In this article, the authors propose that the right to health and its imperative of narrowing health inequities should be central to the post-2015 international health agenda. However, they argue that universal health coverage - as defined by the World health Organisation and typically conceived - is not enough to ensure the right to health. Policy-makers will need to address the social determinants of health such as safe drinking water and good sanitation, adequate nutrition and housing, safe and healthy occupational and environmental conditions and gender equality. The post-2015 health agenda should also explicitly describe the accountability mechanisms that will make it possible for people to claim – not beg for – additional national public resources and international assistance, if needed. Furthermore, it must specify how citizens will participate in the decision-making processes surrounding their health services and their physical and social environment. Participation must be genuine and built on a continuing relationship among researchers, governments and those communities, otherwise goals may end up being formulated by policy elites after token and superficial consultations, undermining the rights of the very communities they serve.
Values, Policies and Rights
Universal health coverage “developed within the particular epidemiological, economic, socio-cultural, political and structural context of each country in accordance with the principle of national ownership”, as it is formulated in the 2012 UN General Assembly resolution, can, it is argued by the author, to possibly mean anything and everything. In low-income countries, it could mean something that looks a lot like selective primary health care, excluding antiretroviral treatment. For AIDS activists, universal health coverage could mean a giant step backwards. However the International HIV/AIDS Alliance came out with a statement in support of “universal health coverage. The words that matter are “rights-based approach”, as the author proposes that universal health coverage anchored in the right to health requires at least comprehensive primary health care, with duty-based international assistance to countries that are unable to provide comprehensive primary health care without assistance.
Getting sick represents a risk of falling into poverty for millions of people around the world. The cost of health care put millions of people in the position to choose between buying food, sending children to school or paying to get healthcare. Yet the author argues that this is not inevitable because solutions exist: Universal Health Coverage (UHC) makes it possible for people to access health care without sacrificing other basic needs.
This paper raises critical questions around the wide and growing enthusiasm for Universal Health Coverage (UHC). Typically defined as a health financing system based on pooling of funds to provide health coverage for a country’s entire population, it often takes the form of a ‘basic package’ of services made available through health insurance and provided by a growing private sector. Such programs are now zealously promoted by global health agencies, yet the evidence to support their implementation remains extremely thin. The paper argues that re-imagining public health care – rather than the private sellout of health systems via UHC – is the only way forward in building truly universal health outcomes.
As a key supporter of universal health coverage (UHC), The Lancet recently partnered with Medical Education Cooperation with Cuba (MEDICC), a non-governmental organisation based in the United States, to produce a Spanish-language translation of The Lancet’s series on UHC in Latin America. This translation was launched as part of Cuba Salud 2015, an international health conference held during April 2015 in Havana, Cuba. Despite its often ambiguous definition, UHC is often used to refer to a financial reform extending insurance coverage in varying degrees to a larger part of a country’s population. This is different to “healthcare for all” (HCA) – a healthcare delivery system that provides equal services for the entire population regardless of an individual’s or family’s financial resources. UHC as a more limited insurance concept has received wide criticism because it does not necessarily create a unified, accessible system; because it usually encourages a role for private, for- profit insurance corporations; and because it involves tiered benefits packages with differing benefits for the poor and non-poor. Although the UHC orientation has become “hegemonic” in global health policy circles, its ideological assumptions have not been confirmed empirically. The authors urge that the Lancet and MEDICC Review provide “equal time” for critiques of UHC and presentations of endeavours to achieve HCA.
This study examines health’s evolving location in the first-phase of the next iteration of global development goal negotiation for the post-2015 era, through the synchronous perspectives of representatives of key multilateral and related organizations. As part of the Go4Health Project, in-depth interviews were conducted in mid-2013 with 57 professionals working on health and the post-2015 agenda within multilaterals and related agencies. Using discourse analysis, this article reports the results and analysis of a Universal Health Coverage (UHC) theme: contextualizing UHC’s positioning within the post-2015 agenda-setting process immediately after the Global Thematic Consultation on Health and High-Level Panel of Eminent Persons on the Post-2015 Development Agenda (High-Level Panel) released their post-2015 health and development goal aspirations in April and May 2013, respectively. Although more participants support the High-Level Panel’s May 2013 report’s proposal—‘Ensure Healthy Lives’—as the next umbrella health goal, they nevertheless still emphasize the need for UHC to achieve this and thus be incorporated as part of its trajectory. The final post-2015 SDG framework for UN General Assembly endorsement in September 2015 confirmed UHC’s continued distillation in negotiations, as UHC ultimately became one of a litany of targets within the proposed global health goal.
This paper proposes policy options based on ILO research and experiences that aim at universal coverage and equitable access to health care. The policy options discussed focus on ensuring the human rights to social security and health and on the rights-based approaches underpinning the need for equity and poverty alleviation. This paper also provides insights into aspects of implementation and related challenges. It includes an overview of ILO concepts, definitions and strategic approaches to achieving socially inclusive and sustainable progress and highlights recent global trends.
The Universal Periodic Review mechanism of the UN Human Rights Council, which came into effect in 2008, has established itself as a mechanism with huge potential and which promotes dialogue and a level playing field for all countries undergoing the review of their human rights record. Building on the Commonwealth Secretariat’s observations and analysis of the process, and the seminars it has conducted with member states, Universal Periodic Review of Human Rights consolidates the lessons learned so far, speaking equally to the three major stakeholders in the process – to states, to national human rights institutions, and to civil society organisations. An effective UPR mechanism will enhance the promotion of human rights across the world. It is therefore essential for the key players to understand and advance the UPR process including at the implementation phase. This publication describes UPR, shares experiences and provides analysis of the Commonwealth countries that reported in the first year of the UPR process.
Uganda is at the centre of current debate on urban refugees. The country’s Refugees Act 2006, which establishes refugees’ rights to live, work and own land in urban areas, has been hailed as exemplary and a global model for humanitarian responses. However, new evidence on refugee livelihoods in Kampala suggests that the rights to work and move freely, and without fear, are often unmet in urban areas. In the absence of financial assistance, urban refugees often struggle to find gainful employment and report frequent cases of discrimination by both the Ugandan state and the public. This briefing outlines the barriers faced in upholding the rights of urban refugees in Uganda, and recommends ways in which these may be overcome.
Urbanisation is one of Africa’s most pressing issues, according to this publication by African Centre for Cities. However, most political and policy leaders remain in denial about its centrality and urgency. The phenomenon represents the most complex and intractable policy questions and as long as Africans do not take responsibility to shift the contemporary situation of policy failure, we are in for a crisis, says the African centre for Cities. This publication is intended to be a resource to policy activists in African governments, development agencies, social movements, universities and business sectors who are committed to addressing the current inertia surrounding urbanisation policy development and should be of help activists to develop a clear agenda on urbanisation on the continent.