The 2023 UN HLM on UHC was a moment to renew commitment to UHC and set the path for action and investment

The UN High Level Meeting on “Universal health coverage: expanding our ambition for health and well-being in a post-COVID world” took place on 21 September 2023 in New York. It represented an important moment for world leaders to recommit to the critical agenda of achieving health for all by 2030.

During the meeting, Member States unanimously recognized that universal health coverage (UHC) is fundamental to achieving all of the Sustainable Development Goals (SDGs) – not only those related to health and well-being (SDG 3), but also those related to poverty eradication, access to education, gender equality, climate change and building peaceful and inclusive societies.

The Political Declaration which was adopted during the opening of the meeting can be used to identify a path forward for ensuring the health and well-being of people everywhere and for correcting the course of action for the billions of people who do not have access to health services or who face financial hardship in doing so. Member States reaffirmed their commitment to take key national actions, make essential investments, and strengthen international cooperation and global solidarity at the highest political level to accelerate progress towards UHC by 2030, using a primary health care (PHC) approach.

In their statements, Member States converged around the importance of UHC for achieving equity, gender equality, climate change, health security, innovation and digital health. All of these are core to the Action Agenda from the UHC Movement, which provides a set of action-oriented policy recommendations that country leaders should implement to strengthen resilient and equitable health systems, advance universal health coverage and health security, and deliver health for all by 2030.

But more important than recommitment is action. “The outcome of a high-level meeting alone is not enough to deliver on our commitments to protect and improve rights and access to health services for all, especially girls, women, sexual and gender diverse people and many other groups in vulnerable circumstances” said the Co-Chairs of the UHC2030 Steering Committee in their statement released after the meeting.

The urgency of action is evident in the staggering data. At least 4.5 billion people — more than half of the world’s population — were not fully covered by essential health services in 2021. Two billion people experienced financial hardship, with over 1.3 billion being pushed or further pushed into poverty when trying to access basic health care – a stark reality of widening inequities affecting people in vulnerable contexts.

UHC2030 partners and constituencies should feel proud of their contributions to raising the voices and perspectives of diverse stakeholders, including non-state actors, in the preparations for the UN high-level meeting on UHC. Their engagement in the multistakeholder hearing in May 2023 provided messages that shaped the negotiation of the Political Declaration among Member Sates. The co-development of the Action Agenda from the UHC Movement also allowed UHC advocates to speak with a common voice and share coherent messages with political leaders.  

The high-level meeting was comprised of an opening segment, two panels, a plenary session, and a closing segment, summarized below.

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Opening segment

Mr. Dennis Francis, President of the 78^th session of the UN General Assembly, emphasized that “The growing burden of out-of-pocket expenses has become a significant barrier to health care access across the globe. By expanding primary health care interventions, national health care systems can better cover the costs of essential health care services… Our focus must be on serving the most vulnerable.” He added that “Strengthened in this way, health systems could better help communities respond to and recover from shocks –  while preventing backsliding on health outcomes.”

Amina J. Mohamed, UN Deputy Secretary-General, in delivering a statement on behalf of António Guterres, UN Secretary-General, referred to latest data on UHC indicators. “This is a human rights tragedy on a massive scale. Universal health coverage aims to address this injustice. The good news is that covering every person in the world is possible. But it requires urgent and focused action in two key areas. One, governments must invest in systems that address communities’ needs through a primary health-care approach… Two, we need financing on a massive scale. Developing countries cannot foot the bill alone. I call on countries to generously support the SDG Stimulus to increase financing for sustainable development to reach at least $500 billion per year, including investments in health systems.”

Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, said, “Ultimately, universal health coverage is a choice – a political choice. The political declaration countries approved today is a strong signal that they are making that choice. But the choice is not just made on paper. It’s made in budget decisions and policy decisions. Most of all, it’s made by investing in primary health care, which is the most inclusive, equitable and efficient path to universal health coverage.”

Dr Axel van Trotsenburg, Senior Managing Director of the World Bank Group, said, “We need to strengthen health systems as the number one priority… and prioritise efficient health spending.” He stated that we “do not just need commitments but investment and budgets for this,” adding “this the smartest way to be prepared for the next pandemics”.

Rebecca Akufo-Addo, First Lady of Ghana, stated: “Let’s make the political choice of universal health coverage,” observing that “the world is not doing enough to achieve universal health coverage, including in developed countries where gaps in access to care persist.” She urged “developed countries to assist developing countries in the distribution of generic medicines.” 

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Panel 1: What is a primary health care approach and why does it matter?

Statements from panelists and interventions from the floor reaffirmed that primary health care, an approach to strengthening health systems centred on people’s needs, is one of the most effective areas for investment to accelerate progress towards UHC, especially for the most vulnerable populations. By placing people at the centre of health systems, this approach shifts the focus away from disease and treatment and towards health promotion and prevention. The benefits of technology in helping to ensure access to essential health services, particularly in times of crises, was also mentioned.

• Mr. Francis Omaswa, Executive Director of the African Center for Global Health and Social Transformation, said that “Health systems should be keeping people healthy, with their full participation, as a duty and a right”. He added that this requires having structures in the health system to engage people and measuring what we are doing in terms of people’s participation in creating and promoting their own health.
• Ms. Neda Milevska-Kostova, Board Chair of the International Alliance of Patients’ Organizations, stated that primary health care is “the only way we can ensure patients can have access to the most holistic and integrated health system [including care and disease prevention],” but the health system must learn from people’s and patients’ own experience.
• Mr. Jagan Chapagain, Secretary-General of the International Federation of Red Cross and Red Crescent Societies, emphasized the importance of a primary health care approach to achieve UHC and ensure we leave no-one behind, both in times of crisis and stability. “Resilient health systems focused on primary health care – with enough well-trained health and care workers, data capacity, and well-functioning basic health services – are better prepared to prevent and respond to health emergencies,” he said.
• Ms. Gabriela Cuevas Barron, Co-chair of UHC2030, mentioned how strengthening health systems based on a primary health care approach – which is centered on people – can be a powerful message to regain public trust and build community engagement. She added that parliamentarians have a critical role to play through legislation that needs to guarantee universal coverage as well as financing. “True love is only shown in budgets. If there is no money for UHC, then you have to be careful the next time you vote,” she said.  

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Panel 2: Aligning our investments for health in a post-COVID world

Statements from panelists and interventions from the floor pointed to public financing, greater prioritisation of health in government budgeting and smarter investments, recognising that achieving UHC by 2030 requires substantial public sector investment. This includes a key role for parliamentarians in approving health budgets and ensuring oversight in their implementation, and the need to drive investments in the right direction by listening to communities, especially marginalized and vulnerable groups. References to country-led processes that align donor support behind a one-plan, one-budget, and one-monitoring framework were also mentioned.

• Dr. Mercy Mwangangi, Co-chair of the Steering Group of the Future of Global Health Initiatives (GHI), spoke about the importance of aligning with country priorities and working more collaboratively for the smarter use of money. Achieving the vision of the Future of Global Health Initiatives requires “an evolution of the GHI ecosystem, which could include moving beyond short-term cycle grants towards longer term investments that are more predictable and prioritise the strengthening of local institutions,” she said.
• Dr. Sania Nishtar, Member of the Senate of Pakistan, spoke about the important role of parliamentarians. “Budget is an opportunity, where the power lies to translate policies into implementation through budget approval and oversight”. She recommended freeing up fiscal space for UHC (such as from fossil fuel subsidies, untargeted subsidies that benefit the elite, and administrative costs and overheads) and thinking beyond the box (such as by realigning investments, repurposing existing earmarked taxes or new levies on affluent sectors, and maximizing efficiency). She also suggested considering lobbying, adding that “we need to lobby political parties when they are entering elections with the aim of embedding UHC in manifestos, rather than speaking only to governments who are likely to have set their priorities.”
• Dr. Werner Hoyer, President of the European Investment Bank, mentioned the importance of involving institutions that can leverage limited public funds. He referred to the collaboration between the European Investment Bank, the European Commission and WHO, combining technical assistance, local expertise, grants and investment at advantageous terms for primary health care, adding that “Public health is a great investment case, with societal benefits… but we need better models and serious partnerships. Higher level partnerships is the name of the game.”
• Ms. Inger Ashing, Chief Executive Officer of Save the Children, spoke about the role of civil society in increasing trust and transparency by organising participatory spaces and mobilizing communities. “If we [civil society and governments] do not work together to facilitate social participation in health care, governance and financing, there is a risk that our investments will not be effective and in turn address equitable access to health, the beating heart of UHC,” she said.

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Plenary session

The plenary session featured interventions by 123 governments, including 10 heads of states or government.

Watch the recording here.          

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Closing segment

Mr. Dennis Francis, President of the 78^th session of the UN General Assembly, summarized the main panel discussions as follows:

“In panel 1, we recognized that UHC is fundamental to optimizing health and well-being. But it also contributes to ending poverty and to supporting education, gender equality and peaceful, inclusive societies… In panel 2, we recognized that achieving UHC by 2030 requires substantial public sector investment and accelerated action by governments and partners alike.”

His closing remarks also emphasized that there is a cost to doing nothing and called on Member States to “place good health within everyone's reach, and in turn create a brighter future of peace, prosperity, progress and sustainable development, leaving no one behind.”

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Select UHC2030 events with partners 

Toward more Resilient, Equitable and Sustainable UHC in 2030: A Toast to the Implementation of the 2023 UHC Political Declaration - Fourth Annual Meeting of the Group of Friends of Universal Health Coverage and Global Health, in partnership with UHC2030

This reception event on 21 September brought together 200 stakeholders, including Member State representatives at the ministerial level, high-level representatives of UN agencies, and partners from civil society organizations, to celebrate the adoption of the Political Declaration on UHC and to share actions and inspiring testimonies of accelerating progress towards UHC by 2030. It concluded with the formal announcement of this year’s UHC Day campaign, Health for All: Time for Action, which emphasizes the need for immediate and tangible steps following the adoption of the Political Declaration, and urges leaders to enact policies that guarantee equitable access to essential health services without financial hardship.

Read our summary of the event here.

Gender Equity Agenda: a pivotal year for the health workforce

UHC2030 co-sponsored this event organized by France, Argentina, Women in Global Health, ILO and Rabin Martin on 19 September. It provided an opportunity to discuss the health workforce language included in the 2023 Political Declarations on UHC and pandemic prevention, preparedness and response and to outline next steps for advancing gender equity in the health workforce at the global, regional and national levels.

Virtual launch of the 2023 Global Monitoring Report by WHO and the World Bank

On 19 September, UHC2030 contributed to this virtual launch , which presented the civil society commentary on the findings to highlight their perspectives on progress towards UHC and calls to action for governments

Post-high-level meeting debrief and strategy session

On 22 September, civil society advocates from across a wide range of health issue areas gathered for a post-high-level meeting debrief and strategy session organized by the Civil Society Engagement Mechanism (CSEM) for UHC2030, the International Federation of Red Cross and Red Crescent Societies, and the Global Health Council. Over 70 advocates attended the event and shared their post-HLM advocacy plans.