Political Declaration of the High-level Meeting on Universal Health Coverage (UHC)

Summary of Coalition for Access to

NCD Medicines & Product’s Advocacy Asks

At the 2023 UN General Assembly in September, there will be a High-level Meeting (HLM) and a Political Declaration on Universal Health Coverage (UHC). The Coalition is advocating that several points around non-communicable diseases (NCDs) be included in this meeting and declaration. Please see the following asks:

People living with NCDs must be recognized as a vulnerable population who do not yet have appropriate access to essential NCD medicines and products.

Ref. PP11, PP28, PP45, OP3, OP21, OP41, OP45

Furthering the call to reach the furthest behind first in the progressive realization of UHC, and recognizing the current disproportional lack of access to essential NCD medicines and products and economic burden of out-of-pocket (OOP) spending on health for people living with NCDs compared to those living with other health conditions, we call on Member States to identify people living with NCDs as a vulnerable population within this Political Declaration. 85% of premature mortality for NCDs occurs in Low- and Middle-Income Countries (LMICs) and current population coverage for basic NCD health services across the continuum of care is low e.g. only 10% of people living with diabetes in LMICs receive appropriate care.[i],[ii]

Ensure an aligned approach to NCDs which focusses on improving access to essential NCD medicines and products.

Ref. OP5, OP10b, OP13, OP56

Current inaction on NCDs, including decentralizing access to essential NCD medicines and products, is impeding social and economic development and there is a need for consistency across UN and WHO processes, recognizing the 5×5 approach[iii] which has been adopted by the UN General Assembly. This Political Declaration can be further strengthened to support action by explicitly mentioning need to adopt innovative solutions to improve access to essential NCD medicines and products (e.g. forecasting tools and human-centered co-packaging solutions) as well as recognizing the link and comorbidity between NCDs and communicable diseases as demonstrated through the COVID-19 pandemic and with HIV/AIDS.[iv],[v]

Funding allocated to diseases should be proportional to country disease burdens.

Ref. PP38, OP39, OP41, OP45

The situation outlined above has arisen because not all diseases are proportionately or adequately resourced with respect to their country-specific disease burden. Nationally prioritized, costed packages of health services should look to ensure financial protection against common health conditions within that country. Any external financing and development aid for health programmes should reinforce and support national priorities and funding. Currently however, the onus is placed on people living with NCDs and their households to pay for care OOP, in contrast to infectious diseases, despite the fact 74% of deaths globally are caused by NCDs. This Political Declaration has the opportunity to emphasize that funding for disease packages within UHC must take into consideration the disease burden within the country and be allocated proportionally.

Coalition for Access to NCD Meds & Products REV2 Text Recommendations

PP28. Note with deep concern that the COVID-19 pandemic severely disrupted the provision of essential health services, including access to essential medicines and products, in countries, with 92 per cent of countries reporting disruptions during the height of the pandemic resulting in millions of excess deaths globally and has reinforced and created new obstacles to the full implementation of the 2030 Agenda for Sustainable Development, increased extreme poverty, widened inequalities and had a disproportionate impact on people in vulnerable situations;

PP38. Recognize that there are significant gaps in the financing of health systems across the world, particularly in the allocation of public and external funds on health, and that such financing can be more efficient, considering that:

(a) On average, in low- and middle-income countries more than one third of national health expenditure is covered by out-of-pocket expenses, leading to high levels of financial hardship, and government spending accounts for less than 40 per cent of funding for primary health care; (Source: Global spending on health: a world in transition. Geneva: World Health Organization; 2019)

(b) External funding represents just 0.2 per cent of global health expenditure but plays important role in health spending in developing countries, accounting for about 30 per cent of national health expenditure on average in low-income countries; (Source: Global expenditure on health: public spending on the rise? Geneva: World Health Organization;2021)

(c) An estimated 20–40 per cent of health resources are being wasted through inefficiencies, which significantly affects the ability of health systems to deliver quality services and improve public health; (Data source: WHO)

(d) Roughly 67% of deaths in lower- and middle-income countries are from non-communicable diseases, but receive less than 1% of total health funding. (Data source: Institute for Health Metrics and Evaluation; 2018)

PP45. Recognize that humanitarian emergencies and armed conflicts have a devastating impact on health systems, leaving people, especially people in vulnerable situations and living with health conditions such as non-communicable diseases, without full access to essential health services and exposing them to preventable diseases and other health risks;

PP47.  Recognize that people’s engagement and the inclusion of all relevant stakeholders, particularly of women and girls, families and communities and those with lived experience of health conditions such as non-communicable diseases, are core components of health system governance, including monitoring and reporting, that empower all people in improving and protecting their own health, giving due regard to addressing and managing conflicts of interest and undue influence contributing to the achievement of universal health coverage for all, with a focus on equitable health outcomes;

OP3.  Ensure that no one is left behind, with an endeavour to reach the furthest behind first, and address the physical and mental health needs of all, while respecting and promoting respect for human rights and the dignity of the person and the principles of equality and non-discrimination, as well as empowering those who are vulnerable or in vulnerable situations, including women, children, youth, persons with disabilities, people living with health conditions including non-communicable diseases and HIV/AIDS, older persons, People of African Descent, Indigenous Peoples, refugees, internally displaced persons and migrants, and those living in poverty and extreme poverty, in both urban and rural areas, people living in slums, informal settlements or inadequate housing, and those facing multiple and intersecting forms of discrimination; (Source: Based on A/RES/74/2 Paragraph 70)

OP5.  Strengthen referral systems between primary and other levels of care and strengthen integrated health-care delivery to ensure their effectiveness;

OP10. Strengthen efforts to address the specific physical and mental health needs of all people as part of universal health coverage, building on commitments made in 2019, by advancing comprehensive approaches and integrated service delivery and ensuring that health challenges are addressed and the achievements are sustained and expanded, including for:

(a) HIV/AIDS, sexually transmitted infections, tuberculosis, malaria, hepatitis, neglected tropical diseases, including dengue, cholera, and other emerging and reemerging infectious diseases with high impact on public health;

(b) non-communicable diseases, including cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, mental health and neurological conditions, including dementia, as well as psychosocial disabilities including through drawing on guidance contained in Appendix 3 of the World Health Organization Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013-2030 and taking into consideration innovative programs to support decentralization of access to NCD medicines and products such as forecasting tools and human-centered co-packaging solutions to support self-care;

(c) eye health conditions, hearing loss, musculoskeletal conditions, oral health, and rare diseases;

(d) injuries and deaths, including those related to road traffic accidents and drowning, through preventive measures and strengthening an integrated emergency, critical and operative care system; (Source: WHA76.2)

OP13. Scale up efforts in primary and specialized health care and services for the prevention, screening, treatment and control of non-communicable diseases and promotion of mental health and well-being throughout the life course as an essential component of universal health coverage, including access to safe, affordable, effective and quality essential medicines, vaccines, diagnostics and health technologies, and palliative care, and understandable and high-quality, patient-friendly information on their use as part of the health promotion policies and noting that these conditions may cause and contribute to disease burdens, and have comorbidities with, communicable diseases, while current inaction is impeding social and economic development;

OP21.  Address the particular needs and vulnerabilities of migrants, refugees, internally displaced persons, which may include assistance, health-care services and mental health and psychosocial support and other counselling services for existing health conditions including non-communicable diseases, in accordance with relevant international commitments, as applicable, and within available resources and in line with national contexts;

OP25.  Promote equitable distribution of and increased access to quality, safe, effective, affordable essential medicines, including generics, as well as vaccines, diagnostics and other health technologies, to ensure affordable quality health services and their timely delivery including through inclusion within nationally prioritized and costed health benefit packages, essential drug and diagnostics list as well as through adoption of innovative programs to support decentralization of access to NCD medicines and products such as forecasting tools and human-centered co-packaging solutions to support self-care;

OP39. Scale up efforts to ensure nationally appropriate spending targets for quality investments in public health, consistent with national sustainable development strategies, in accordance with the Addis Ababa Action Agenda, and transition towards sustainable financing through domestic public resource mobilization that align national health challenges and priorities with adequate financing;

OP41. Mobilize domestic public resources and fiscal measures, including the menu of policy options within Appendix 3 of the World Health Organization’s Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013-2030, as the main source of financing for universal health coverage, through political leadership, consistent with national capacities, and expand pooling of resources allocated to health, eliminate wasted resources and improve health systems efficiency, address the environmental, social, and economic determinants of health, identify new ways to progressively raise public sources of revenue, improve the efficiency of public financial management, accountability and transparency, including with routine analysis disaggregated by stratifiers, better align funding strategies and priorities with disease burdens and domestic health challenges, and prioritize coverage of the poor, vulnerable and underserved populations and people in vulnerable situations, including those living with multiple chronic conditions, while noting the role of and the risks associated with private sector investment, as appropriate;

OP44.  Provide aligned, adequate, predictable, evidence-based and sustainable external finances, while improving their effectiveness, to support national efforts in achieving universal health coverage, in accordance with national contexts and priorities, through bilateral, regional and multilateral channels, including international cooperation, financial and technical assistance, debt debt relief and debt restructuring, considering the use of traditional and innovative financing mechanisms such as, inter alia, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Unitaid, Medicines Patent Pool, Gavi, the Vaccine Alliance, the Global Financing Facility for Women, Children and Adolescents, the Pandemic Fund, the Coalition for Epidemic Preparedness Innovations (CEPI), the United Nations Multi-Partner Trust Fund to Catalyze Country Action for Non-Communicable Diseases and Mental Health (Health4Life) and the United Nations Trust Fund for Human Security, within their respective mandates, as well as partnerships with the private sector and other relevant stakeholders, including public-private partnerships, while recognizing the need to avoid duplication and foster synergies and complementarity to make global health partnerships more efficient, effective and resilient, noting the work of the Future of Global Health Initiatives; (Source: Based on A/RES/74/2 Paragraph 45)

OP56.  Continue to strengthen health information systems and collect quality, timely and reliable data, including vital statistics, disaggregated by income, sex, age, race, ethnicity, migratory status, disability, geographical location and other characteristics including existing health conditions relevant in national contexts as required to monitor progress and identify gaps in the universal and inclusive achievement of Sustainable Development Goal 3 and all other health-related Sustainable Development Goals, while protecting the privacy of data that could be linked to individuals, and to ensure that the statistics used in the monitoring progress can capture the actual progress made on the ground, including on unmet health needs, for the achievement of universal health coverage, in line with the 2030 Agenda for Sustainable Development;

OP57.  Promote strong global partnerships with all relevant stakeholders to collaboratively support the efforts of Member States, as appropriate, to achieve universal health coverage and other health- related targets of the Sustainable Development Goals, including through technical, scientific and legal support, capacity- building and strengthening advocacy, building on existing health-related initiatives and global networks such as the and the Global Action Plan for Healthy Lives and Well-being and the International Health Partnership for UHC2030, which launched the UHC Action Agenda in May 2023, as well as promote global awareness and action on universal health coverage through the commemoration of International Universal Health Coverage Day on 12 December of every year, including by convening multi-stakeholders to support the monitoring of progress and set milestones for the progressive achievement of universal health coverage at the national level, to establish and strengthen nationally-prioritized health coverage strategies, plans and programmes as appropriate.

[i] NCD Alliance. Paying the Price: A deep dive into the household economic burden of care experienced by people living with noncommunicable diseases. 2023. Access here: https://ncdalliance.org/resources/paying-the-price-a-deep-dive-into-the-household-economic-burden-of-care-experienced-by-people-living-with-NCDs

[ii] The Lancet. Diabetes: a defining disease of the 21st century. 2023. Access here: https://www.thelancet.com/series/global-inequity-diabetes

[iii] The “5×5 approach” focuses on five major NCDs (cardiovascular disease, cancer, diabetes, chronic respiratory disease and mental health conditions and neurological disorders) and five modifiable risk factors (tobacco use, physical inactivity, harmful use of alcohol, unhealthy diets and air pollution)

[iv] NCD Alliance. A Global NCD Agenda for Resilience and Recovery from COVID-19. 2021. Access here: https://ncdalliance.org/resources/a-global-ncd-agenda-for-resilience-and-recovery-from-covid-19

[v] NCD Alliance. From Siloes to Synergies: Integrating noncommunicable disease prevention and care into global health initiatives and universal health coverage. 2021. Access here: https://ncdalliance.org/resources/policy-brief-from-siloes-to-synergies-integrating-noncommunicable-disease-prevention-and-care-into-global-health-initiatives-and-universal-health