We welcome the broad consultation organised by the governments of Botswana, Sweden, WHO and UNICEF and congratulate in particular the Task Team for the participatory process and the quality of the consultation. The report reflects well the debates that were held, building on the merits and limits of the current Millennium Development Goals (MDGs), as well as the need to continue our efforts to meet these goals.
We welcome the fact that reaching the most disadvantaged, marginalised, stigmatised, and hard-to-reach populations in all countries has been identified as a priority. We support the emphasis on reaching these populations, and call for political and social mobilisation as well as health system strengthening and financial protection.
We also welcome the inclusion of Universal Health Coverage (UHC) as part of the proposed framework for the post-2015 agenda “as the key contribution (…) to achieving health goals and targets and also as a desirable goal in its own right (…).” We believe that governments should guarantee the suggested “guiding principles” of human rights, equity, gender equality, accountability, and sustainability. Without these measures, there is a risk that limited implementation of UHC by government will result in a focus on treatment only (rather than on health as a human right in itself), in more commercialisation of health services, thus affecting the quality of health services, and will fail to address current inequities in access to health. We believe governments should set-up mechanisms to pool funds in order to provide this risk protection, based on the principle of solidarity between healthy and sick, and rich and poor. If these principles are not applied, UHC is unlikely to succeed in delivering on the unfulfilled health MDGs or in being truly universal.
However, we are concerned that the report does not sufficiently reflect CSO views on how the agenda will be implemented by development cooperation actors, in particular by governments and donors.
Following the Busan High Level Forum on Aid Effectiveness, all stakeholders agree that accountability must be an integral part of the new development framework. However, ensuring accountability requires more than mere ”participation of communities, young people and civil society”. It requires proper engagement. Civil Society Organisations, both at community, district, regional and national level, must therefore be engaged in and, when appropriate, be part of the health system set-up by the (national) government. Governance and health policies should include those who are currently excluded from health services as a result of poverty and discrimination. Governance and health policies should include those excluded from current health services, because they live and work at the margin of society, and are discriminated. Simply adding indicators and targets is not sufficient to address this. Instead, we call on governments and policy makers to address existing discrimination and exclusion, for example by providing legal protection to those vulnerable groups.
Further, there is a need to engage those same populations, whether represented by CSO, directly in the governance of health plans. The success and quality of national health plans will not only benefit from policy coherence as a result of a ”whole of government” or ”health in all policies” approach. It should also be built on a stronger demand side that is best represented and guaranteed by the beneficiaries themselves. CSOs and communities including and representing health beneficiaries are well placed to inform and shape the demand requirements of a health plan. In addition, these same organisations and communities can contribute to increased accountability through their continuous assessment of the quality of services provided.
In conclusion, we strongly support a development agenda that is people-centred and equitable. However, only if such an agenda helps national health systems to build on people’s needs for health, and engages them in the implementation and quality assessment of the health services, will we achieve a health development agenda that is truly universal and equitable. We believe UHC, via a rights-based and evidence-based approach and implementing the above-mentioned principles, will ensure equitable access to health for all, including people living in vulnerable communities such as rural populations, ethnical and sexual minorities, people living with HIV, children, women, young people, disabled or migrants. Health is a right for all.