Ambitious Universal Health Coverage Declaration Goes Before World Leaders at UNGA

NEW YORK – As heads of state and international organisations 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.

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.

A nurse consults her patient with family planning needs. Sexual and reproductive health has been a controversial issue in the UHC debate. Photo: Dominic Chavez/World Bank

While the lofty vision of this far-reaching effort is further detailed in the 11-page declaration text, observers will look to leaders’ statements for signals of how concrete actions may follow.

Some two dozen heads of state are said to be planning to attend Monday’s UHC session at the General Assembly (GA), which began Wednesday and runs to 30 September.

The draft agenda for the one-day UHC meeting shows a mix of plenary segments with government statements, and two panels. There may be more than two dozen heads of state in attendance, according to sources.

In the draft version of the agenda, panel speakers included: the prime ministers of Bangladesh and Spain; the heads of the UN, WHO, World Bank, UNHCR, GAVI, Oxfam, and Medtronic; and well-known political figures such as former WHO Director General Gro Harlem Brundtland (the “Eminent High-Level Champion of UHC and member of the Elders”); Jeffrey Sachs founder of Columbia University’s Earth Institute; former New Zealand Prime Minister Helen Clark, now the Board Chair of the Partnership for Maternal, Newborn & Child Health; and Keizo Takemi, member of the Japanese House of Councillors and WHO UHC Goodwill Ambassador.

A series of side events are taking place around the High-Level Meeting, many of which are open to all. A list of side events UHC2030 is hosting or co-organizing during the General Assembly is here. A list of further events during the General Assembly is in the UNGA guide 2019.

The UN has, in recent years, stepped up its high-level political attention to health issues, with a landmark declaration on AIDS, and in last year’s GA session, high-level meetings on non-communicable diseases, and tuberculosis. Observers argue, however, that such meetings lead to optimistic language but not enough concrete progress. From a development perspective, achieving UHC will require governments to take the broad declaration and fit it to their specific national needs, while increasing outlays for stronger health systems.

“Next week’s High Level Meeting on Universal Health Coverage is a window of opportunity that we need to seize,” Francesca Colombo, head of OECD’s Health Division, told Health Policy Watch. While acknowledging that the declaration sets ambitious aims, she said that drawing attention to the UHC issue at the UN’s highest level was already a “tremendous achievement.”

However, she acknowledged that the declaration and the High Level Meeting were just the beginning of the journey. “It’s unfinished business.” she said. “Much more needs to be done to draw attention to health as a critical economic development issue.”

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 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 describe 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 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.

The UHC political declaration text is accompanied by a letter from the President of the General Assembly, María Fernanda Espinosa Garcés and the two co-facilitators of the political declaration negotiations, Georgia’s Ambassador Kaha Imnadze and Thailand’s Ambassador Vitavas Srivihok.

Sexual and Reproductive Health Settled

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.

Negotiators removed the controversial reference to sexual and reproductive health at the end of paragraph 29, according to the letter from the co-facilitators’, Imnadze and Srivihok. The paragraph previously stated:

  1. “Take measures to reduce maternal, neonatal, infant and child mortality and morbidity and increase access to quality health-care services for newborns, infants, children as well as all women before, during and after pregnancy and childbirth, including in the area of sexual and reproductive health;”

The final text of paragraph 29 now ends after the word “childbirth”.

However, the text retained intact the reference to sexual and reproductive health in paragraph 68, which also hearkens from the SDGs. That states:

  1. “Ensure, by 2030, universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes, which is fundamental to the achievement of universal health coverage, while reaffirming the commitments to ensure universal access to sexual and reproductive health and reproductive rights in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences;”

Meanwhile, reference to sexual and reproductive health was also removed from a third paragraph, 69, on gender rights, which had previously stated:

  1. “Mainstream a gender perspective on a systems-wide basis when designing, implementing and monitoring health policies, taking into account the specific needs of all women and girls, with a view to achieving gender equality and the empowerment of women in health policies and health systems delivery and the realization of their human rights, consistent with national legislations and in conformity with universally recognized international human rights, acknowledging that the human rights of women include their right to have control over and decide freely and responsibly on all matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence;”

It now reads:

  1. “Mainstream a gender perspective on a systems-wide basis when designing, implementing and monitoring health policies, taking into account the specific needs of all women and girls, with a view to achieving gender equality and the empowerment of women in health policies and health systems delivery;”

The co-facilitators also noted that negotiators moved paragraph 12 up to paragraph 6, with no change to the text, effectively raising its profile somewhat. That paragraph emphasises the importance of “national ownership and the primary role and responsibility of governments at all levels to determine their own path towards achieving universal health coverage….”

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.


Image Credits: Dominic Chavez/World Bank.

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