What the Political Declaration on UHC says and what this means for South Africa
Political declarations are just that – statements of what countries say they want to achieve, individually and collectively. They are not binding in a way that a law or a treaty would be binding. Nevertheless, they have power because, by signing the declaration, a country commits to certain principles, priorities and actions.
The Political Declaration on UHC, while imperfect, contains some important and useful principles, priorities and actions that, in South Africa, we should be using to define National Health Insurance.
The first principle relates to investment in health. By signing the declaration, South Africa has confirmed that it sees investment in health as investment in “human capital”. That it will prioritise investment in health and will see such investment as a priority for the whole of government and not just the Department of Health.
Second, by agreeing to the political declaration, South Africa has said that it agrees with the principle of people engagement and the inclusion of all stakeholders as a core component of health systems governance. The country agrees that such engagement and involvement, in order to be meaningful, requires transparency particularly in relation to prices and contracts in health.
Third, South Africa has agreed that it needs to set targets and to monitor and evaluate progress. To do this it needs to collect and to analyse quantitative and qualitative data.
Fourth, the political declaration makes clear that countries must meet the specific needs of particular populations. It is not just the needs of the population in general that must be met but also the needs of individuals within it. Primary health care services and prevention should be the basis for any health system but this cannot be to the exclusion of other required levels of care. South Africa has agreed that it must cater to the needs of migrants, people with disabilities, people with communicable or non-communicable diseases, with rare or tropical diseases, with mental health concerns, with eye or oral health care needs, among others
Finally, in signing the political declaration, South Africa has recognised the clear links between climate change and health. It has recognised the need for action on climate change, in particular in relation to the need for a health focus in efforts to adapt to climate change.
Unless government works to implement the principles, priorities and actions of the political declaration on UHC, it will mean very little for South Africa. Civil society, health care workers and everyone in South Africa can use the political declaration, a document to which South Africa has agreed, to enhance advocacy efforts on universal health coverage and to demand the creation of a health system that meets the needs and realises the rights of everyone in South Africa.