This report, commissioned by the Global Innovation Hub for Improving Value in Health and produced by the Lemann Foundation Programme, was written by João Pedro Caleiro under the supervision of Professor Anna Petherick. It looks at coordination and equity in health as two key focus areas that: (i) hold relevance for all G20 nations; (ii) have been challenged amid the COVID-19 pandemic; and (iii) play a significant role in advancing high-value health systems, by either laying the groundwork for its progress, or addressing some of its core components. Additionally, they stand as top priorities for health policymakers in Brazil, the host country for the G20 in 2024.

These focus areas are explored through the lenses of two value models: the ten components of the HVHS (High-Value Health Systems) model and the four pillars of the European Union’s value model. The report draws connections between these models and the priorities outlined by the Brazil presidency and the G20+ at large, with the goal of making health systems more equitable, robust, and resilient.

The challenges associated with improving coordination and equity are illustrated by case studies of G20 countries, such as the United Kingdom, Saudi Arabia, Indonesia, and Italy, with a major focus on Brazil and state-level efforts towards operationalising regionalisation of health, a principle of the health system that is yet to be fully realised.

The recommendations of the report include building, supporting, and strengthening national high-level health coordination forums, ensuring a unified digital health infrastructure at the national level, and developing health equity frameworks and targets to be monitored and advanced alongside more standard measures of access, among others.