July 5, 2023

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United Nations (UN) States are expected to adopt a political declaration on universal health coverage during the high-level meeting to be held in September 2023. On May 22, 2023, the co-facilitators of the intergovernmental consultation for the high-level meeting circulated a Zero Draft for a prospective political declaration on universal health coverage. Recently, the co-facilitators circulated a Revised Draft for a prospective declaration. The Revised Draft has 48 preamble paragraphs (PP) and 64 operative paragraphs (OP). It covers a range of topics, including service coverage, access to health technologies, digital health, health emergencies, financing, health workforce, multi-stakeholder engagement, and accountability. The Zero Draft, as recently revised, is expected to serve as the basis for negotiations for a political declaration that “seeks to accelerate progress towards achieving universal health coverage by 2030.”

A wide variety of international documents have addressed critical issues in public health, human rights, recognition of populations made vulnerable by law or policy, and access to medicines. The HIV Language Compendium (HIVLanguageCompendium.org) compiles “agreed language” on a set of key contentious issues–illustrating that there exists strong consensus and political settlement on many of these issues. Based on these elements from international instruments, sources, and agreements, our analysis proposes improvements to the Zero Draft that could be reflected in the final universal health coverage political declaration to make it as bold as other declarations in selected areas.

While strong in some aspects, the Revised Draft does not reflect internationally agreed terms in some important areas relating to universal health coverage. Contrary to several international precedents, the Revised Draft does not recognize the importance of community leadership in health service delivery and responses. The Revised Draft also lacks pledges to increase support for community leadership in health service delivery. The Revised Draft also fails to explicitly mention several key vulnerable populations, commit to expanding self-care interventions, and acknowledge governance gaps in digital health.

Furthermore, the Revised Draft does not capture the role of intellectual property and the lack of technology transfer in creating global inequities in the distribution of treatments, diagnostics, and other health technologies in addition to vaccines. The Revised Draft would be stronger if, as in previously concluded resolutions and documents, it included strong commitments for exploring delinkage research and development models, for embedding equitable access to publicly funded research, and for strengthening regional pharmaceutical research and development capabilities. Lastly, the Revised Draft is missing clear language on equitable access to comprehensive healthcare for migrants.

Read the analysis here.

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