Reflections from the UN High level meeting on Universal Health Coverage – a major step towards attaining the SDGs

By Lilian Otiso

One of the major events that happened at the United Nations General Assembly this year was the UN High Level Meeting on Universal Health Coverage (UHC).  The event was held on 23rd September 2019 in New York City and I was privileged to attend and witness this historic event. The declaration builds on SDG target 3.8 on UHC and the World Health Organization’s (WHO’s) ‘triple billion goals’, which include extending UHC to one billion more people by 2023.

UHC has been talked about for many years by academics, researchers and civil society organisations with varied interpretation and implementation by different governments. This UN High Level Meeting was therefore a major achievement for UHC because the political declaration shows that UHC now has the full backing of member states.

The event was marked by approval of the Political Declaration with brief speeches from global leaders including the UN secretary general, the WHO director general, the World Bank  president  and others all echoing the importance of the declaration and what it means for the world and the achievement of SDGs. This was then followed by declarations by member states led by their presidents and ministers of health. As a member of the ARISE consortium, I noted that leaders from Kenya, Sierra Leone, Bangladesh and India (where ARISE works) were present and made commitments towards UHC.

Focus on vulnerability

The key message that permeated across the conference was the need to focus on Primary Health Care (PHC), women and children’s health, build multi-sector responses and accountability. Some statements that stood out for me include remarks made by the Bangladesh Prime Minister who said that development has to be inclusive to ensure everyone has an equal opportunity regardless of social background with equitable access and distribution of wealth. Other speakers also spoke about equity for all and a focus on the disadvantaged people. Winnie Byanyima, the Oxfam executive director, challenged the audience to reach the most underserved and marginalized saying “these people are not being left behind, they are being pushed behind”.

The Thai Prime Minister, whose country has been a leader in UHC highlighted that their programme was based on three principles of equity, efficiency and participation and going beyond the health sector with a strong focus on people’s participation.

Leaders recognized emerging global challenges (noting that the climate change conference was going on next door) and how health cannot work in isolation without addressing the social determinants of health including safe water, security and better nutrition. Building health systems with a major focus on community engagement and community health workers and other frontline workers was emphasized by many speakers during the multi stakeholder engagement forums. There was consensus that frontline health workers should be valued and rewarded and public health systems strengthened with a focus on prevention using a multi-sector and multi-stakeholder approach.

What was not said

Even though there was focus on vulnerable populations, there was no mention of key populations with whom we work in LVCT Health in the HIV response. Some countries opposed some of the sexual and reproductive health language being included although others countered these concerns stating action here is a key global priority that must be addressed if UHC is to be attained.  Urban health was also not mentioned although we know this is a major challenge in a rapidly urbanizing world as we are tackling in the ARISE consortium. Access and financial protection were the major aspects of UHC addressed with little mention of quality in our health care systems. There was little opportunity for civil society organisations to give input and there were no specific targets set with follow up actions including setting targets and indicators. In addition, the political declaration reaffirmed the primary role and responsibility of governments to determine their own path towards achieving UHC which may mean that some priorities may be ignored by countries especially gender, human rights and equity with implications for addressing the needs of the most vulnerable and marginalized.

Next steps for Universal Health Coverage

A day after the high level meeting, WHO and 11 other multilateral organizations, launched the Global Action Plan for health and well-being for all, which defines how they would support countries to deliver UHC and achieve the health-related SDG targets.  Countries now have to set their UHC targets towards their commitments to the UHC political declaration.

The challenge is now on us; the civil society organizations, researchers, academics and implementers to make UHC a reality in order to achieve the sustainable development goals by 2030. As countries define their UHC agenda, we need to have a seat at the table and provide evidence to inform the country priorities. We must hold governments accountable for the commitments made at global and country level and work with the communities we serve to hold their governments at local and national level accountable.

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