Universal health coverage (UHC) is defined by the World Health Organization (WHO) as when ‘, all individuals and communities receive the health services they need without suffering financial hardship including ‘, health promotion …,prevention, treatment, rehabilitation, and palliative care. ’, 1 Achieving UHC globally is part of the United Nations’,Sustainable Development Goals and central to the 2018 WHO Global Conference on Primary Health Care Astana Declaration. 2 Universal systems of primary healthcare (PHC) within countries are widely recognised as central to the task of achieving UHC. 2 Such systems are crucial to reduce the adverse impacts of both communicable and non-communicable diseases (NCDs) and reduce health inequities within and between countries. However, while the WHO’, s and the United Nations’,objectives for UHC seem clear, putting those objectives into practice, with PHC systems capable –,over time –,of delivering the desired health outcomes, is quite another matter. In 2020 we published an article in this journal3 examining lessons from the relatively mature Australian system of UHC on how to structure and deliver a system of universal PHC to address NCDs, deliver equity of access to services and, ultimately, promote health equity. (Hereafter we will use ‘, equity’,as shorthand for the two latter goals). We identified both strengths and weaknesses of the Australian system in this regard. The journal then sought and published eight commentaries on our article from experts in UHC and PHC from around the globe. 4-11 Together with our original article, these thoughtful commentaries reinforce our contention that, while commitment to a principle of UHC is welcome, and implies concerns for equity, actual benefits for equity will depend on how UHC is defined and implemented in practice. 6 In this reply, we describe common themes arising from the commentaries, which highlight key issues for policy makers implementing UHC, and respond to points raised about limitations of our research. Although our research focus (conceived in 2015) was on system responses to NCDs, several commentators noted relevance of the issues raised for the coronavirus disease 2019 (COVID-19) pandemic. . .

The indefinite nature of test fairness and different interpretations and definitions of the concept have stirred a lot of controversy over the years, necessitating the reconceptualization of the concept. On this basis, this study aimed to explore the empirical validity of Kunnan’s (2008) Test Fairness Framework (TFF) and revisit the established test fairness conceptualization following the principles of grounded theory. To this end, 10 university lecturers of TEFL, 20 high school English language teachers, 15 PhD students in TEFL, and 15 MA students in TEFL participated in open-ended and semi- structured interviews. Following grounded theory rubrics, the researchers read, codified, and analyzed the obtained interview data. Simultaneously, memos were written, comparisons were drawn, possibilities were seen, and robust categories were developed through theoretical sampling. This process continued iteratively until the categories saturated. Next, the categories were juxtaposed and compared to see how they fit together and finally several major categories emerged accordingly. The opinions were diagrammed and a visual image of the categories and their relevant scope, power, and associations were represented to construct a theoretical logic. The new hierarchy of test fairness categories became discernible as the interviewees named distinct characteristics for a fair test. The identified levels of the new conceptualization of test fairness were entitled validity, construction and structure, administration, scoring, reporting, decision-making, consequences, security, explicitness, accountability, equality, and rights. The need for advancing context-specific and locally agreed-upon equity principles as driven by the impossibility of the fulfillment of the equality principle in the real world conditions is an important finding of this study with concrete implications for both theory and practice in the field.