Universal Health Coverage negotiations are failing communities!

Universal Health Coverage negotiations are failing communities!
Last updated on: 04 March 2024

The negotiations around the new Political Declaration on Universal Health Coverage (UHC), to be adopted by UN Member States in New York in September during the second UN High Level Meeting on UHC, are in full swing. In May 2023, a first draft of the political declaration was circulated, which kicked off negotiations among all Member States to agree on new commitments to realize UHC.  Aidsfonds, together with the Love Alliance and You(th) Care country partners and other organisations, developed a UHC Civil Society Statement, highlighting priorities for the UHC agenda. Recently, a revised version of the political declaration was released, covering a range of topics, including service coverage, access to health technologies, digital health, health emergencies, financing, health workforce, multi-stakeholder engagement, and accountability. A final draft is expected to be ready by the end of July.

A Disappointed Draft Declaration

While some civil society priorities have been taken up in some way or form in the revised draft, including a reference to self-care for health, we are disappointed to see that some critical issues we have been advocating for are missing. There is no reference to community leadership or community-led responses to health, and LGBTQI people, people who sell sex and people who use drugs have been left out of this draft.

Numerous UN and international resolutions, declarations and other sources explicitly name these populations and recognise their rights and vulnerabilities in accessing healthcare, and there is ample international precedence around community leadership in healthcare. The HIV Language Compendium developed by the HIV Policy Lab of Georgetown University’s O’Neill Institute in collaboration with the Love Alliance compiles “agreed language” on these issues, among other key contentious issues in UN negotiations.

Ensuring all marginalised groups have equitable access to health care and communities are in the lead is central to achieving UHC.  Failing to do so is not an option.

Leaving no one behind?

The draft declaration calls for ensuring that “no one is left behind.” It also calls for addressing “the physical and mental health needs of all” while empowering “those who are in vulnerable situations.” In particular, it names “women, children, youth, persons with disabilities, people living with HIV/AIDS, older persons, People of African Descent, Indigenous Peoples, refugees, internally displaced persons and migrants, those living in poverty and extreme poverty, people living in slums, and people living in conflict and post-conflict situations.

Excluding LGBTQI people, people who sell sex and people who use drugs is a dangerous omission in a political declaration where governments will make commitments to realise access to health for all. As we know from decades of fighting HIV and AIDS, these so-called “key populations” are among the most marginalised, stigmatised and criminalised people in society, and are not accessing the services they need due to persistent fears of being refused, judged, mistreated or worse, getting arrested because of their sexual orientation, gender identity, drug use or sex work. In addition to the critical importance of including these populations in the UHC political declaration, ensuring they are not left behind also requires the repeal of harmful laws and policies that lead to the denial of access to health services for these populations.

Community leadership?

Although there are specific mentions of community-based health care in paragraphs discussing primary health care in the draft declaration, this is not the same as “community-led.”

Community-led responses are defined by UNAIDS as actions and strategies that seek to improve the health and human rights of communities, and that are specifically informed and implemented by and for communities and community-led organisations themselves. Community-led responses complement and fill the gaps of the public health sector by providing services to people that are left behind by the public sector and advocating on their behalf. when it comes reaching people left behind by the public health sector with the services they need. More effective, sustainable and equitable systems that are essential to the scope and cost efficiencies required by UHC are developed when communities are involved at all stages of decision-making processes.

Yet, community-led responses are still severely underfunded and are rarely referred to outside of the HIV context, despite plenty of evidence demonstrating that community-led initiatives and equal partnerships between government and community together are equally central to stopping COVID-19, Mpox, Ebola and preparing for the next pandemic.

A call to all UN Member States

We are calling on all Member States to ensure the final draft of the political declaration explicitly lists LGBTQI people, people who sell sex and people who use drugs as populations excluded from accessing the health care they need and to recognise the importance of community leadership in health service delivery and responses using the term “community-led” next to “community-based.”

Ensuring all marginalised groups have equitable access to health care and communities are in the lead is central to achieving UHC. Failing to do so is not an option.