Coordinating external assistance for UHC: Pakistan's early experience of the SDG3 GAP.

Pakistan is a lower middle-income setting. External assistance for health and development partners play an important role in health sector development. The federal system and health care delivery as a devolved provincial subject warrant regular and effective coordination among federating units and partners. Pakistan was selected as a priority country in 2019 for the implementation of the Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP). Given the ongoing universal health coverage (UHC) reforms, the country prioritized two SDG3 GAP accelerators, related to primary health care (PHC) and sustainable financing for health (SFH). Eight partner agencies representing PHC and SFH accelerators jointly planned and conducted a 'PHC for UHC mission' to Pakistan in 2021. This mission paved the way for setting up an SDG3 GAP Coordination Committee and a 'PHC Service Delivery and Financing working group', which have been regularly coming together through in-person and virtual meetings; the latter was relatively uncommon before and this new way of working provided a chance to build rapport, share workplans, identify duplications in technical assistance, and jointly gauge governments' priorities. This has shifted the focus of reforms deliberations from 'what' to 'how', enabling joint strategic planning and implementation. The joint work by SDG3 GAP partners with the Ministry of NHSR&C has linked discussions on health financing and service delivery reforms for the first time, and has contributed to advocacy, analysis, strategic policy dialogue, institutional strengthening, and implementation of UHC reforms, with a focus on PHC. Even though joint work by SDG3 GAP partners undoubtedly shows the potential of better alignment and collaboration, the translation of the commitment to better collaboration into concrete impact has been the result of committed and engaged staff members, rather than institutionalized change, which will require strong incentives for collaboration.