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Keep the promise: why governments need to deliver health for all

“Really? Universal health coverage? Again?” I hear you ask. “And just when the UK is going to the polls in a momentous general election?”.

Actually, this is exactly the time we should be talking about universal health coverage (UHC). And not just because today is UHC day (nor because I seem to only ever talk about the right to health for all). Because fundamentally, UHC is a political choice. Ensuring all people have access to timely, good-quality healthcare without facing financial hardship is the kind of message election wins are made of!

Those of us who’ve been in the UK long enough know nothing gets people riled up at election time as much as the National Health Service. It’s a source of national pride – and votes! Quite right too.

But how do we help build the same response in all countries? How can communities all over the world make sure their right to health is respected and delivered by their governments?

A political choice

Healthcare free at point of service: governments know how popular that is. It’s the reason they always make election promises to improve access to it. Fitting then that the strapline for UHC day this year is Keep the promise.

At the G20 earlier this year, the World Health Organization (WHO) launched Health: A political choice calling on global leaders to look at the bigger picture of health. Achieving UHC will not only improve the lives of many, but will contribute to countries’ economic development. WHO Director-General Dr Tedros Adhanon Ghebreysus  wrote:

“The benefits of UHC go far beyond health. UHC reduces poverty by removing one of its causes, creates jobs for health professionals, improves productivity and stimulates inclusive economic growth because healthy people are productive people.”

What’s not to want?

Where does the international community stand on UHC?

It’s been a big year in the push for UHC. September saw the first ever High-Level Meeting on UHC – bringing  together hundreds of heads of state, health ministers and other government ministers to commit to deliver UHC in their countries. The UK government, based on its experience of the NHS, acknowledged the importance and value of safe healthcare free at point of use and committed to support international efforts in the same vein.

There were signs of genuine progress at the meeting. In particular, all member states took the huge step of endorsing the Political Declaration on Universal Health Coverage, which is the most ambitious and comprehensive document of its kind on health in history. Negotiations on the declaration took months; there were sticking points that seemed insurmountable. But in the end, countries’ commitment to realising the right to health prevailed.

The Political Declaration is long – perhaps too long. But it captures a wide range of issues and priorities and sets out a clear message that UHC is not about specific diseases or specific groups, but covering as many people as possible with the best possible care.

Figure 1. Ambitious, comprehensive – and potentially transformational: six key areas covered in the Political Declaration on Universal Health Coverage

Figure 1 shows six key areas that the political declaration covers. We were very pleased to see tangible commitments to these areas and which we will continue to advocate for and hold governments to account on. While this was encouraging, some of us in civil society had hoped that heads of state and ministers at the meeting would go further and present concrete actions on how they would achieve UHC, with tangible deliverables we could measure and track.

Unpicking the Political Declaration on UHC: what did we like? and what do we want more of?

It was encouraging to see heads of state commit to promote equitable distribution of and increased access to timely, quality, safe, effective, affordable and essential services and commodities. They also noted the importance of collecting and using better data on current inequalities and how to address them. And critically:

“Ensure that no one is left behind, with an endeavour to reach the furthest behind first, founded on the dignity of the human person and reflecting the principles of equality and non-discrimination, as well as to empower those who are vulnerable or in vulnerable situations and address their physical and mental health needs, which are reflected in the 2030 Agenda for Sustainable Development, including all children, youth, persons with disabilities, people living with HIV/AIDS, older persons, indigenous peoples, refugees and internally displaced persons and migrants.”

Public financing: A significant part of the political declaration is dedicated to financial protection – ensuring people can access care without suffering financial hardship – and the importance of raising domestic resources to publicly finance health systems. We were very pleased to see this explicitly mentioned in the declaration, as we know that public financing means the most equitable care is provided. The declaration mentions “a recommended target of an additional 1 per cent of gross domestic product or more” to be spent on health. While we welcome a clear focus on domestic financing, we would have liked to see an even stronger declaration, with a concrete and more ambitious target. Our recent research shows that an increase of 1% of GDP will not be enough if countries want to close their health financing gap by 2030. Countries need to make bold political choices and commitments, moving towards a target for government spending on health of 5% of GDP.

Integrating nutrition: It was heartening to see the inclusion of addressing malnutrition in all its forms in the declaration.  However, we would have liked to see a nutrition-sensitive thread running through the declaration rather than only as a standalone section.

It shows that more progress is needed to ensure nutrition is recognised as an integrated and integral part of strong health systems. Governments need to show true political leadership to better integrate nutrition sensitive programming into UHC efforts – as recommended by WHO. And civil society should hold them to account on delivering UHC programmes that do not neglect nutrition or the underlying causes of malnutrition.

Keep the promise

Ahead of the High-Level Meeting, civil society pushed for concrete accountability mechanisms for UHC. This demand was not met, but that’s not the end of it. We’ll use our voices globally and nationally to push our governments to keep their promises. This year, UHC Day is about just that – continuing to make progress on the commitment to health for all and highlighting the political nature of that promise. Governments need to move from rhetoric to action – by financing their own health systems or through using official development assistance to support countries to raise domestic resources to sustainably fund the fulfilment of health rights.

Governments have been asked to report back to the WHO on their progress on UHC and to hold another High-Level Meeting in 2023 to expand on how far they’ve come. These are brilliant opportunities on the global stage – but on their own they’re not enough. Our politicians need to know that fulfilling their promises and committing to equity, public financing, financial protection, integration of nutrition and meaningful multi-stakeholder partnerships is a critical part of their political agenda and their commitment to their populations. A whole-of-government approach and a healthy population are good for governments and good for their citizens. Governments then must make the space for civil society to participate and to hold them to account.

So, if you’re voting anywhere in the world over the next few years, let your government know that delivering on their commitment to health for all is not a choice or a niche issue: it’s fundamental.

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