Acting on the 2023 High-Level Political Declaration for Universal Health Coverage

Last week in New York, governments adopted the 2023 High-Level Political Declaration for Universal Health Coverage during the United Nations High-Level Meeting on Universal Health Coverage. Attending alongside other global health leaders and advocates, PAI applauded this achievement and the opportunity it creates at this half-way point of the Sustainable Development Goals. Now we must implement it.

High-level political declarations are only as good as the paper they are written on if action is not taken. Political commitments, matter. Global convenings, such as what took place at the United Nations General Assembly last week, matter. The spaces to recognize achievements and be called upon to course correct, also matter. However, what ultimately makes the commitments, intentions and promises meaningful, are when we act.

That is precisely the focus of an event that took place in New York and virtually on September 27, the day after the adoption of the universal health coverage (UHC) political declaration, for civil society and community members committed to advancing UHC. The sessions not only reflected on the outcomes of the high-level meeting but also advanced discussions on the UHC Action Agenda and the importance of advocates working as a collective along with governments to ensure implementation of commitments and hold leaders accountable.

From PAI’s perspective, the achievement of the aspirations of UHC require:

• Primary health care that meets the needs of people. Priorities include investing in primary health care (PHC) services and systems and expanding the frame of what PHC encompasses beyond brick-and-mortar establishments, which still require fortification, the inclusion of community health workers, youth health volunteers, midwives, technology-based platforms and more must be part of the mix to ensure we leave no one behind.
• Policies and national budgets that are clear, coherent and inclusive of the full suite of essential health care needs. National policies and domestic resources can be far more effective if UHC/PHC priorities are approached as one suite of services and support, instead of individual care verticals, supply chains for commodities and more, which only create silos and inefficiencies. A cohesive approach and package that are funded as such — while still being able to collect data and monitor individual services — improve efficiencies and quality of care and reduce the burden on health systems, health workers and people who seek care.

• Alignment among multilateral, bilateral and private donors and institutions. International donors and institutions advancing global health have an opportunity to better coordinate and leverage their investments and value add in manners that meet the needs and priorities of national governments and local communities. Funding for global health continues to be threatened and reduced, yet the needs remain high. As leading institutions complement domestic resources, stronger partnerships, additional coordination and better-leveraged resources will ensure we make the most of the funding and resources available.

• Centering comprehensive sexual and reproductive health and rights (SRHR). There can be no UHC without ensuring that SRHR can be realized by all. This means universal access to contraceptives and family planning. It also means ensuring comprehensive sexuality education for young people, making menstrual health products and services fully accessible for young people, integrating abortion as part of essential services and providing comprehensive maternal and newborn health care in reliable and compassionate ways. If leaders and donors say they endorse UHC, gender equality and youth empowerment, then they must also support SRHR for all.

• Recognition of and investments in civic space-, youth- and women-led movements. The role of civil society-, youth- and women-led movements should be elevated if we plan on getting the job done while also holding commitment-makers accountable, driving access and utilization of health services and transforming opportunities for communities. We do this not only to speak truth to power, but as participants in strengthening health systems, partners in informing and shaping policies and advocates who elevate the perspectives of communities, while also engaging deeply with these same communities to advance knowledge and use of health care. We need funding, institutional capacity support and a valued, equal seat at the table because we are the ultimate changemakers.