SDG 3 measurement in integrated health system reform: a growing gap as 2030 approaches

Integrated health system reforms are implemented across financing, service delivery, digital health, and governance, while SDG 3 monitoring relies on indicator-based frameworks designed for discrete interventions. This creates a misalignment between how reforms are implemented and how progress is assessed, particularly where outcomes emerge from interactions across system components. Using Saudi Arabia's Vision 2030 reform as an illustrative case, this analysis identifies three constraints: indicator-based measurement, limited evaluability of concurrent reforms, and data and governance limitations. These constraints limit the ability of policymakers to assess system performance, determine reform effectiveness, and allocate resources. Addressing this gap requires a shift toward system-level evaluation that integrates indicators across domains, strengthens data linkage, and aligns national and global monitoring frameworks.