An analysis of the new UN declaration on UHC: commitments and omissions

On October 5, 2023, the UN General Assembly adopted a new Political Declaration entitled “Universal Health Coverage (UHC): expanding our ambition for health and well-being in a post-COVID world“. And while the document reaffirms the goals of the 2019 Political Declaration, it also includes several new commitments.

In particular, intensifying national efforts and international cooperation to provide health coverage to an additional 1 billion people by 2025, to reverse the trend of rising catastrophic personal health expenditures, especially among the poor and those who are vulnerable or in vulnerable situations.

Also, some areas of progress or omissions in the new declaration, based on a detailed analysis of the UHC 2030 Civil Society Engagement Mechanism (CSEM):

1. Political leadership built on national processes:

• The Political Declaration reaffirms the commitment to strengthen political leadership at the national and international level and to adopt a whole-of-government approach.
• The importance of national ownership and strengthening and sustaining political leadership to achieve universal health coverage is emphasized, with primary health care playing a major role.

2. Addressing vulnerable groups and gender:

• Like the previous declaration, the new document commits to leave no one behind and to take action to ensure equality, dignity and non-discrimination in health care, seeking to prioritize the most vulnerable groups, including people living with HIV/AIDS, refugees, internally displaced persons and migrants.
• Reference is made to “those who are vulnerable or in vulnerable situations” but there is no mention of sex workers, people who use drugs, prisoners or LGBTQI people.
• The document notes the importance of system-wide gender mainstreaming in the design, implementation and monitoring of health policies. However, the document does not include specific provisions to eliminate bias and discrimination.
• There is no commitment to remove barriers to access for vulnerable people, other than people with disabilities, in national and local health policies to ensure access to quality and affordable health care.

3. Funding:

• There are no specific new funding commitments, although the new document refers to the previous declaration’s goal of spending an additional 1% of GDP on primary health care.
• The declaration emphasizes prioritizing and optimizing budget allocations for health through investing in primary health care and addressing high prices of health commodities.
• It is noted that higher public spending is associated with less reliance on personal spending, but there is insufficient discussion of the use of public spending to ensure stable and sustainable health systems.

4. Engaging civil society and communities through a whole-of-society approach:

• Governments commit to “promote participatory, inclusive approaches to health governance for universal health coverage, including by exploring ways to strengthen a meaningful whole-of-society approach and social participation involving all relevant stakeholders.”
• The document emphasizes the importance of citizen and relevant stakeholder participation in health system governance, but makes no mention of institutionalizing mechanisms to ensure inclusive governance.
• The new document recognizes the potential role of community-led initiatives and their involvement in strengthening the legal and regulatory framework to achieve universal health coverage.

A high-level meeting on UHC will be convened in 2027 to conduct a comprehensive review of the implementation of this declaration to identify gaps and solutions to accelerate progress towards achieving UHC by 2030.