There is no accountability or good governance if we don’t get vulnerable and stigmatised communities around the table.
- Wanja Ngure (UHAI EASHRI)

We weren’t asking for too much: like many other advocates around the world, we would have liked to see strong commitments and targets that governments can be held accountable for; a specific recognition of groups most left behind in global health, including LGBTIQ+ people, people who use drugs, and sex workers; community-led responses for health to feature much more prominently; and the inclusion of self-care as a critical component of UHC.

Governments failed to include our asks and the Political Declarations lack any concrete new commitments. Language on controversial issues, such as sexual and reproductive health and rights, was watered down. Many paragraphs were copied from the 2019 UHC Political Declaration and no strong accountability framework or inclusive governance mechanism for global health was established.

Decades of responding to HIV/AIDS have shown us that inclusive governance is critical. As stated by Love Alliance partner Wanja Ngure (UHAI EASHRI), “there is no accountability or good governance if we don’t get vulnerable and stigmatised communities around the table. During a side event organised in the margins of UNGA 78 discussing the lessons learned of the HIV/AIDS response for inclusive governance, Love Alliance partners together with representatives of the Dutch Ministry of Foreign Affairs, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the African Union highlighted the critical importance of communities holding governments accountable. Peter-Derrek Hof from the Dutch Ministry of Foreign Affairs couldn’t have said it any better: “The Netherlands is not just a donor but a strategic partner to communities. We have seen a lot of successes when communities are in the lead.” And Kate Thomson, Head of the Community, Rights, and Gender Department at the Global Fund to Fight AIDS, Tuberculosis and Malaria added: “Without communities at the center , the Global Fund would not have achieved the results we are seeing. Communities are at the heart and soul of Global Fund governance.”

A commitment to promoting “social participation” did make it into the new UHC Political Declaration and the text refers to a  “whole-of-society approach and involving local communities, civil society organisations and youth in the design, implementation and review of UHC. Governments also committed to setting measurable national targets and strengthen national monitoring and evaluation platforms to track progress towards the achievement of UHC by 2030.

These are promising intentions, but they will not become reality without civil society following up with their governments. The Love Alliance will contribute to these efforts. We will ask governments about their specific plans for implementing the Political Declaration. We will highlight the gaps in commitments and present them with data, evidence and stories illustrating why UHC is still a distant reality for many of the communities we work with. We will advocate for country-level commitments to invest in community-led responses, to reach key populations with the health services they need, to scale up self-care interventions for health, and to set targets and indicators that measure the right things. 

It will be pointless dedicating that much energy in influencing these kinds of Declarations if all we end up with is vague and flowery texts with lots of intentions, ambitions and concerns but no follow up action and accountability. Let’s receive an actual ‘act’ of love in New York next time.