UN Adopts Political Declaration On Health Coverage For All – Financing A Big Challenge

NEW YORK CITY – United Nations members today quickly adopted a high-level political declaration 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 today’s High Level Meeting 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.”

(Left to right) David Malpass, president of the World Bank; Tedros Adhanom Ghebreyesus, director-general of World Health Organization (WHO); Secretary-General António Guterres; General Assembly President Tijjani Muhammad-Bande; and Movses Abelian, Under-Secretary-General.

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 family’s 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.

Surgeons stitch up a patient in Banadir Hospital, Mogadishu, Somalia. Access to basic surgical care is limited in many parts of the world.

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.

Antonio Guterres and Dr. Tedros speaking at the opening of the High-Level Meeting on Universal Health Coverage

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 don’t, 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 they’re 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 people’s needs over their lifetimes.”

In comments to the panel, the Brazilian health minister agreed with Sachs that it is about money, but said it’s also about organization, how to do it. He said Brazil did it on a budget far below what was needed, based on three principles – universality, integrality, and equity.

Based on its policies, Brazil does not have drug resistance, for example, and has less than 10% population that smoke and may be the first tobacco-free country in the world. From the price of cancers from smoking you can see the price of it, he said. He suggested vaccination could be the first universal goal, and “talk against those fake news that talk against vaccination.” The minister noted measles this year returned in New York, has appeared in Sao Paolo from tourist ships from Europe which bring it, polio has resurfaced in Philippines, diphtheria in Venezuela.

Winnie Byanyima, executive director of Oxfam International, said Big Pharma must be “faced down,” as high prices and lack of competition mean vaccinating a child costs some 68 times more today than it did in 2001. She referred to the UN Secretary General’s High-Level Panel on Access to Medicines as an example of progress, and welcomed the commitment to price transparency in today’s political declaration.

Better Legislation, Budgets, Monitoring Among 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.

GAVI CEO Seth Berkley called for prioritizing primary health care, reaching the most underserved and marginalized first, and strengthening policy coherence for sustainable health with increased resource mobilization maximized.

UHC2030 Co-Chair Ilona Kickbusch said political decisions beyond health are needed, and that we have heard from countries that have made this choice. It is a social contract, she said.

Bachelet agreed with the need for replenishment, but said governments need to prioritize health nonetheless. Uruguay and Chile made it happen, she said, and they not rich countries. We need to call on the rich people of the world, but each government needs to make it a priority themselves.

Byanyima said people are paying for health at the expense of their food, selling their land, their houses, affecting their children to pay for health.

“We know the super-rich are hiding $17 billion from tax authorities,” she said, and the big companies should also be scrutinized, while the poor are taxed relatively higher in every country. “Let’s end tax dodging,” she said. She noted that in the poorest countries, governments are paying for the vast majority maternal health.

Another speaker called for an end to corruption. This led Sachs to remark, “If you want to start with corruption, start with the United States.”

A summary of the panel’s key points will be given at the High Level Meeting plenary at 5:30pm today. A second panel is taking place this afternoon.

Expert Views

In a press briefing earlier in the week, several experts spelled out messages for this week’s General Assembly.

Benoit Kalasa, Director, Technical Division at UNFPA, said for him, 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, he said. Kalasa 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,” he said.

Francesca Colombo, Head of the Health Division at OECD, said “a political declaration draws political attention, and that is fundamental.” This declaration will accelerate momentum if leaders get behind it. “It’s a tremendous achievement to have a political declaration that draws attention at the highest level,” she said. “It’s an unfinished business of course.”

The declaration is in a way a starting point, she said, 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.

Second, she said 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,” Colombo said.

Stefan Peterson, chief of health at UNICEF, said UHC is a political project, so “obviously it’s 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,” he said. And he made a point that the H in both UHC and PHC means Health and not just Health Care, saying that’s 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.

Peter Salama, WHO’s executive director of Universal Health Coverage & Life Course, said at WHO, we say UHC is a political choice, and in that light a global political declaration is a necessary but insufficient step towards translating this into health outcomes to the world’s most vulnerable.

So we need commitment to actions, at the country level, he said. “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,” said Salama. “And we believe firmly that primary health care is the cornerstone to achieving UHC, so we want to see heads of state, ministers, 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, he said, they 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,” he said. There is a group of countries that won’t achieve it alone, and “that’s where one of our asks is for the international donor community to focus aid on the most vulnerable, the poorest countries, the fragile countries, predominantly in sub-Saharan Africa,” Salama said. “This is what we want to see, and a commitment of an additional 1% of GDP put into action.”

Separately, civil society groups issued their assessment of the political declaration, raising concerns about specific commitments in the text.

Image Credits: UN Photo/Kim Haughton, UN Photo/Tobin Jones.

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