On 22nd and 23rd March 2018, the World Health Organization (WHO) organized a meeting with Civil Society (SC), WHO staff and Global Partners at the WHO headquarters in Geneva. The topic of conversation was to “Promote health, keep the world safe, serve the vulnerable: HIV, Viral Hepatitis, Tuberculosis, Sexually Transmitted Infections and Universal Health Coverage.” GATE was represented by our Director of Programs, Erika Castellanos.
The meeting objectives were to:
- identify opportunities to strengthen HIV, hepatitis, tuberculosis (TB) and sexually transmitted infections integration across the health system in the context of universal health coverage (UHC);
- identify opportunities for WHO and civil society collaboration to maximize public health impact in the context of the Global Health Sector Strategies on HIV, Viral Hepatitis and STIs, the end TB Strategy and the 13th WHO General Program of Work 2019-2023;
- orient key civil society partners on the strategic priorities and organizational and strategic shifts of WHO; and
- improve WHO-wide responsiveness to, and engagement with, civil society with regard to communicable diseases.
Participants in the meeting included: India HIV/AIDS Alliance, The International Community of Women Living with HIV (ICW), The Global Forum on MSM & HIV (MSMGF), World Hepatitis Alliance, International Network of People who use Drugs (INPUD), Eurasian Harm Reduction Association, The Thai Red Cross AIDS Research Centre, Treatment Action Group, amfAR, Médecines du Monde, Youth Against AIDS, Global Network of Sex Work Projects (NSWP), International Treatment Preparedness Coalition (ITPC), Global Network of Young People Living with HIV (Y+), International Planned Parenthood Federation (IPPF), STOP TB Partnership, UNICEF, UNFPA, UNAIDS, UNITAID, IAS and The Global Fund, among others.
During the two days, participants had the opportunity to increase their knowledge of the objectives of the WHO with regards to UHC and the work of partners such as UNAIDS, UNICEF and The Global Fund. The aim is to work towards a horizontal response to health, and to move away from past top-down approaches to epidemics. Participants were able to have a healthy dialogue about UHC with each other, which provided a useful learning experience for all present. The main issue that came out of the discussions was that few participants had in-depth knowledge of UHC, its implications, benefits and risks. The lack of understanding of the subject was evidenced by the numerous fears expressed during the dialogues.
What is UHC?
Universal Health Coverage is defined as ‘ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardships.’ 
- At least half of the world’s population still do not have full coverage of essential health services.
- About 100 million people are still being pushed into ‘extreme poverty’ (living on $1.90 or less a day) because they have to pay for health care.
- Over 800 million people (almost 12 percent of the world’s population) spent at least 10 percent of their household budgets to pay for health care.
- All UN Member States have agreed to try to achieve universal health coverage (UHC) by 2030, as part of the Sustainable Development Goals.
Countries commit to universal health coverage through the goals of the 2030 Agenda for Sustainable Development:
“Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”.
Central to all Sustainable Development Goals (SDGs) is a commitment to ‘leave no one behind’. The SDGs advise countries to put people first when designing health services, program and systems.
There was a wide range of opinions and stances towards UHC, which created excellent dialogue among all participants, providing a key opportunity to learn from each other. Some participants were enthusiastic UHC supporters, some took a more neutral stance, while still others expressed reservations towards UHC. Some of the fears and reservations expressed towards UHC were:
- loss of financial resources that, in the top-down approach, were allocated
- to specific epidemics;taking a step backwards in the gains of CS in the current response to HIV;
- fear of what will happen to key populations;
- concerns of whether key populations will still be a priority;
- fears that UHC is too medicalized, with no room for the participation of civil society; and
- worries that countries will not commit to, or will make their own interpretations of, UHC.
Ultimately, committing to UHC is an opportunity that should be embraced. Fears of reduced financial resources for projects are unfounded, as this has only come about a result of our traditional top-down approach to health. Many of us have narrowed our work to such specific areas that we lack the ability to see and appreciate the holistic approach to healthcare. Epidemics cannot be addressed in isolation, and UHC gives us the opportunity to provide a holistic response by addressing specific epidemics within a broader healthcare response. UHC is also an invitation for us to work together. All too often, we fail to communicate with each other, replicating activities and failing to achieve cost-effectiveness. With UHC, we can address health in unison with one another, sharing our expertise for a stronger, effective, better-value-for-money health response. Key populations can still be prioritized within the UHC context. ‘Leave no one behind’ results in identifying and addressing the needs of the most vulnerable communities.
As civil society, we have a special role in UHC. Sustainable and resilient systems for health include community systems for health: services provided by communities that are effective in reaching those left behind. Moreover, with a people-centered approach, States must be held accountable for the inclusion of all partners in UHC in the establishment of dynamic, multi-sector health responses.
UHC is the future of sustainable healthcare. We need to learn, research, discuss and inform one other. It is important that we connect UHC to the needs of our communities to identify where we fit and to ensure those needs are addressed. During the meeting, we requested WHO to provide guidance to countries and to be more specific on certain topics, such as addressing barriers, in order for all States to implement a unified UHC and to avoid parallel interpretations. As civil society, we must remain vigilant to ensure that UHC excludes no one, and benefits all. It is our role to hold countries, global partners and ourselves accountable for successful UHC.
As civil society we must continue to express our concerns, our fears and our reservations and we must demand answers to them. This global meeting was a perfect example of a healthy discussion that should trickle down to regional and national consultations. The UHC train has left the station, and we must get on board!
If you are interested in learning how, as civil society, you can get more involved in UHC, visit UHC2030.org.