## 4 Discussion
Hence, the sustained support of donors such as Australia, New Zealand, the United States, Japan, and China and development partners including WHO and the Secretariat of the Pacific Community (SPC) will be required for the foreseeable future. Determining the most helpful contributions external agencies can make will inevitably be context-specific; however, they should align with an ethos of health systems strengthening and promoting health equity, national leadership, and sustainability. The global and regional action frameworks for UHC [30, 41, 42], together with PICTs' National Health Strategic Development Plans provide endorsed, established, and widely used guidance for UHC-aligned health sector investment. Interestingly, despite the call for increased financing for PHC in the 2017 WHO report, Universal health coverage on the journey towards Healthy Islands in the Pacific [11], we found little evidence of the issue being discussed at senior level meetings. This may be because there are relatively high government and donor allocations for health and relatively low out of pocket costs, perhaps lessening the urgency of financing strategies directly linked to UHC and PHC, or because such matters are discussed in different forums. With the achievement of health service delivery goals so resource-sensitive in PICTs, opportunities to explore, compare, analyze, and document the success and failure of different approaches to PHC delivery and financing are needed. Consideration of existing financing analysis, including those developed by the World Bank for some PICT [43, 44, 45], would seem to warrant discussion at senior health fora. Furthermore, the application of implementation science-based research to build evidence for what constituted 'good' PHC/UHC policy and practice in the Pacific Island context is required. We note that Regional Committee Meetings included a range of technical agenda items relevant, if not central, to UHC that PICT delegates would likely have commented on but for which there is no evidence in the meeting reports. These include items relating to the regional action frameworks and agendas for UHC [42], on regulatory strengthening, convergence and cooperation for medicines and the health workforce [46], on improving hospital planning and management [47], and on strengthening legal frameworks for health in the SDGs [48]. While not discussed in this paper, these broader issues and the related focus on access, quality, equity, and financial protection are central to the achievement of UHC in the PICTs and must not be overlooked. Health authorities and their development partners will need to consider a more comprehensive suite of setting-specific evidence (including internal reports and data) when assessing, planning, and implementing activities in response to setting-specific UHC challenges. While there is no 'one-size-fits-all' plan for achieving UHC, PICT health authorities may look to the Western Pacific Region's Action Framework for UHC and its 15 action domains to frame a comprehensive whole-of-system approach to health sector strengthening [42]. The 15 action domains relate to five core attributes of a high-performing health system; these are quality, efficiency, equity, accountability, and sustainability and resilience [42] (Table 1). Our review found growing attention to the opportunities digital technologies offer UHC in the Pacific. Specific mention of the value of digitization of health records, telemedicine, online information sharing, and e-learning may offer PICT health authorities' efforts to improve health informatics (and hence capacity to monitor health system performance), provide remote health care to rural and remote communities, and for health worker training and support were noted.