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23 September, 2019 00:00 00 AM / LAST MODIFIED: 22 September, 2019 11:15:57 PM
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Thoughts on Universal Health Coverage Declaration at UNGA

The UN High-level Meeting on universal health coverage (UHC) is the first meeting on this topic at the UN
Mohammed Abul Kalam, Ph.D.
Thoughts on Universal Health Coverage Declaration at UNGA

As heads of state and international organizations gather for the 74th United Nations General Assembly, Monday’s High –Level Meeting on Universal Health Coverage (UHC) is one of the key events of this session. It aspires to elevate access to quality healthcare for the global population by 2030, and one billion more people by 2023.

On 23 September 2019, the United Nations General Assembly will hold a high-level meeting on universal health coverage.  This meeting, held under the theme “Universal Health Coverage: Moving Together to Build a Healthier World,” aims to accelerate progress toward universal health coverage (UHC), including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. As part of the 2030 Agenda for Sustainable Development (A/RES/701), all countries have committed to trying to achieve universal health coverage by 2030, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.UN General Assembly resolution 72/139 and 73/131, the President of the General Assembly will convene a one-day high-level meeting on 23 September 2019 in New York under the theme “Universal health coverage: moving together to build a healthier world”.

The UN High-level Meeting on universal health coverage (UHC) is the first meeting on this topic at the UN and will be the most, political meeting held on UHC to date.UHC means that all people and communities receive the quality health services they need, without financial hardship.  Key barriers to UHC achievement include poor infrastructures and availability of basic amenities, out of pocket payments and catastrophic expenditures, shortages and misdistribution of qualified health workers, prohibitively expensive good quality medicines and medical products, low access to digital health and innovative technologies, among others. Each of these barriers has solutions that not only lead to UHC but also boost the economy and have an important impact on other SDGs. For example, Goal 1 (end poverty), Goal 4 (quality education), Goal 5 (gender equality), Goal 8 (decent work and economic growth), Goal 9 (infrastructure), Goal 10 (reduce inequality), Goal 16 (justice and peace), and Goal 17 (partnerships).  UHC is a catalyst for socio-economic development and a key contributor to equity, social justice, and inclusive economic growth.  UHC delivers on the human right to health as well as the broader human rights agenda.

Primary health care (PHC) is the foundation for UHC.  PHC oriented health systems provide quality services that are comprehensive, continuous, coordinated and people-centered. With these characteristics along with its emphasis on prevention and promotion, PHC reduces inequities in health, and is highly effective and efficient, particularly for the management of chronic conditions such as non-communicable diseases, including mental health.

The first High-level meeting on universal health coverage is an opportunity to mobilize the global community and secure political commitment from Heads of State and Government to accelerate progress toward achieving universal health coverage by 2030.

The High-level Meeting will bring together representatives of the Member States, observers of the General Assembly, parliamentarians, representative of local government, relevant UN entities, civil society organizations, non-governmental organizations, academia, professional associations, and the private sector and broader communities.

Member States are encouraged to participate at the highest possible level, preferably at the level of Heads of State and Government.  Observers of the General Assembly and other stakeholders should also be represented at the highest possible level. The opening segment will feature statements by the President of the General Assembly, the United Nations Secretary-General, the Director-General of the World Health Organization, the President of the World Bank Group, as well as an eminent high-level champion of universal health coverage.The plenary segment will comprise statements by the Member States and observers of theGeneral Assembly. The two multi-stakeholder panels will be held in parallel to the plenary segment, and will address the following themes:Panel 1: Universal Health Coverage as a driver of equity, inclusive development and prosperity for all; and Panel 2: Accelerating Multi-sectoral and Multi-Stakeholder Action and Investments for achieving Universal Health Coverage.

The High-level meeting shall approve a concise and action-oriented political declaration agreed in advance by consensus through intergovernmental negotiations, to be submitted by the President of the General Assembly for adoption by the Assembly.The closing segment will include summaries of the multi-stakeholder panels and concluding remarks by the President of the General Assembly.

The stated aim of the event, ‘Universal Health Coverage: Moving Together to Build a Healthier World’,” is to “accelerate progress toward universal health coverage (UHC), including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”

A draft UHC political declaration (note: text starts on p.3) – stripped of controversial language over thorny issues like sexual and reproductive health, and finalized last week – is to be approved at the High-Level Meeting. It commits governments to the stated UHC aim of covering one billion more people by 2023, and all people by 2030 (paragraph 24). It also commits governments to halt rising out-of-pocket health expenditures by providing greater financial risk protection (such as insurance) for healthcare procedures.

Political Declaration: The final political declaration contains 83 paragraphs that capture the remarkably broad scope of global and public health issues such as health systems, financing, emergencies, health workers, gender, children, aging, migrants and refugees, discrimination and violence, communicable and non-communicable diseases, digital health and data, access to health technologies, and partnerships.

The declaration contains calls to use all levels of policymaking, governments, regions and the multilateral system and existing agreements, and details dozens of specific topics, such as eye and oral care, mental health, protection in armed conflict and humanitarian issues, sanitation, safety, healthy diets, and neglected diseases. It has numerous references to improving women’s health and involving them more completely in health care, and it stresses that primary health care is essential for UHC.

A core focus of UHC efforts is on financing and budgets, but no specific commitments are made, despite the many mentions throughout. The declaration does, however, cite the WHO’s recommended target of public spending of 1 percent of GDP or more on health. It also cites WHO estimates that an additional US$ 3.9 trillion in global spending by 2030 could prevent 97 million premature deaths and add between 3.1 and 8.4 years of life expectancy in LMICs.

The declaration repeatedly cites the need for affordable health care and medicines, vaccines, and diagnostics, and urges bolstered domestic budgets and global coordination through financial groups like the Global Fund for AIDS, Tuberculosis, and Malaria. It also mentions a growing strategy of pooling resources allocated to health, and it gives a clear message about the importance of private sector funding and contributions.

The declaration also highlights statistics showing the magnitude of the need for stronger health systems to fulfill the aims of UHC – such as the shortfall of 18 million health workers, especially in low- and middle-income countries.

And it declares “that action to achieve universal health coverage by 2030 is inadequate and that the level of progress and investment to date is insufficient to meet target 3.8 of the [SDGs], and that the world has yet to fulfill its promise of implementing, at all levels, measures to address the health needs of all.”

SDG 3.8 states: “achieve universal health coverage (UHC), including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.”

The text’s preamble of 23 paragraphs describes problems and shortfalls in the global, regional and national efforts in health, stating that in many cases efforts are not on track to fulfill the SDGs by 2030 and must be stepped up. Paragraphs 24 to 81 are action items to be undertaken across every front, from national governments to the UN system. The UHC declaration calls for another high-level meeting to be held at the UN in New York in 2023 to review the implementation of this year’s declaration. Next year’s General Assembly will receive a progress report on implementation of the declaration, and a report on recommendations on implementation. Next year’s General Assembly will decide the modalities for the 2023 meeting.

Sexual and Reproductive Health in Stake: In the final agreed text, negotiators resolved an issue over references to sexual and reproductive health rights, which had prevented consensus on an earlier draft negotiated over the summer.Negotiations over a planned United Nations political declaration on universal health coverage (UHC) reopened last week after about a dozen countries reportedly objected to language in the final draft covering two sensitive issues – sexual and reproductive health and rights (SRHR) and the health needs of migrants, refugees, internally displaced persons and indigenous peoples.

The United States was one of the 10-14 countries posing objections, sources told Health Policy Watch, after negotiations over the draft were closed on 24 July. The draft was then put under a “silence procedure” for five days, a period in which countries may file objections to effectively reopen the debate. “We regret to inform you that the silence procedure has been broken by several delegations on paragraphs 29, 68, 69, 70 and 71,” the Ambassadors of Georgia and Thailand, co-facilitators of the UN High-Level Meeting on Universal Health Coverage, wrote in a 29 July letter to the president of the UN General Assembly, María Fernanda Espinosa Garcés. As of Monday, 5 August, it remained unclear which other countries besides the US had broken the silence procedure, and over which paragraphs. But time is now running out for negotiators to reach agreement on the declaration, which will be the focal point of the 23 September UN High-Level Meeting on Universal Health Coverage, bringing heads of state and other political and health leaders to the UN in New York.

After the silence was broken, the negotiations were elevated from the level of the expert to the level of ambassador, in order to ensure that national representatives with the highest possible level of authority would be engaged to finalize the declaration as soon as possible, sources said. The emerging dispute over language on SRHR and migrants represented a shift in focus of the debate over the painstakingly negotiated declaration text. Earlier debates had centered on language calling for greater public disclosure of prices of health products, more transparency for related research and development (R&D), and alternative incentives for R&D beyond conventional patent monopolies.However, member states have now reached consensus on those issues, according to civil society observers. The sections of text that are now under debate (noted below) include final draft paragraphs 29, 68 and 69 on women’s and girls’ rights to “sexual and reproductive health, free of coercion, discrimination and violence;” as well as paragraphs 70 and 71 on addressing “the particular needs and vulnerabilities of migrants, refugees, internally displaced persons and indigenous peoples.”

According to sources, the US objected to the language on SRHR in the declaration because it can be interpreted to include abortion, which is inconsistent with the US rule under the “Protecting Life in Global Health Assistance” policy to not commit funds to international health activities that are in any way related to abortion.

Measuring Impact: The overarching set of guideposts for the UHC declaration work is the 2030 Sustainable Development Goals (SDGs), which include many objectives related to health throughout the 17 SDGs, along with the dedicated “Good health and well-being” goal of SDG 3. The declaration is filled with undefined goals, but it also contains numerous references to measuring progress. It will remain to be seen whether the momentum, pressure, and language of the commitments will be strong enough to bring about the much-hoped-for UHC achievements.

The writer is Former Head, Department of Medical Sociology, Institute of Epidemiology, Disease Control & Research (IEDCR),  Dhaka, Bangladesh

 

 

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Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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