On Monday, the United Nations (UN) members unanimously adopted a high-level political declaration on universal health coverage (UHC), which World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus called a “landmark for global health and development.” While the adoption of the declaration is welcome news, in many ways it represents a starting point for the next phase of UHC, in which the thornier issues of financing, follow through, and accountability will rise to the forefront.
It was a bit of a bumpy journey to Monday’s political declaration. After months of tense negotiations among member states, the UHC debate had stalled over two hot-button issues—sexual and reproductive health and the rights of migrants and refugees—which weren’t resolved until a few days before the High-Level Meeting. Thankfully, countries were able to push the UHC declaration across the finish line, with a several countries, including the United States, disassociating themselves from the provisions linked to those thornier issues. It was encouraging to see that the final declaration was inclusive of GHTC-supported language on research and development (R&D), focused in particular on innovative financing for new products and technologies, emphasizing the role of the private sector and new models for sustainable investment.
“This declaration represents a landmark for global health and development,” Dr Tedros Adhanom Ghebreyesus
The UHC process now moves into a new phase: countries are tasked with developing their own strategies or national action plans to fulfill these commitments and advance UHC within their own borders. The agreement is intended to be country-led, and as member states adopt the commitments to their own geographic contexts, they must outline a clear path for how they will mobilize their governments and increase investment in UHC. Assessing gaps in the tools to mitigate each countries’ priority health challenges also needs to be considered as part of this new phase.
Now that countries have committed to UHC, how will they pay for it? That question seemed to be on everyone’s mind as numerous events throughout the week of the UN General Assembly focused on the financing side of UHC. The message was clear: not enough is being done, particularly on domestic resource mobilization. Most countries don’t have a UHC investment strategy to achieve the lofty goals set forth in the UHC declaration and the Sustainable Development Goals.
As countries start to develop their health investment plans, it is crucial that investment in R&D remain an integral pillar. UHC cannot be achieved without stepping up the fight against the world’s endemic and emerging infectious diseases. This will require new tools and technologies, as was echoed by stakeholders throughout the week, including Global Fund Executive Director Peter Sands and Dr. Tedros. We also need to invest more in the uptake and scaling of innovations and technologies and ensure that we are thinking of end-to-end solutions.
"Existing tools won't be enough"@PeterASands highlights that innovation hasn't been fast enough. We need to push more aggressively to scale up innovation and integration of new tools. @GlobalFund #TBinnovation #HealthForAll pic.twitter.com/7tSluSlIL5
— GHTC (@GHTCoalition) September 22, 2019
There were several side events this week on financing reforms, tax redistribution into UHC—from the tobacco industry, for example—and the need for innovative financing approaches. Outcomes-based finance such as social impact bonds and blended finance models, in particular, attracted some attention.
All countries did commit to spending one percent or more of their GDP on public health as part of the declaration. That is likely insufficient to achieve UHC, but money isn’t the only factor for success. Some countries, such as the United States, already spend more on health care but still lack access to coverage for all citizens.
Now the real work begins. Many speakers this week devoted time to discussing the challenge of accountability and follow through, drawing on past experiences from other high-level meetings. Stakeholders recognized that the declaration is just a starting framework and that the lofty language needs to be translated into tangible actions and investment. While this declaration symbolizes a major shift for the global health agenda, fears persist that the momentum will dissipate and that countries won’t be able to follow through on their commitments by 2030—just over a decade from now.
Those fears are warranted. Just last week, WHO published a report stating that while advances have been made on UHC, as many as five billion people will be left without full access to healthcare in 2030 at the current rate of progress. Countries must set clear targets for moving their populations on the journey towards UHC and create specific metrics through which progress can be monitored. Mechanisms and incentive structures must be put in place to allow for follow-up and accountability, underscoring the political will expressed in New York this week.
In adopting the declaration, member states have committed to investing in policies which would allow everyone, everywhere to have access to quality health care products and services without financial hardship. Leaders must now pivot to move from commitment to concrete action.