With a short accreditation process (deadline for applications: 3 March!) and a series of consultations, the preparations for a UN High-Level Meeting (UN HLM) on Universal Health Coverage (UHC) that will take place on 23 September 2019 are already in full swing. The theme of the UN HLM will be “Universal Health Coverage: Moving Together to Build a Healthier World.”
For organizations such as Medicus Mundi International and many of our Network members and partners who have been engaged in promoting access to health and strengthening of people and community centred national health policies and systems in their technical and political work over decades, it is difficult to resist the temptation. You know: if I can make it there, I’ll make it anywhere…, or, in the words of the Civil Society Engagement Mechanism of the UHC2030 Alliance: “Don’t miss it! Get your voice heard at this critical moment for UHC.”
Nevertheless, allow me to look at the meeting and its preparatory process with a little bit – let’s say threes steps – of distance:
Another UN High-Level Meeting
After Tuberculosis and Non-Communicable Diseases last year, it’s now up to Universal Health Coverage (UHC) to enter the limelight of a UN High-Level Meeting in Ney York. The concrete output of such meetings is difficult to assess; after last year’s events, feelings of WHO staff were quite mixed. And if you fail with the key metrics (in particular: number of heads of state attending), you have a problem. However, “going to New York” has become a core strategy – and ritual – for WHO.
The dilemma is obvious: If, to fulfil its core function of “providing leadership on matters critical to the health of all people”, WHO needs to “advocate” for health “at the highest political level” (quoted from WHO 13th General Programme of Work), and if to reach that highest level, this means that health or a particular a health topic need to get the blessings of a UN High-Level Meeting, this has the potential to undermine both the status of the World Health Assembly (which should itself represent the highest political level for global health matters) and the status of WHO and its Geneva Headquarters as authoritative convenor.
And there are costs related, and not only for the WHO. “Being in New York” adds to “being in all these places” where global health is featured. No problem for those who have the money and capacities, but not easy for civil society organizations with small budgets and tough decisions on priorities. Two years ago, MMI Network opened an office in Geneva, to be closer to the WHO and to better play its role of contributing, also by hosting the “Geneva Global Health Hub”, to civil society coordination related to the processes in “Global Health Capital Geneva”. We have never been in New York so far…
Another Political Declaration
The call by UHC2030 to “contribute to the UN HLM preparation” and to participate in a consultation on “key asks” to be considered for the UN HLM political declaration is worth to be looked at in detail. As a starting point, here is a key quote from the introduction to the call:
“Before 2023 – the mid-point of the SDGs – this will be the last chance to mobilise the highest political support to package the health agenda together, under the umbrella of UHC, and sustain health investments in a harmonised manner. To fully accomplish these objectives, it is critical to identify how the UHC political declaration can add value and set milestones to accelerate progress towards achievement of UHC by 2030.”
Can a Political Declaration “add value” to what is already being done to achieve Universal Health Coverage? In this regard, the outline of the current consultation on “UHC2030 key asks” is disappointing: It includes, in its background information, a long and detailed list of previous commitments or declarations they considered in the drafting of these “key asks”. These references should also be respected in the contributions to the consultation: “Are there agreed targets or text that have been through the UNGA member states consensus process? Adoption or improvement of existing approaches/language (previously supported in UN declarations or resolutions) is most likely to be acceptable in the HLM negotiations.”
If adoption or improvement of existing approaches and language is the ambition regarding the outcome of the High-Level meeting and the content of the Political Declaration, the case for “adding value” is already lost: The meeting and its declaration will be just another tick box. It will confirm the status quo and current minimal consensus. The High-Level meeting will not contribute to debating or even resolving some of the challenging realities and questions regarding UHC.
…and another “Multi-Stakeholder Process”
Already the ambition to use the High-Level meeting to “package the health agenda together, under the umbrella of UHC” (see above) would be worth a public debate, and I am quite confident that this debate would be pretty controversial. The same counts for some of the “key asks” proposed. So yes, there are crucial questions such as what shall/can be the health system’s contribution to the achievement of the right to health and what could be the political space for shared responsibility are crucial ones, and yes, we would have something to say.
However, the invitation to engage, in the preparation of the UN HLM, in a “multi-stakeholder process” with a series of meetings and online consultations does not mainly intend to foster such a debate, but rather aims at fabricating consensus. It is another mandatory tick-box: Yes, we consulted “the stakeholders”, and yes, everybody had an opportunity to contribute.
Our experiences with similar consultations (such as the recent one on the Astana declaration) indicate that there is little space for hope that this tokenism can be overcome this time. With the strict guidance on how the topic and questions are framed, with the short deadlines (the consultation on the “UHC2030 key asks” will close on 10 March), and with the consultation process set up as a black box (participants have no idea how their input is dealt with and, for example, why a key demand is neither considered nor referred to in the further process), we only can guarantee that, yes, there will be a reference to a “broad and inclusive consultation process” in the Political Declaration.
Referring to the civil society participation in the World Health Organization’s governing body meetings, I recently concluded that there is a gap between the rhetoric and reality of “inclusive” processes, and this gap is a governance issue that needs to be urgently addressed.
So what…
So yes, the MMI Network nevertheless submitted an application for accreditation for the UN HLM. For our preparation – if we are accepted as a participant – we would love to know from colleagues within and beyond the MMI Network what are your concrete expectations and ambitions, and how, together and as civil society we can make the most out of the meeting and its preparatory process, within and beyond the standard “format”. You might remember the civil society café session on “Calling for a New Global Economic Order – the forgotten element of the Alma-Ata Declaration” at the Astana PHC conference last year…
And yes, we will nevertheless contribute to the various consultations related to the High-Level Meeting, as a civil society member of UHC2030 and its “Civil Society Engagement Mechanism” (CSEM) that has itself already set up its own consultation “to inform Global Health Initiatives in 2019”, again with a short deadline. You might read, in the “High-Level meeting” section of the new CSEM website, what a “genuinely transformative” UN High Level Meeting would mean for them – and make up your mind.
A key challenge will be to agree on advocacy and communication strategies to promote the issues that, once more, risk to be neglected in the mainstream conversation on UHC and health system, such as: redistribution at national and international level to undo health inequities; governance and democratic legitimacy of health policy making, regulation not only in the health care sector but also on international financialisation, trade rules, capital flight and economic conditionalities that currently hinder or undo policy advances towards UHC.
So yes, let us engage, but at the same time continue to keep a bit of distance anyhow, not by bad intentions, but as an intellectual and political starting point, and to see things more clearly.
Thomas Schwarz, Secretariat
Medicus Mundi International Network
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Published also as blog on the G2H2 website
MMI Network: Events, news, reports, resources
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Network event: Medicus Mundi Switzerland
Young people as actors in sexual health
Bern, Switzerland, 8 May 2019
This conference organized by Medicus Mundi Switzerland will explore how young people want to improve sexual health and what we “the adults” can learn from them. The conference aims to give young people the space to talk about sex and relationships in their way. What is needed to lift the taboo of sexuality, HIV and relationships and how to overcome the consequences of missed opportunities of comprehensive sexuality education?
> https://www.medicusmundi.ch/de/tagungen/young-people-as-actors-in-sexual-health
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Network news: MMI
Welcome to Vittorio Giorgetti!
For the first time, the Executive Secretary of Medicus Mundi International has a “companion”: Vittorio Giorgetti started working at the MMI Geneva Office in January. He will be supporting the MMI Board and Secretary over the next 15 months with strategies and specific activities on communication, relations with Network members and external partners, and fundraising. So welcome!
> http://www.medicusmundi.org/contributions/news/2019/welcome-to-vittorio-giorgetti
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Network news: DWA Cuamm
Celebrating 60 years of Doctors with Africa CUAMM in Uganda
On Tuesday 5th February, 2019, Doctors with Africa CUAMM celebrated 60 years of great service and contribution to the Health sector of Uganda reaching out to all human beings especially the neediest and suffering in hard to reach areas of Uganda.
> Watch the video: “60 anni di Medici con l’Africa Cuamm in Uganda”
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Network news: Health Poverty Action
Health Poverty Action condemns the report “Global Britain:
A Blueprint for the Twenty-first Century”
HPA, February 2019. Health Poverty Action condemns the report ‘Global Britain: A Blueprint for the Twenty-first Century’ by Bob Seely MP and James Rogers which would divert aid spending for the UK’s ‘national interest’. The report proposes abolishing the Department for International Development and expanding the definition and government spending of aid to further the UK’s own interests.
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Network news: Cordaid
3 year health care project started in Yemen
“Together with Yamaan Foundation, our Yemeni partner organization, Cordaid has started a 3 year healthcare project in Yemen. This comes on top of the humanitarian food and shelter support we started providing in 2018, also in collaboration with Yamaan Foundation.”
> https://www.cordaid.org/en/news/3-year-health-care-response-yemen/
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Network paper: Wemos
Highlights 2018
“The start of the new year calls for some reflection. This is why we have compiled an overview of our highlights of 2018. We are proud of the results of our work for health for all. Have a look!”
> https://www.wemos.nl/en/our-highlights-of-2018/
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Network paper: Federation of Medicus Mundi Spain
Female Genital Mutilation (FGM): Rebuilding her dignity
FAMME, 5 February 2019. The death of Deeqa Dahir Nuur, a 10-year-old Somali girl who suffered a hemorrhage after undergoing Female Genital Mutilation (FGM)
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Network paper: Cordaid
Restoring the health system in the Central African Republic
The Central African Republic has struggled with violence and political instability for decades. Recurring violence and ineffective government have resulted in a lack of access to basic services. Health services are sparse and there is a shortage of skilled medical personnel. People do not have the economic opportunities to provide for themselves, let alone their families. Cordaid has helped to improve the health system through Results-Based Financing.
> https://www.cordaid.org/en/publications/restoring-the-health-system-in-the-car-bekou-trust-fund/
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Network paper: Medicus Mundi Switzerland
Digital Health – A Blessing or Curse for Global Health?
The Bulletin of Medicus Mundi Switzerland on „Digital Health – A Blessing or Curse for Global Health?” is online now. To follow-up on the debate at an MMI side event to the 2018 Geneva Health Forum, you might read – and compare – some of the really nice articles (in English and German). And let us consider continuing the conversation on digital health, through publications or maybe a workshop at one of the Network members?
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Network resource: HPA/medico
Global Health Watch 5
For over a decade, Global Health Watch has been the definitive source for alternative analysis on health. Global Health Watch is published by the People’s Health Movement, Medact, medico international, Third World Network, ALAMES & Health Poverty Action. Combining rigorous analysis with practical policy suggestions, Global Health Watch 5 offers an accessible and compelling case for a radical new approach to healthcare across the world.
> https://www.medico.de/en/global-health-watch-5-17277/
> Download GHW5 chapters: https://phmovement.org/download-full-contents-of-ghw5/
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Network resource: ITM – IHP Network
Switching the poles in international health policies
You know that the MMI executive secretary is a fan and fierce promoter of the weekly “IHP news” published by our Network member, the Health Policy Unit at the ITM Antwerp. However, the IHP website and communication channel provides more than the newsletter. With one or two weekly blogs, most of them written by great (and not just “emerging”) voices from the Global South, “switching the poles” in the conversation on global health has become not only a programmatic statement – but almost a reality. Have a look!
> http://www.internationalhealthpolicies.org/
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Network resource: EPN
EPN newsletter “Netlink”
The mission of MMI Network member Ecumenical Pharmaceutical Network EPN is to promote access to quality pharmaceutical services for all. The bimonthly “Netlink” newsletter is one of EPN’s key communication channels, as highlighted in its January issue
> https://www.epnetwork.org/netlink-newsletter/
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Network reporting: CWGH
Annual Report 2018 of the Community Working Group on Health
In its Annual Report, the Community Working Group on Health (Zimbabwe) looks back at its 20 years jubilee, but it is not all about celebrating…
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Network Resource: MMI
mmi-cooperate: Use our tool for horizontal communication within the Network
The mailing list set up by the MMI secretariat is intended to facilitate horizontal communication among the members of the Medicus Mundi International Network engaged in international health cooperation. All MMI Network members are invited to use “mmi-cooperate” to inform their colleagues about current activities and events, to enquire about opportunities for collaboration, to share key publications and resources, or to launch a conversation on a particular technical or political topic.
> Send your messages to: mmi-cooperate@lists-medicusmundi.org