30 April 2019, New York City, early in the morning…

If you have read my earlier blog “it’s up to you, New York, New York”, you know that I travelled to New York with mixed feelings to attend yesterday’s “interactive multi-stakeholder hearing” promoted as the major milestone in the preparation of the UN High-Level Meeting on UHC in September. Mixed feelings remain after the hearing (can feelings become “more mixed”?). And a bit of a headache…

Off the record, the assessment by some WHO staff remains the same (and the same as mine): It is time that the recent procession of UN High-Level meetings on health – HIV/AIDS, TB, NCSs, UHC – comes to an end or at least to a break. It is difficult to explain here why health is presented to the UN as a series of subtopics, and the “umbrella” rhetoric and iconography around UHC does not change this, but is rather misunderstood: One more health topic pretending to be the most important one. On the other hand (yes: mixed feelings…) it is good that this parade will end with the too long neglected focus on health systems – and on the related policies and political struggles.

If yesterday’s hearing is used as an indicator for the attention given by UN member states to Universal Health Coverage, the result looks dire. Only few member states were represented in the UNGA main hall except those technically involved in the preparation of the high-level meeting such as Thailand andGeorgia. And the harsh statement of the Russian delegate in the last session shows that UN diplomats do not really like to listen to a “multi-stakeholder” thing, and in particular not to civil society. The Russian delegate said about the following, freely translated into my non-diplomatic language: The high-level meeting must focus on sectorial policies, and not on unrelated matters. In particular, we cannot accept controversial vocabulary in the political declaration. And please respect country ownership on health policies.”

Well, I must admit that I really loved some of the “controversial vocabulary”, and in particular the inputs by four great civil society panellists: Thank you, Dear Khuat Thi Hai Oanh, Harriet Adong, Batool Al-Wahdani, and Justin Koonin for your compassion and clarity in both analysis and related political calls. Representing Medicus Mundi international, I was political, too, starting my input – see here at 2.45.56 – with the favourite quote of my old companion Nick: “It’s the economy, stupid”. I was impressed by some colleagues such as Joia Mukherjee who, waiting for the closing segment (and the UNGA President returning to the meeting…), shouted her messages into the room – although I did not understand all of it. I liked the statements promoting to put people and communities at the centre of all health policy and planning. And I liked the sound and inspiring conversation in the initial panel.

But for the rest: too many of the statements from the floor followed once more a pattern that I have too often heard at the WHO EB or the World Health Assembly: It was all  about “my baby and UHC” (take any health topic, in particular any disease, or any global health initiative or programme). This approach of mainly promoting the own cause is not only fragmenting and distorting the discourse. A report by the WHO secretariat to be discussed at the upcoming 145th session of the WHO Executive Board (Document EB 145/4, on “Involvement of non-State actors”) shows that the amount of bubbles produced by civil society speakers can be easily used as an argument to further restrict the space and voice of civil society in the political processes of the World Health Organization.

And yes, this temptation to follow and promote the “multi-stakeholder” and “partnership” narrative just to be heard as civil society… The last session yesterday showed clearly where this will lead to: The smart private sector lobbyists in the room (WEF, IFPMA, Merck, Business Council for the UN) found a mostly sympathetic ear in their blurring language on business standing ready to support UHC through its unique contributions, on successful partnership mechanisms, on inviting each other to each other’s tent, on learning from the industry’s successful business models, on the advantage of considering patients as clients etc. There was no contradiction. And the Global Fund promoted its Country Coodination Mechanism with its “equal partnership with the private sector, CSO and communities” as benchmark for getting better organized in view of achieving UHC (“learn from what already works”). If there was not at least a strong reminder by Justin Koonin on the need for regulation and critically assessing the interests of the diverse actors, the hearing would have ended with a bad aftertaste.

It’s the economy, stupid. UHC cannot be organized nor left up to the private sector or to “multi-stakeholder partnerships”, but is the result (or not) of a difficult societal and political negotiation process (some of us still dare to call it “struggle”). Blurring the realities of political and economic power and interests will not help us in this. I invite those who can make it to the World Health Assembly in Geneva, in May, to join our conversations on UHC, power and privatization”, and on the difficult relationship between WHO, civil society and ‘non-State actors. These and more “neglected diseases” of global health governance will be discussed in a two-day civil society workshop (and yes, this was my piece of self-promotion).

For the further process in the lead-up the September High-Level Meeting, I recommend civil society colleagues to be political, outspoken and strategic: Instead of focusing on promoting the inclusion of a particular topic in the outcome document, rather refer to the set of political key asks that have been framed by UHC2030. These “key asks” are a surprisingly strong, political, precise document, far beyond the multi-stakeholder mainstream blabla. They need and deserve to be read, critically assessed discussed, challenged, strengthened – and defended. The headwind here in New York is strong, and cold, and if we continue to be distracted and fragmented, we will not succeed.

Blog by Thomas Schwarz, Executive Secretary, Medicus Mundi International – Network Health for All

More here and in a briefing to MMI members and interested colleagues as a public side event to the MMI Assembly on 25 May in Geneva.