NCDA response to the Political Declaration of HLM UHC – Keep the pressure on!

NCD Alliance | 30 Oct 2023

This Advocacy Briefing presents the NCDA response to the UN High-Level Meeting on Universal Health Coverage (HLM UHC) Political Declaration, which is currently in silence procedure and shall be adopted at the UN HLM on UHC on 21 September 2023. It is intended to support advocates in their efforts with governments.

The draft Political Declaration of the United Nations (UN) High-Level Meeting (HLM) on Universal Health Coverage (UHC) rightly recommits to principles and actions outlined by UN Member States at the first HLM on UHC in 2019 but should have advanced further, especially to address the needs of people living with NCDs.

If the Political Declaration is adopted as expected at the HLM on 21 September, NCD advocates worldwide will need to urge their national governments to fill that gap, says the briefing released on Wednesday 30 August.

“Member States settled for safe, previously agreed language rather than agreeing to new, stretching commitments that would facilitate substantial policy changes at the national level around primary health care (PHC) and health benefits packages,” says the advocacy briefing.

Other main omissions include:

  • Targets for investment in health, beyond increasing PHC spending, despite calls to set targets of 5% of gross domestic product (GDP) or 15% of general government spending on health;
  • Development or strengthening of commitments to governance and accountability, particularly by omitting the important role of people living with a wider range of health conditions, including NCDs;
  • Expanding the definition of vulnerability to include people living with NCDs. This is especially relevant during health emergencies, during which people living with NCDs are more susceptible to premature mortality, infection and disruptions in their routine care and services. As a result, “there is a potential gap in coverage and access to care that is created as Member States seek to implement their commitments.”
The advocacy briefing recommends that advocates prioritize several critical issues that will advance implementation of the Political Declaration and build momentum for greater progress at the 4th HLM on NCDs, scheduled for 2025. These are:
  • Invest: “Advocates should engage policymakers and undertake campaigns to build support for increased funding for health in national budgets.” In holding governments accountable for their commitments, advocacy should include a focus on tracking the allocation and spending of current and new resources, and on increased transparency.
  • Accelerate: “Advancing the call to first reach the furthest behind in the progressive realization of UHC and recognising the current environmental, social, commercial and economic determinants of health, people living with NCDs should be recognized as a vulnerable population group across all UN processes.”
  • Align: The health sector and health policies alone cannot alleviate the health and economic burden caused by NCDs. A whole-of-government and whole-of-society approach is necessary to address the NCDs burden and achieve UHC. Text in the Political Declaration outlining the synergies with other components of the Sustainable Development Goals serves to benefit health outcomes and overall progress on the 2030 Agenda, as per a health-in-all-policies approach. But more should be done to ensure that implementation of the Political Declaration adequately addresses the influence that health-harming industries and unhealthy commodities have in national policymaking.
  • Engage: Advocates should continue to call for the inclusion of people with health conditions, including NCDs, in the development and monitoring of national UHC policies.
The advocacy briefing does commend Member States, noting the Political Declaration:
  • Includes language that improves on the 2019 declaration by recognising NCDs and the role they play in the progressive realisation of UHC, most notably on the role of prevention and the continuum of NCD care in health benefits packages.
  • Recognises the continued, worsening trend of increasing out-of-pocket expenditures and the financial hardship this creates, particularly in lower- and middle-income countries, and the importance of PHC in lowering these costs.
  • Includes increasing references around environmental, social, and economic determinants of health, and acknowledging linkages between health and its determinants.