Values, Policies and Rights

Universal health coverage, real or selective? Time for global health advocates to unite
Gorik Ooms

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.

Universal Health Coverage: Because nobody should have to choose between health, food and education
Hannah Yous, Health Advocacy Officer, Oxfam France 2014

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.

Universal health coverage: Beyond rhetoric
Sengupta A: Municipal Services Project Occasional Paper, November 2013

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.

Universal health coverage: The strange romance of The Lancet, MEDICC, and Cuba
Waitzkin H: Social Medicine 9(2) 93 -97, 2015

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.

Universal Health Coverage’s evolving location in the post-2015 development agenda: Key informant perspectives within multilateral and related agencies during the first phase of post-2015 negotiations
Brolan C; Hill P: Health Policy and Planning 31(4) 514-526, 2015

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.

Universal Health Protection: Progress to date and the way forward
Social protection Department, International Labour Office: ILO Geneva September 2014

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.

Universal Periodic Review of Human Rights
Dr Purna Sen: July 2009

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.

Upholding the rights of urban refugees in Uganda
Monteith W; Lwasa S; Nsangi G; et al: International Institute for Environment and Development (IIED) Briefing, 2017

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 imperatives for Africa: Transcending policy intertia
African Centre for Cities, University of Cape Town: 2010

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.

US applies for United Nations Human Rights Council membership
VOA News: 4 May 2009

The United States has announced that it will seek a seat this year on the United Nations Human Rights Council. The decision to run reflects the US commitment to helping the Human Rights Council play its intended role as a balanced, credible, and effective forum for the advancement of human rights. Elections to the Human Rights Council are scheduled for 12 May in the UN General Assembly in New York. UN Secretary General Ban Ki-moon welcomed the US decision to join the UN Human Rights Council saying, ‘Full US engagement on human rights issues is an important step toward realising the goal of an inclusive and vibrant intergovernmental process to protect rights around the globe.’