Written by Jonathan Jay, JD MA, coordinator of Health for All Post-2015, a global campaign of civil society organizations advocating for universal health coverage in the post-2015 development agenda, and senior writer for Management Sciences for Health, a global non-profit that develops sustainable health systems in Africa, Asia, Latin America and the Middle East.
What do the next 500 days mean for global health?
The looming deadline of the Millennium Development Goals (MDGs) will prompt a final push to achieve the health targets that have helped guide the global community since 2000: to reduce maternal and child mortality, provide contraception and curb the HIV, TB and malaria epidemics. Undoubtedly, many people will benefit from vital health services in the next 500 days.
But many others won’t, and they’re likely to be the people who are already most vulnerable and least served. For example, as maternal deaths have dropped in developing countries, deaths are more concentrated in poor regions; the HIV epidemic still rages in marginalized populations like sex workers and people who use drugs. A key lesson of the MDG era is that nothing contributes to illness more than poverty and exclusion.
In the next 500 days, therefore, many voices will be calling for a new approach to global health in the post-2015 development framework. It’s a dramatic reinvention around a simple idea: that everyone, everywhere, should have affordable access to the health services they need.
A Grassroots Movement for UHC
While the concept of universal health coverage (UHC) has emerged as a rallying call for organizations of all types, grassroots organizations are particularly attuned to the need to reshape health systems. They see the daily reality often lost behind public health statistics: people can’t get the services they need. Services either aren’t available, or their cost is prohibitive to those living on meager income.
It’s other stakeholders, however, who have advanced UHC in post-2015 deliberations. The World Health Organization and World Bank have been particularly vocal champions on the global stage. Along with international NGOs, the Rockefeller Foundation, and countries like France and Japan that have focused their post-2015 advocacy on UHC, there has been steady dialogue on UHC around UN headquarters in New York.
With all this political firepower behind UHC, why must grassroots organizations engage? First, while the negotiations will occur in New York, many countries’ decisions will be made at home. Capitals—often foreign ministries—determine the agenda, making national advocacy an important priority. While many countries have endorsed a UN resolution on UHC and UHC is effectively endorsed by the Common African Position on post-2015, only a handful of countries have emerged as strong UHC advocates in post-2015.
Second, there’s still a critical need to define the global UHC agenda as rights-based and participatory. For example, the discussion of equity in UHC must extend beyond reaching the poor. NGOs have pushed for explicit reference to dimensions like disability and marginalization to help define the post-2015 approach to UHC. Moreover, the governance agenda within UHC remains poorly defined, without adequate recognition of the need for strong civil society representation in UHC programs (building on examples like in Brazil and Ghana). Grassroots organizations have got a particular stake in this aspect of UHC.
Third, grassroots voices can be particularly compelling. With attention focused on leaders like WHO’s Margaret Chan and the World Bank’s Jim Kim, there’s been a misperception that the UHC movement is “top-down”—driven by bureaucrats, not a broad-based social movement. During UNGA week last year, former Pakistani minister of health Sania Nishtar said UHC loses political momentum because people aren’t on the streets calling for UHC. Grassroots organizations can show officials that people everywhere believe in fair and just health systems.
After each demonstration must be a conversation with national policymakers on why UHC is important in post-2015 and what it should look like. Educate them—the post-2015 agenda has become so broad as to encompass virtually all of development policy, making it impossible for agencies to understand all the nuances. Simply sharing information on UHC is an important first step.
This national advocacy will bolster UN advocacy as well. Campaigns like Article 25 and Health for All Post-2015 can use the Day of Action to stimulate discussion on UHC among UN missions. Images from the October 25 Day of Action will be powerful in New York, particularly when diplomats see demonstrations from their home countries.
A New Movement for Health
The post-2015 framework will represent a new era of global health. The question is whether it will represent meaningful change. If you remove UHC, existing health proposals for post-2015 read virtually like an extension of the MDGs. We know this model can improve health, but not enough, and not for everybody.
Instead, over the next 500 days, we can usher a true renewal of global health. On October 25th of this year, groups all over the world are joining for the first Global Health Day of Action. From big cities to small villages, we’ll gather for rallies, marches and vigils for the right to health and UHC. These actions will combine to spark a new kind of movement in health.
In these 500 days, we can secure global commitment to a vision that will reshape how health systems operate. Together, we can make these systems more fair, more effective, and, ultimately, more accountable to the people who need them.