The UN High-Level Meeting (UN HLM) on Universal Health Coverage took place on 23 September 2019 during the United Nations General Assembly (UNGA) high-level week. This was a great opportunity for all universal health coverage (UHC) champions and advocates to make their voice heard and help mobilise high-level political attention globally and in their countries.
The theme of the HLM-UHC is ‘Universal Health Coverage: Moving Together to Build a Healthier World.’ This UN HLM was the last chance before 2023, the mid-point of the SDGs, to mobilise the highest political support to package the entire health agenda under the umbrella of UHC, and sustain health investments in a harmonised manner. To do this, it is critical to identify how the political declaration on UHC can add value to these efforts and set milestones towards achieving UHC by 2030.
UHC2030 had been asked to support the preparatory process for the UN HLM, particularly to share “evidence and good practices, challenges and lessons learned.” We have organized a series of multistakeholder consultations, including an online survey, to define a set of key “asks” that partners used to feed consolidated messages into the UN HLM including the multistakeholder hearing on 29 April 2019, inter-governmental negotiations and interventions during the UN HLM.
An important step in the preparation process was the interactive multistakeholder hearing convened by the President of the UN General Assembly on 29 April 2019. The hearing aimed to engage the active participation of “appropriate senior-level representatives of Member States, observers of the General Assembly, parliamentarians, representatives of local government, relevant United Nations entities, non-governmental organizations in consultative status with the Economic and Social Council, invited civil society organizations, philanthropic foundations, academia, medical associations, the private sector and broader communities, ensuring the participation and voices of women, children, youth and indigenous leadership” as part of the preparatory process. Participants were encouraged to exchange views on key priorities to raise with Heads of States during the HLM, while underscoring experiences and best practices on the ground, highlighting the special challenges faced by civil society organisations, private sector and other stakeholders.
To develop a set of key asks for the UN HLM, UHC2030 conducted three-month consultations with all actors of the UHC movement – parliamentarians, civil society, the private sector, agencies, networks and academia. The UHC Key Asks will feed into the UHC Political Declaration, and are the foundation for coordinated advocacy efforts that all partners can promote together throughout the preparation of the UN HLM, the Financing for Development Forum and the SDG Summit as well as other regional or economic fora in 2019.
1. Ensure Political Leadership Beyond Health
Commit to achieve UHC for healthy lives and wellbeing for all at all stages, as a social contract. Health is the foundation for people, communities and economies to reach their full potential. Universal health coverage (UHC) is primarily the responsibility of governments, which ensure people’s health as a social contract. Achieving UHC is essential for inclusive development, prosperity and fairness, and requires political decisions that go beyond the health sector.
Milestone By 2023
Governments incorporate aspirational health-related SDG targets into national planning processes, policies and strategies to ensure everyone can access quality health services without financial hardship.
- Prioritise UHC as a commitment at all levels of government and as a whole-of-government and whole-of-society action in order to provide equitable access to health services, irrespective of socio-economic and legal status, health condition, disease, religion, gender, age or any other factors. • Prioritise essential public health functions and address the social, environmental and commercial determinants of health.
- Support international and national regulation and fight tax evasion and corruption through cooperation with finance ministries, national treasuries and national anti-corruption agencies to ensure more powerful people and entities pay their fair share.
- Invest in health as a key component of sound macroeconomic policies to foster economic growth, human capital and workforce participation, especially for women.
- Promote peace and strengthen cooperation between humanitarian and development actors in fragile settings. Develop strong relationships to enhance the health security agenda, including through resilient foresight capabilities.
- Strengthen national policy and institutional coherence between trade and intellectual property for the right to health. This requires establishing inter-ministerial bodies to coordinate laws, policies and practices that impact health technology innovation and access.
2. Leave No One Behind
Pursue equity in access to quality health services with financial protection. Health is enshrined as one of the fundamental rights of every human being. UHC is key to reducing poverty and promoting equity and social cohesion. Governments should invest in everyone’s health. Extension of geographical coverage and reaching the most marginalised and hard-to-reach populations are essential to achieving positive health outcomes. A strong system for monitoring and evaluation is needed to ensure accountability and participation.
Milestone By 2023
Governments report disaggregated data to SDG official statistics to capture the full spectrum of the equity dimensions of UHC monitoring progress (SDG 3.8.1 and 3.8.2).
- Establish resilient, responsive and inclusive health systems that are accessible to all, irrespective of socio-economic or legal status, health condition or any other factors. Such systems should prioritise an essential health package based on PHC principles.
- Incorporate the health needs of vulnerable populations, in particular in fragile settings, in national and local health care policies and plans, with increased focus on PHC, including disease prevention, immunisation services and health promotion activities.
- Establish inclusive social accountability mechanisms for all parts of the health system so that everyone is responsible for progress toward UHC.
- Pursue the concept of progressive universalism and establish health systems that promote equity, reduce stigma and remove barriers based on multiple types of discrimination. Improving health outcomes for populations on the move, migrants and refugees is critical, as huge gaps remain to be addressed.
- Institutionalise data collection to implement the SDG Global Indicator Framework, especially concerning indicator 3.8.1. and 3.8.2 with equity dimensions of progress (age, sex, geographical location, income level).
- Evaluate the impact of policies and programmes regularly and document who is left behind to promote inclusive access and utilisation of health services.
3. Regulate and Legislate
Create a strong, enabling regulatory and legal environment responsive to people’s needs. UHC requires a sound legal and regulatory framework and institutional capacity to ensure the rights of people and meet their needs. Governments are the primary duty bearer under the International Covenant on Economic, Social and Cultural Rights, even in cases when they rely on private providers.
Milestone By 2023
Governments introduce legal and regulatory measures that accelerate progress toward UHC.
- Create an evolving and responsible regulatory and legal system that sets an ethical framework, promotes responsiveness and inclusiveness of all stakeholders and supports innovations. This system must respond to changing needs and comply with medical and public health ethics in a period of rapid technological evolution and medical innovation.
- Set and implement national quality control mechanisms or minimum national quality health service standards, and create legislation on data protection and security, patient rights and the education of health workers.
- Prioritise public oversight, data protection and data ownership by the patient, and resolve data transferability.
- Support redress mechanisms to manage conflicts of interests that aim to promote equity, quality and financial risk protection.
- Take steps to ensure coherence with national and international legislations on population health, such as tobacco legislation, including the Framework Convention on Tobacco Control (FCTC), labour laws, emergency response and implementation of IHR, international humanitarian principles and international human rights laws.
- Invest in health regulatory agencies (food & drug; tobacco & alcohol; medicines & technologies; medical & nursing training) and the implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel, the FCTC and other existing laws.
4. Uphold Quality of Care
Build high-quality health systems that people and communities trust. Quality primary health care (PHC) is the backbone of UHC and creates trust in public institutions. Expansion of health coverage must be accompanied by investments in the quality of health services. People should be able to access a full spectrum of safe, quality services and products in their community, delivered by well-trained, well-paid, culturally and gender-sensitive health workers.
Milestone By 2023
The coverage of quality essential health services has been delivered to one billion additional people (SDG 3.8.1).
- Put better quality on par with expanded coverage. Progress on UHC must be measured through the achievement of equitable and effective coverage and access to promotive, preventive, curative, rehabilitative and palliative health services. This requires new investment and delivery models, as well as collaborations through participatory and inclusive service delivery redesign and planning.
- Build quality assurance measures to achieve resource optimisation and the satisfaction and safety of patients, families and providers.
- Ensure the appropriate, safe and affordable use of digital and AI innovation. Digital health and AI provide new opportunities to respond to the unique needs of each person, organise services seamlessly, involve patients in decision making and collect, connect and disseminate data with smart and autonomous systems.
- Promote innovation and harness a variety of technologies, including digital technologies, to improve equitable access to health services, complement and enhance existing health service delivery models and empower and enable people and communities to play an active role in their own health.
- Train a health workforce based on quality and competence, with a special focus on nurses, midwives and community health workers. Education must improve overall management capacity and skills and foster the appropriate use of technology. UHC requires supportive education policies, labour market regulations, effective environmental stewardship and monetary and non-monetary incentives for health workers and health organisations.
- Empower providers to undertake real-time implementation research to identify and scale best practices for achieving quality.
5. Invest More, Invest Better
Sustain public financing and harmonise health investments. Current funding levels are insufficient to achieve UHC by 2030. Governments need to increase domestic investment and allocate more public financing for health through equitable and mandatory resources. Governments must improve efficiency and equity in the use of existing resources and reduce reliance on impoverishing out-of-pocket payments. Development assistance to health should reduce fragmentation and strengthen national health financing capacities.
Milestone By 2023
Governments adopt ambitious investment goals for UHC, make progress in mobilising domestic pooled funding and reduce catastrophic health expenditure (SDG 3.8.2).
- Set nationally appropriate spending targets for investments in health (e.g., ideally at least 5% of GDP on public health spending) consistent with sustainable national development strategies, and ensure efficient and equitable allocation of resources to PHC. Mobilisation of domestic resources requires cooperation between ministries of health and finance
- Foster strong alignment among global health actors and development partners to support progress, including coordination of financing mechanisms. Countries need to adapt to transition from external funding that aim to increase effective coverage of priority interventions toward achieving and sustaining UHC
- Invest in global and regional public goods including universal access to essential medicines, vaccines, technology and emergency preparedness.
- Explore how digital, technological, financial and social innovations can help to address challenges to deliver quality health services.
- Prioritise debt restructuring to address the debt sustainability challenges faced by many countries and decrease competition in the fiscal space between debt servicing and health spending.
6. Move Together
Establish multi-stakeholder mechanisms for engaging the whole of society for a healthier world. All countries must take active steps to meaningfully engage non-governmental actors - particularly from unserved, underserved or poorly-served populations - in shaping the UHC agenda. Solutions for each country must be tailored to context and population needs. The international community and global health partners should unite to support countries to build a healthier world.
Milestone By 2023
All UN Member States endorse the UHC2030 Global Compact and establish multistakeholder platforms to ensure the involvement of civil society, communities and the private sector, in regular policy dialogue and review of progress with all government
- Enable and introduce processes for structured and meaningful engagement of all government sectors and actors, the private sector and a broad base of civil society, including youth and academia.
- Empower individuals, families, communities, local providers and civil society organisations to be at the centre of UHC, especially by strengthening and enhancing community capacity to get involved in decision-making and accountability processes • Empower communities through a PHC approach. This applies, among other issues, to promoting good health, managing disease and mitigating health crises at the community level, while also strengthening community participation of all populations.
- Improve health literacy, legal and systems literacy and capacity for health decision-making by focusing on prevention, appropriate technology and a multisectoral approach at the local level, including addressing all determinants of health • Support financially civil society and community groups as key contributors to health systems development, and critical advocates for vulnerable and marginalised populations
- Support women as community leaders and changemakers. Their significant unpaid contribution to family care should be recorded, redistributed, rewarded and recognised
- Enhance international coordination and enabling environments at all levels to strengthen national health systems and share knowledge and experience to strengthen the sustainability of UHC.
- NEW: Read the High Level Meeting Statements 2019
- Final Political Declaration on UHC
- UN HLM Official Program
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