The Covid-19 pandemic has disrupted health systems in unprecedented ways. Urgent needs to respond to the crisis and mitigate its impact have been met with a lack of coordinated efforts across many countries.

As health systems around the world are placed under considerable strain, essential health services are interrupted or displaced, and are rapidly becoming increasingly difficult to access by those who need them the most.

This crisis, unlike any other in our recent history, has amplified the need to accelerate efforts to build strong and resilient health systems, and achieve progress towards Universal Health Coverage (UHC). UHC means that all people can obtain quality health services that they need without suffering financial hardship and significantly reducing out of pocket expenditures to avail health services.

In many ways, this pandemic is no different from past outbreaks; far from being the ‘great leveller’ hitting poor and rich alike, as initially labelled by a few governments, Covid-19 will result in just the opposite – not only perpetuating but exacerbating and amplifying existing inequalities and injustices.

Those likely to endure the most suffering during the crisis, and in its aftermath, are those already negatively impacted by marked health inequities and lacking access to quality and affordable health services in normal circumstances.

Alarmingly, the worst outcomes of Covid-19 are yet to be seen as the virus spreads across the most fragile settings, including in complex emergencies and protracted humanitarian crises, refugee camps, and nations with already weakened health systems.

Women, girls, and marginalised groups are most likely to be disproportionally affected as this crisis continues to aggravate existing gaps in access to essential health services, including sexual and reproductive health and rights (SRHR) – as well as affecting their source of livelihood, increasing the risk of sexual and gender-based violence (SGBV) and limiting access to sexual health information and education.

As they are also likely to carry a heavier burden of the devastating downstream economic and social consequences of this pandemic, applying a gender- and a human rights-lens is critical to ensure that we address the needs of women and girls, and those most vulnerable including the elderly, youth, people living with disabilities, migrants and refugees.

Most high-income countries have struggled to provide adequate protection to their healthcare workforce, in a context of record high demand for personal protective equipment (PPE), medical commodities, diagnostic testing, and specialised ICU equipment.

As vital resources are reallocated towards these critical needs, access to essential health services has become increasingly restricted, including access to essential SRH services such as contraceptives, abortion care, pre- and post-natal healthcare.

Women, girls, and marginalised groups are most likely to be disproportionally affected as this crisis continues to aggravate existing gaps in access to essential health services, including sexual and reproductive health and rights.

The lack of coordination between key decision-makers in charge of the response is made worse by the increasing politicisation of healthcare, and the political exploitation of the crisis in attempts to shift the blame and exploit social divisions. Now more than ever, progress towards universal healthcare is needed.

During this crisis and its aftermath, strong and adequately resourced health systems are key to the success of immediate and long-term responses. Countries with effective universal health coverage, such as South Korea and Singapore, have performed better during the Covid-19 pandemic.

Sustainable financing and investments in healthcare reforms will contribute to ensuring that all people can access affordable care, health workforces receive the training and equipment they need, infrastructures can respond to protracted crises, and that essential supplies can be more efficiently sourced and made available.

As part of these efforts, strengthening primary health care (PHC) is fundamental to enhance efforts on prevention, early detection of diseases and health education. The PHC is critical to address this crisis in the long term by helping to administer future vaccines and treatments to millions who need them the most.

Covid-19 has brought into focus the need for healthcare reforms that promote access to affordable care. Now more than ever, the bold commitments towards UHC made by governments must be upheld.

Implementing rapid UHC reforms where they are needed the most will create pathways for actions that will not only help to address health inequities made worse by the pandemic, but also support the development of stronger and more resilient health systems able to provide timely responses to emergencies.

The writer is a senior public health leader from Pakistan with international experience of design and management of health systems strengthening initiatives