New York, 23 September 2019: United Nations Secretary General Antonio Guterres opened the first High Level Meeting on Universal Health Coverage today. He drew the link between health and the economy, noting that good health is both an outcome and a driver of economic progress and that investment in health is an investment in people. The political declaration agreed to at the High Level Meeting has been negotiated for months and is, in the words of the Secretary General, the most comprehensive agreement ever reached on global health.

In many ways, the political declaration is an important step forward. It demonstrates a measure of commitment to ensuring access to health care services across the world and to greater investment in health. There are, however, significant shortcomings in the declaration:

  • It does not go far enough. Rather than reaffirming “the enjoyment of the highest attainable standard of physical and mental health” as a right of every human being, it limits the meaning of universal health coverage to “nationally determined sets” of health care services. Thus rather than setting up a standard towards which nations can strive, it makes the meaning of universal health coverage subject to what a country can provide at a point in time, and focuses on “coverage” rather than “care”.
  • It fails to include provision for sexual and sexual health rights. The declaration explicitly includes reference to sexual and reproductive health care services and to reproductive rights, but is silent on the important issue of sexual and sexual health rights. The exclusion of sexual and sexual health rights is a result of government, including US government, push back and reflects a worrying trend of decreasing recognition of and respect for sexual and reproductive health rights.
  • It gives too much focus to inclusion of the private sector and market-driven change in the move towards universal health coverage, while placing insufficient emphasis on the strengthening of the public health sector.
  • It shifts the focus on funding from international solidarity to the use of domestic resources – explicitly referencing an increase in funding for health of 1% of GDP in each country – which will be insufficient in many countries. While there is a clear need to increase domestic funding in many countries, there is a real risk that universal health coverage will result in a decrease in international funding for health, at the expense of the most vulnerable.

South African Minister of Health Dr Zweli Mkhize welcomed the adoption of the political declaration and committed to achieving UHC for all by 2030. He spoke about NHI in South Africa, and noted that South Africa supports a primary health care approach to health reform and the principle of leaving no one behind. He also said that NHI will ensure the reduction of maternal and child mortality and will further South Africa’s progress in improving life expectancy, addressing communicable and non-communicable diseases, and prioritising vulnerable populations. Disappointingly, Minister Mkhize did not, as many other country representatives made a point of doing, make any mention of the removal of sexual health rights from the political declaration. Instead, he focused on the provision of sexual and reproductive health services.

We do, however, welcome South Africa’s signing on to the statement of 54 countries emphasising the importance of sexual and reproductive health care rights and services. This statement, read out by the representative of the Netherlands, countered a statement by the United States and 18 other countries which said “We do not support references to ambiguous terms and expressions, such as sexual and reproductive health and rights in U.N. documents, because they can undermine the critical role of the family and promote practices, like abortion”.

SECTION27 joined the HealthGAP, Partners in Health, and other activists, in a protest against the removal of progressive language from the political declaration, for real funding for health, and for a more expansive understanding of health and the right to health.

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