###### Abstract  
In 1995, Pacific Health Ministers articulated their vision of a healthy Pacific as 'a place where children are nurtured in body and mind; environments invite learning and leisure; people work and age with dignity; where ecological balance is a source of pride; and where the ocean is protected.' Central to this vision is the achievement of universal health coverage (UHC). To provide an indication of the UHC-related priorities of Pacific health authorities and promote alignment of domestic and international investments in health sector development, we thematically analyzed the discussion, resolutions, and recommendations from 5 years (2015-2020) of senior-level Pacific health meetings. Five main themes emerged: (i) the Healthy Islands vision has (and continues to have) a unifying influence on action for UHC; (ii) adoption of appropriate service delivery models that support integrated primary health care at the community level are needed; (iii) human resources for health are critical if efforts to achieve UHC are to be successful; (iv) access to reliable health information is core to health sector improvement; and (v) while not a panacea for all challenges, digital health offers many opportunities. Small and isolated populations, chronic workforce limitations, weak governance arrangements, ageing and inadequate health facilities, and supply chain and logistics difficulties (among other issues) interact to challenge primary health care delivery across the Pacific Islands. We found evidence that the Healthy Islands vision is a tool that garners support for UHC; however, to realize the vision, a realistic understanding of needed political, human resource, and economic investments is required. The significant disruptive effect of COVID-19 and the uncertainty it brings for implementation of the medium- to long-term health development agenda raises concern that progress may stagnate or retreat.  
universal health coverage; Pacific Islands; primary health care; health systems; sustainable development goals; global health +
Footnote †: journal: Journal of Environmental Research and Public Health  
twice (at 2015 [5] and 2017 [8] meetings of Pacific Health Ministers), remains a seminal guide for social, environmental, and health development in the Pacific today.  
Central to the Healthy Islands vision is improving the health of Pacific populations, driven, in part, by an effort to advance universal health coverage (UHC) [9; 10]. UHC is the concept that all people, regardless of who they are or where they live, have access to the full range of health services they need, when and where they need them without financial hardship [11]. Achievement of UHC is at the core of attaining the goal of 'health for all' set out in the Alma-Ata declaration of 1978 [12], and the more contemporary Sustainable Development Goals (SDGs) (specifically target 3.8) by 2030 [13]. The status of UHC in the Pacific, as indicated by the mean PICT Global Health Observatory 'UHC index of essential service coverage' score in 2017 was 50.4 (SD: 8.7) out of a possible 100, well below the mean level of other countries in WHO's Western Pacific region (74.7 (SD: 12.3)) and of the world (64.0 (SD:15.5) [14]. The emergence of the coronavirus pandemic in 2019/20 and its associated impact has had severe and likely long-term ramifications of UHC implementation and priorities in the PICTs.  
With the Healthy Islands vision, the SDGs, and UHC core concepts around which health system development efforts are framed in the Pacific, and dialogue about achieving them has been a feature of high-level regional public health meetings for many years. This paper analyzes the discussions, resolutions, and recommendations of regional health leader fora and the peer-reviewed literature to provide an indication of the UHC-related priorities of PICTs with the aim of promoting alignment of domestic and international investments in health sector development.