017.9-eng.pdf;jsessionid=4CDD82E80F8F76082870805AB070F9B8?sequence=1 (4 pages).
  4. Rohwerder, B. (2020). Social impacts and responses related to COVID-19 in low- and middle-income countries. K4D Emerging Issues Report 35. Brighton, UK: Institute of Development Studies. Available at: https://www.ids.ac.uk/publications/social-impacts-and-responses-related-to-covid-19-in-low-and-middle-income-countries/. Executive summary (pages 1-8, especially pages 1-5) (8 pages).
  5. Hankivsky O. Intersectionality 101. Institute for Intersectionality Research & Policy, SFU; 2014. Available at: https://www.researchgate.net/profile/Olena_Hankivsky/publication/279293665_Intersectionality_101/links/56c35bda08ae602342508c7f/Intersectionality-101.pdf (19 pages)
  6. Kimberlé Crenshaw (2016). The urgency of intersectionality YouTube clip – (20 mins)
  7. WHO: What is people-centred care? https://www.youtube.com/watch?v=pj-AvTOdk2Q (2.35 mins)


Leave No-one behind assessment methodology

An integrated approach to leaving no one behind: Overview and methodology, ODI, Dec 2016. Available at:. Especially pages 7-8, pages 9-11, pages 12-14, pages 31 -32.


Elizabeth Larson, Asha George, Rosemary Morgan, Tonia Poteat, 10 Best resources on… intersectionality with an emphasis on low- and middle-income countries, Health Policy and Planning, Volume 31, Issue 8, October 2016, Pages 964–969,https://doi.org/10.1093/heapol/czw020

Gender and UHC

RinGS. 2020. Adopting a gender lens in health systems policy: A guide for policy makershttps://www.ringsgenderresearch.org/wp-content/uploads/2020/01/Adopting-a-gender-lens-in-health-systems-policy.pdf

Disability and UHC

Millington, K.A., Dean, L., Thomson, R. and Tolhurst, R (2018). Shaping Health Systems to Include People Living with Disabilities. K4D Emerging Issues Report. Brighton, UK: Institute of Development Studies. Available at: https://opendocs.ids.ac.uk/opendocs/bitstream/handle/20.500.12413/14549/EI012_Shaping_Health_Systems_to_Include_People_with_Disabilities.pdf?sequence=1&isAllowed=y

Leave no-one behind and COVID-19

  1. People with disabilities during COVID-19: A story from Kenya: By Joseph Etyang. Available at: http://www.ariseconsortium.org/kenya-disabilities-during-covid-19/
  2. Alvira Farheen Ria, Samira Ahmed Raha, Sajib Rana, Prantik Roy, Taslima Aktar, Saklain Al Mamun, Mehedi Hasan Anik and Farhana Alam. 2020. Exploring the impact of covid-19 on adolescents in urban slums in Dhaka, Bangladesh. Available at: https://covid-bracjpgsph.org/front/covid/assets/files/research/brief/Exploring-the-impact-of-covid-19-on-adolescents-in-urban-slums-in-Dhaka-Bangladesh.pdf
  3. Sabina Faiz Rashid, Sally Theobald, Kim Ozano. 2020. Towards a socially just model: balancing hunger and response to the COVID-19 pandemic in Bangladesh. BMJ Global Health (Volume 5, Issue 6) DOI: doi:10.1136/bmjgh- 2020-002715.
  4. Wilkinson A and contributors (2020) Local response in health emergencies: key considerations for addressing the COVID-19 pandemic in informal urban settlements. Environment & Urbanization, 1–20. DOI: 10.1177/0956247820922843.

Leave no-one behind and immunisation

  1. Chopra M, Bhutta Z, Chang Blanc D, Checchi F, Gupta A, Lemango ET, Levine OS, Lyimo D, Nandy R, O’Brien KL, OkwoBele J-M, Rees H, Soepard J, Tolhurst R & Victora CG (2020) Addressing the persistent inequities in immunization coverage. Bulletin of the World Health Organisation, BLT.19.241620. Available at: https://drive.google.com/file/d/1y_JdSEJSCylJ0e61dImk_uO5YcsH0Nt9/view
  2. Marta Feletto, Alyssa Sharkey, Elizabeth Rowley, Nikki Gurley, Antara Sinha (2018) A gender lens to advance equity in immunization. Equity Reference Group for Immunisation Discussion Paper 05. Available at: https://drive.google.com/file/d/1fVPq1n-7uWimThlO7vusGkzObntM046s/view
  3. Feletto M, Sharkey A. The influence of gender on immunisation: using an ecological framework to examine intersecting inequities and pathways to change. BMJ Global Health 2019;4:e001711. Available at: https://gh.bmj.com/content/4/5/e001711
  4. Equity reference group for Immunisation Summary Brief. Available at: https://drive.google.com/file/d/1VpuVX85RWd_vq6FJ4lcmCnPOYJp1AhuM/view
  5. Cesar Victora and Tove Ryman (2018) Potential approaches to better measure and track equity in immunization using survey and administrative data, and data triangulation. Equity Reference Group for Immunisation Discussion Paper 02. Available at: https://drive.google.com/file/d/1z6t9P_Av9J1yEpJmATPhTS_P5jiGTmIE/view
  6. Equity Reference Group for Immunisation. 2018. Tackling inequities in immunisation outcomes: A gender lens: summary. Available at: https://drive.google.com/file/d/1KowBaWNtYAsW42MJBjRVSDoe_QCbmB4-/view
  7. Equity Reference Group for Immunisation. 2018. Tackling inequities in immunization outcomes: conflict contexts: summary. Available at: https://drive.google.com/file/d/18QssPIJWcx70m_Q53Q5Ctj9TI82j7USv/view
  8. Equity Reference Group for Immunisation. 2018. Tackling inequities in immunization outcomes: urban contexts: summary. Available at: https://drive.google.com/file/d/1dyqvhXpq9T8s4NZZDZ0PDYZ_WT4wxoSc/view
  9. Equity Reference Group for Immunisation. 2018. Tackling inequities in immunization outcomes: remote rural contexts: summary. Available at: https://drive.google.com/file/d/1Q6Et93sggsdAwNBziWxtKkJURtiWWPXV/view
  10. UNICEF 2019. GUIDANCE NOTE – COVERAGE AND EQUITY ASSESSMENTS FOR IMMUNIZATION PROGRAMS. Available at: https://drive.google.com/drive/u/0/folders/1az5TGw4WBjF3IskHRXjh4qdyW7suwFMj
  11. UNICEF 2020. EMBEDDING A HUMAN-CENTRED DESIGN APPROACH IN SUBNATIONAL COVERAGE AND EQUITY. Available at: https://drive.google.com/drive/u/0/folders/1az5TGw4WBjF3IskHRXjh4qdyW7suwFMj

Leave no-one behind and urban informal settlements

  1. Shadowing Suvartha on her waste-picking route in Vijayawada. A photo essay by Shrutika Murthy, The George Institute for Global Health India, available at: http://www.ariseconsortium.org/learn-more/multimedia/shadowing-suvartha/
  2. For a range of blogs, audio and photo stories on Leaving No-One Behind in Informal Settlements please see http://www.ariseconsortium.org/arise-map/

Session providers

This session will be delivered by Professor Sabina Rashid, Dean & Professor of Social Anthropology at BRAC James P Grant School of Public Health, BRAC University, Bangladesh, Dr. Lilian Otiso, Director LVCT Health, Kenya and Sushil Chandra Baral, HERD Nepal and will be facilitated by Dr Rachel Tolhurst, Reader, Liverpool School of Tropical Medicine.


Supported by


Related content