Voices for health: driving universal health coverage through social participation

Authors: Svetlana Akselrod, Michael Adekunle Charles, Pamela Cipriano, Katie Dain, Rajat Khosla, Magda Robalo

Global Noncommunicable Diseases Platform (SA), UHC2030 (PC, MR), Partnership for Maternal, Newborn and Child Health (RK), NCD Alliance (KD), RMB Partnership to End Malaria (MAC)

Currently, more than half of the world’s population lacks access to essential health services, and 2 billion people face financial hardship when accessing the health services they need.¹ These are not just numbers; they represent the daily struggle of billions of people who are denied the right to health, well-being, and dignity.

To realize people’s right to health, countries need to accelerate action on strengthening health systems to achieve universal health coverage (UHC). Universal health coverage means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course.²

Institutionalizing social participation is necessary to build equitable, resilient and people-centred health systems and place people at the center of policy decisions and programmes. It ensures all relevant stakeholders, including women, local communities, people with lived experience of diseases, disorders, and chronic health conditions, people in vulnerable and marginalized situations, health and care workers, civil society organizations, and people of all ages, such as children, adolescents and the elderly, are involved in the development, planning, implementation, monitoring, and review of health decisions.

Social participation and community engagement have played critical roles in combating health crises and improving people’s health for decades. Community responses to HIV/AIDS have led to positive health outcomes, fostered community resilience, and are cost-effective.³ Active involvement of individuals living with HIV in decisions about their care has resulted in better adherence to antiretroviral therapy, longer survival, better clinical outcomes and quality of life, and reduced stigma and discrimination in healthcare settings.⁴ Engagement of young people and adults in out-patient and community settings for addressing mental health and substance use has reduced hospital readmissions, improved adherence to treatment, increased the well-being and engagement of service users and provided educational opportunities for the health and care workforce.⁴ In the same vein, engaging adolescents and youth meaningfully in health decision-making processes has resulted in better health outcomes.^5,6

Social participation is essential for progress on UHC. It fosters the implementation of appropriate, context-specific policies, programmes and services tailored for each target population’s health, especially for those in vulnerable and marginalized situations, and supports their relevance and uptake.⁴ Insights and evaluations from relevant stakeholders can indicate challenges and opportunities such as health-seeking behaviors, barriers to accessing, affording and sustaining health care, and the limitations of health interventions.⁴ Application of these insights can accelerate operationalization of health agendas by bridging gaps between global and national commitments and local realities.⁴

Social participation also facilitates inclusive governance and transparency and accountability of the government, and it builds trust between governments and communities. As demonstrated during the COVID-19 crisis, the lack of these aforementioned conditions contributed to low compliance with public health guidelines, slow vaccine uptake and negative health outcomes.

Robust health systems demand strong governance; otherwise progress towards UHC risks stagnating or even reversing. In the Political Declaration from the 2023 UN HLM on UHC, Member States committed to promoting participatory, inclusive approaches to health governance for UHC, and at the 77^th World Health Assembly they have the opportunity to build on this commitment by adopting the draft resolution on social participation for UHC and well-being. By adopting this resolution, Member States will commit to the following:⁷

• Strengthening public sector capacities for the design and implementation of meaningful social participation; 
• Enabling equitable, diverse and inclusive participation, with a particular focus on promoting the voices of those in vulnerable and/or marginalized situations;
• Ensuring that social participation influences transparent decision-making for health across the policy cycle, at all levels of the system; 
• Implementing and sustaining regular and transparent social participation using a range of mechanisms supported by public policy and legislation; 
• Allocating adequate and sustainable public sector resources in support of effective social participation;
• Facilitating capacity strengthening for civil society to enable diverse, equitable, transparent and inclusive social participation; and 
• Supporting related research, and pilot projects/programs and their monitoring and evaluation to promote the implementation of social participation.

We, the Coalition of Partnerships for UHC and Global Health, urge Member States to support this resolution and turn their commitments into tangible action so everyone’s voice is not only heard but also responded to. Institutionalizing social participation in health will not only lay the foundation for enhanced trust, social cohesion and policy effectiveness, but it will also foster economic stability and growth. Let this resolution mark the beginning of a new era where health governance is by the people and for the people, ensuring a healthier future for all.

We thank Neena Joshi, Consultant, UHC2030 core team, and Laetitia Bosio, Program Manager, UHC2030 core team, for their support in drafting and editing this blog.

References

1. World Health Organization, International Bank for Reconstruction and Development/The World Bank. Tracking Universal Health Coverage: 2023 Global Monitoring Report; 2023. Accessed May 6, 2024. www.who.int/publications/i/item/9789240080379
2. Universal health coverage (UHC). Accessed May 14, 2024. www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)
3. UNAIDS. How UNAIDS Supports Civil Society Engagement and Community Responses to HIV. Accessed May 6, 2024. open.unaids.org/sites/default/files/documents/FINAL_CM_A3-prepress-2.pdf
4. World Health Organization. WHO Framework for Meaningful Engagement of People Living with Noncommunicable Diseases, and Mental Health and Neurological Conditions; 2023. iris.who.int/bitstream/handle/10665/367340/9789240073074-eng.pdf
5. Dunne T, Bishop L, Avery S, Darcy S. A Review of Effective Youth Engagement Strategies for Mental Health and Substance Use Interventions. Journal of Adolescent Health. 2017;60(5):487-512. doi:10.1016/j.jadohealth.2016.11.019
6. Meaningful Youth Engagement. Accessed May 13, 2024. pmnch.who.int/news-and-events/campaigns/meaningful-youth-engagement
7. Social participation for universal health coverage, health, and well-being draft decision. Published online January 22, 2024. Accessed May 6, 2024. apps.who.int/gb/ebwha/pdf_files/EB154/B154_CONF10-en.pdf