Political declaration on Health Coverage for All at UNGA
UHC is a political project, so obviously its great to get commitments from heads of state
Mohammed Abul Kalam, Ph.D.
United Nations members adopted a high-level political declaration on September 23, 2019 raising the stakes in the global push to ensure everyone in the world has affordable access to health a decade from now.The political declaration is the most comprehensive agreement ever reached on global health, UN Secretary General Antonio Guterres told the opening session of todays High Level Meting on Universal Health Coverage, being held within the context of the annual UN General Assembly. This is a significant achievement that will drive progress for the next decade.
World Health Organization Director General Tedros Adhanom Ghebreyesus (Dr Tedros) called it a landmark for global health and development. Today world leaders adopted a high-level United Nations Political Declaration on universal health coverage (UHC), the most comprehensive set of health commitments ever adopted at this level. This declaration represents a landmark for global health and development, said Dr Tedros Adhanom Ghebreyesus, Director-General at WHO. The world has 11 years left to make good on its sustainable development goals. Universal health coverage is key to ensuring that happens. He added: Universal health coverage is a political choice: today world leaders have signaled their readiness to make that choice. I congratulate them.
The declaration comes the day after the World Health Organization (WHO) and partners flagged the need to double health coverage between now and 2030 or leave up to 5 billion people unable to access health care. In adopting the declaration, U.N. Member States have committed to advance towards UHC by investing in four major areas around primary health care. These include mechanisms to ensure no one suffers financial hardship because they have had to pay for healthcare out of their own pockets and implementing high-impact health interventions to combat diseases and protect womens and childrens health. In addition, countries must strengthen health workforce and infrastructure and reinforce governance capacity. They will report back on their progress to the U.N. General Assembly in 2023. Now that the world has committed to health for all, it is time to get down to the hard work of turning those commitments into results, said Melinda Gates, Co-Chair of the Bill Melinda Gates Foundation. We all have a role to play. Donors and country governments need to move beyond business as usual to bolster the primary health care systems that address the vast majority of peoples needs over their lifetimes, said Gates.
On 24 September, WHO and 11 other multilateral organizations, which collectively channel one third of development assistance for health, will launch their Global Action Plan for health and wellbeing for all. The plan will ensure the 12 partners provide more streamlined support to countries to help deliver universal health coverage and achieve the health-related SDG targets.Tedros told the High Level Meeting that the focus should not only be on Ebola in the Democratic Republic of the Congo (DRC), as other diseases actually killing more people in that country. He also spoke about the affordability of care, giving an example of a father who chose to die rather than use his familys savings to treat his illness. No one should ever have to make a choice like that, and yet that is the reality for millions of people every day, he said.Tedros also stressed the need for a crucial shift to protecting health rather than just treating diseases. He noted the smallest countries will need help, and he said, Ultimately health is a political choice, urging governments to make that choice.The world we want is one where health is not a cost but an investment, he said. Our vision is not health for some, not health for most. It is health for all.
The declaration comes a day after the WHO and partners flagged the need to double health coverage between now and 2030 or leave up to 5 billion people unable to access health care.WHO said the political declaration committed UN members to invest in four major areas around primary health care.
These include mechanisms to provide financial protections for all who need to pay for health care out-of-pocket and implementing strategies to fight diseases and protect the health of women and children. It also commits them to strengthen health workforce and governance capacity.
Governments will report on progress at the UN General Assembly in 2023: On Tuesday (24 September), 12 multilateral organizations including WHO will launch a Global Action Plan for health and wellbeing for all. The plan will ensure the 12 partners provide more streamlined support to countries to help deliver universal health coverage and achieve the health-related SDG targets, WHO said.
At the opening session today, World Bank President David Malpass pointed to several priority areas; including increased investment in affordable primary health care, as it has been shown demonstrably that detecting and treating conditions early has a tremendous economic benefit. The costs of not investing are enormous, he said, pointing to the situation in the DRC as an example.He also called for an increase in private-sector projects with more privately run health centers, a focus on human capital, and lastly changing the way health is financed.
Gro Brundtland, a former WHO director general who holds the title of Eminent High-Level Champion of UHC and member of the Elders, referred to the Global Preparedness Monitoring Board, which she chairs and which launched its annual report on Sunday.She told the meeting that UHC can only be achieved through public financing, and said a few years ago some governments tried to put health care costs on households with disastrous results of causing millions of people to lose health care, an outrageous human rights violation still in practice in some countries. She called on all governments to ban this practice.
UHC Aspirations and Needs: Following the opening session, a range of national presidents took the floor, and were continuing at press time. Most of them spoke about successes in their countries, and progress made so far on reaching UHC.For instance, the Kenyan President Uhuru Kenyatta said health is one of the four pillars of his administration.
They have learned it is necessary to involve all levels of leadership in the process, which must come from a shared vision, and involve every citizen. It also must be aligned with local, national and international policies, and must recognized the interdependence of health systems with others.
A president speaking on behalf of the Pacific Island States called on the UN to scale up resources for resilient health systems, and stressed that non-communicable diseases such as diabetes are the leading cause of health problems in the region to the extent that 7 of the top 10 countries for diabetes are in the region.While plenary statements went on, a panel was held entitled, UHC as a driver of equity, inclusive development and prosperity for all, involving several senior speakers.UN High Commissioner for Human Rights Michelle Bachelet said that large segments of the global population are only surviving instead of thriving. She emphasized the right to health for all as essential, and strongly encouraged countries to implement binding legislative policies in order to protect and fulfill the rights of millions.
Wealthy Urged to Pay More: On the panel, Columbia University (US) Professor Jeffrey Sachs put it bluntly, saying this is about money. Sachs said that people in rich countries need to be willing to pay more to ensure that people in more settings survive. If they dont, then children die, mothers die, he said. There is nothing else to talk about. Everything else is fake. Sachs named 15 of the richest billionaires in the world, such as Jeff Bezos and Bill Gates, and said they could easily end malaria in a long weekend, or set AIDS on the way to being ended in 5 days, for instance, and called on them to directly replenish the Global Fund for AIDS, Tuberculosis and Malaria, which he said needs $17 billion over 3 years, a small amount for a list of people who have incomes of $50 billion per year. Honestly these mega-billionaires cannot give way their money faster than theyre making it, Sachs said.
This message may be resonating with the Gates Foundation, for one. In a WHO press release today, Melinda Gates, Co-Chair of the Bill Melinda Gates Foundation, was quoted as saying: Now that the world has committed to health for all, it is time to get down to the hard work of turning those commitments into results. We all have a role to play. Donors and country governments need to move beyond business as usual to bolster the primary health care systems that address the vast majority of peoples needs over their lifetimes.
Better Legislation, Budgets, and Monitoringamong Needs: During the panel, Inter-Parliamentary Union President Gabriela Cuevas Barron called for better legislation, better budgets, and better monitoring. In the end, policies are only going to work if people are at the center, she said. If a child is not healthy, she is not going to learn, and she placed particular emphasis on young teen rights. An important point is to work with science, not on policies or morals, she said. We have to come up w genuine policies that can be implemented and hope that nothing gets lost along the way, Cuevas said.
Now as an observer, I want to spell out a few messages for this General Assembly.The message for the High Level Meeting would be to tell the world on why we should not SDG 3 in isolation to the other goals. This should be integrated. I noted that most of the pushback seen in the negotiations for the political declaration was in relation to gender and sexual and reproductive health and rights. We cannot achieve UHC if we undermine the gender and social norms.A political declaration draws political attention, and that is fundamental.This declaration will accelerate momentum if leaders get behind it. Its a tremendous achievement to have a political declaration that draws attention at the highest level.Its an unfinished business of course.The declaration is in a way a starting point because there is so much that needs to be done to be on track for the SDGs and UHC.
For instance, there needs to be much more attention drawn to how much health is a contributor to the economy, and it is that dimension that draws attention even more for political leaders. Health is needed to have productive workers, people successful at school, and so on. It could be said that health is lagging behind compared to other sectors of the economy in leveraging data and digital in a way that transforms health systems for better access, more efficiency, and more effective results. Digital is definitely an area where there are opportunities to achieve more.
UHC is a political project, so obviously its great to get commitments from heads of state, we really need those. Then as they move to the strategy level, we need to see that converted to more resources and more attention to primary health care. And the H in both UHC and PHC means Health and not just Health Care thats where we need primary care, preventive, promotive, but also the multisectoral determinants of health, and we need to empower communities as equal actors in this.So we need commitment to actions, at the country level. We want to see heads of state turning this global political declaration into a real choice at country level to invest in the right programmatic choices.
And we believe firmly that primary health care is the cornerstone to achieving UHC, so we want to see heads of state, ministers, and cabinets, investing in a multisectoral and from a health perspective in those hard choices around the most cost-effective health measures which we believe are captured by PHC.
Secondarily, we want to see the commitment to financial services. Most countries, by either increasing their health budget or reallocating budgets toward primary health care, can actually achieve these goals from their own domestic resources. This is absolutely, imminently achievable. There is a group of countries that wont achieve it alone, and thats where one of my asks is for the international donor community to focus aid on the most vulnerable, the poorest countries, and the fragile countries.
This is what we want to see, and a commitment of an additional 1% of GDP put into action. The writer is Former Head, Department of Medical Sociology, Institute of Epidemiology, Disease Control Research (IEDCR),
Dhaka, Bangladesh
