A reflection by Marielle Hart and Wanja Ngure of PITCH

Global leaders gathered in New York at the first ever High-Level Meeting on universal health coverage (UHC) in September. They adopted a Political Declaration that aims to shape worldwide efforts to ensure all citizens have equal access to universal health care, including comprehensive HIV and sexual and reproductive health services.  

However, the road ahead will be bumpy. Putting the Political Declaration’s mantra “leave no one behind” into action means putting the needs and rights of marginalised and vulnerable populations first. Unfortunately, in many countries, key populations, including LGBTI people, sex workers and people who use drugs, are stigmatised, criminalised and rendered invisible by their own governments. 

Faced with ongoing human rights abuses, exclusion and health access barriers, UHC will only remain a distant dream for key populations

Serious efforts are needed to create a health environment where laws and policies enable everyone to access health services without stigma and discrimination and fear of arrest. For this to happen, strong partnerships and effective funding models for UHC are crucial. The HIV response has demonstrated that civil society and community-led organisations have an extremely important role to play. They reach the people left behind with health services and link them to care. Community-led organisations are filling the gaps left behind by governments through service provision, advocacy and human rights promotion, and data collection. They also hold governments accountable for their commitments and play a critical role in monitoring progress towards UHC. In short, community-led organisations are critical partners on the road to UHC and require funding and support by donors, governments and private sector to carry out their much-needed role. 

Governments and multilateral donors speak out on the role of communities in UHC
To highlight the importance of such partnerships, PITCH together with the Global Fund and other partners organised a discussion in the margins of the High-Level Meeting. Government and private sector representatives joined civil society actors to share reflections and best practices on how to partner with communities. 

The opening remarks were provided by PITCH focal point and activist Wanja Ngure who stated that the only way UHC will work in Kenya is through partnerships. “Civil society still needs funding from donors to support populations who are criminalised.” 

Kitty van der Heijden, Vice-Minister for International Cooperation at the Netherlands Ministry of Foreign Affairs applauded Wanja Ngure’s remarks and added: “Governments, including my own, are not always getting it right. We need to hear from the field, enter into a dialogue on the ground, and we need to support communities to dissent and openly challenge governments like we are doing through PITCH. This is why the Dutch government has mobilised millions of dollars to invest in civil society and communities, so their voices are heard, their concerns are taken into account, and through this, a better, more dignified life becomes a realistic perspective.”

PEPFAR Ambassador Birx agreed that UHC “has to run through the community” and Peter Sands, the Executive Director of the Global Fund, added that:

The U of UHC will not happen automatically but should deliberately engage and be led by the communities affected, especially the ones that are most marginalised. This will be the focus of the Global Fund.  Otherwise UHC will not happen

Donor funding cuts impact marginalised communities
Despite the ongoing international support for health and civil society by donors such as the Global Fund, the U.S. and the Netherlands, the reality is that achieving UHC will for a large part be the responsibility of governments themselves. This will particularly be the case in countries which have reached the status of middle-income countries due to economic growth resulting in donors leaving or severely cutting funds.  In many of these countries, health spending, especially on HIV, TB and Malaria, has relied heavily on donor funding, including in Kenya. In the past number of years, however, Kenya has experienced massive cuts in donor support. Marginalised communities in the country, including key populations, depend greatly on this external funding to access life-saving HIV and sexual and reproductive health services. In Kenya, like in many other countries, these groups are likely to suffer most when donors leave, subjected to exclusion and human rights abuses by their own governments.

Communities central in UHC roll-out
With donors leaving and marginalised communities being left behind by their own governments, the question is: who is going to fill the gap? The solution to ensuring marginalised and vulnerable groups are accessing services lies in strengthening community-led interventions, ranging from service delivery, to advocacy (including human rights and budget advocacy), and holding governments accountable. Now more than ever, there is a need for effective partnerships between donors, governments, the private sector and civil society to ensure UHC becomes a reality for all. Communities need to be funded, whether this is through the Global Fund, programmes such as PITCH, through public-private partnerships, or through government initiatives themselves.  

In the words of Oanh Khuat, the Director of PITCH partner organisation SCDI in Vietnam:

Only the people themselves know what is good for them. Governments don’t, not even medical doctors like myself do. We need to listen to the communities, partner with them and invest in them. There will be no UHC without this