Protect the gains, push for progress
This year’s International Universal Health Coverage (UHC) Day on December 12th is taking place nearly one year into the COVID-19 pandemic. COVID-19 has more than ever demonstrated that global solidarity, shared responsibility and protecting everyone is critical to any serious effort to end pandemics, including AIDS, and achieve health for all.
UHC has been a key advocacy priority for the PITCH programme at the global and country-level, driven by key political opportunities such as the Sustainable Development Goals (SDGs) process and the first ever UN High Level Meeting on UHC, which led to the adoption of the Political Declaration on Universal Health Coverage in 2019 guiding all UN Member States towards the achievement of UHC by 2030.
As a follow up of the Political Declaration, countries have started working on UHC implementation plans and strategies which PITCH country partners are seeking to influence. To support these efforts, PITCH is launching 'Protect the gains, push for progress', a new advocacy guide for country-level HIV advocates and community partners to support them in their UHC advocacy during COVID-19 and beyond.
UHC is a complex agenda to influence
Strengthening the capacity to advocate for an inclusive UHC
UHC is a complex agenda to influence. It is multi-sectoral, it cuts across diseases and focuses on many different components of health care, including accessibility, affordability, and quality of services, health systems reform, the social determinants of health, and accountability.
As UHC discussions are relatively new to many HIV advocates, PITCH has been supporting partners to better understand what it entails, how it relates to HIV and why it is important to engage, equipping them with the skills to advocate for a UHC that works for HIV and key populations in their communities and countries.
PITCH partners have made significant efforts to engage with the UHC agenda in their countries.
Policy research - in partnership with the London School of Hygiene and Tropical Medicine - generated critical knowledge about country realities in terms of UHC implementation and to a better understanding of UHC by country partners. They identified opportunities for influencing government plans and gathered evidence on the services and groups that are being left behind on the road to UHC.
In Kenya, partners assessed a UHC pilot project in two counties. This provided key insights into how key populations and other vulnerable groups accessed HIV and SRHR services. This shaped recommendations to the national government on how to best roll out UHC at the national level to meet the needs of key populations. In Uganda, partners engaged with Members of Parliament on the gaps in the current national health insurance draft bill, especially the exclusion of vulnerable populations and youth who are not in formal employment. As the national health insurance scheme is one of the main resources to finance UHC in Uganda, this will result in the exclusion of these groups from UHC.
As more partners have started to engage with UHC advocacy, we have generated more specific tools and guidance to shape these conversations, especially in the current COVID-19 crisis.
UHC advocacy in COVID-19 context
Since the outbreak of COVID-19, partners have raised concerns about how different preventive measures by countries are affecting the continued delivery of HIV services and the further exclusion of key populations and other marginalised groups.
Lockdowns, quarantines and disruption of public transport services have prevented people living with and affected by HIV to go to clinics to access services; delays and shortages of ARVs and condoms have been reported; and women, children and young people have been exposed to increased domestic violence. Some measures taken by governments have led to a further increase of stigma and discrimination of key populations.
As a result, more tailored advocacy messages and communications are needed on the links between HIV, UHC and COVID-19. It is critical to urge governments and donors to ensure comprehensive HIV services are available to all during pandemics, such as COVID-19 and to achieve UHC. This requires continued resources for HIV and more investment in inclusive and rights-based health systems.
The new advocacy guide is designed to support partners in developing advocacy strategies that integrate rights-based, community-led and inclusive approaches into the UHC agenda in the context of COVID-19 and beyond. It will be useful for longer-term advocacy to ensure countries have health systems in place that are strong and resilient to future health crises.
Community advocacy can support governments to achieve universal health coverage that contributes to ending AIDS, health for all and protection for everyone