zero draft HLM on UHC_WMA comments

ASSOCIATION MEDICALE MONDIALE
WORLD MEDICAL ASSOCIATION
ASOCIACION MEDICA MUNDIAL
CIB Immeuble A “Le Keynes” Postal Address :
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01210 Ferney-Voltaire Telephone : (33) 4 50 40 75 75 01210 Ferney-Voltaire
France E-mail address : wma@wma.net France
Zero Draft
Political Declaration of the High-level Meeting on Universal Health Coverage
Version 22nd
May 2023
Changes to wording from the World Medical Association
General comments:
A shorter and more focused outcome document, concentrating more on general principles
how to implement UHC would been more helpful to achieve UHC.
We appreciate:
• that the political leaders of the world take up the challenge to commit to deliver UHC
• the emphasize on how critical the situation of the health workforce with severe shortage,
poor working conditions and unequal distribution is, as well as a clear message that the
health workforce is the core component of each health system.
• to highlight the involvement of whole of society into the leadership and governance of
UHC.
• to in-cooperate the WHO Operational Framework for Primary Health Care concept to reach
out to the community level in multi-disciplinary teams with the aim to offer equitable high
quality health services to all people. This involves as well the close link of promotion,
prevention, curative, rehabilitation and palliative car as well as specialized care.
• to stress the adverse impact of climate change, natural disasters, extreme weather events as
well as other environmental determinants of health.
• to underline the special situation of migrants, refugees, internally displaced persons.
• to accentuate the severely disrupted provision of health services due to COVID pandemic.
Missing in the document:
• the paragraphs on health workforce OP 36-39 stay quite vague how to improve the working
conditions for the health workforce. We think it is important to give clearer guidance how
to implement this. The WHO Global Health and Care Worker Compact, which includes
obligations on preventing harm, ensuring inclusivity, providing support and safeguarding
rights is a core document on improving working conditions and should be named in the
document.
• the need to extend public financing for UHC and consider funding across sectors to foster
whole in government approach.
• Overcome siloed approaches of vertical and other parallel health programs.
• mention of the youth workforce and in-training workforce and their special challenges.
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• to include all vulnerable groups, such as indigenous people, minority groups (ethnicity,
sexual orientation, etc) and not only migrants, refugees and displaced people. We would
appreciate a comprehensive and inclusive wording throughout the document.
Proposed change of wording:
New: in bold and underlined
Deleted: crossed
New after PP6
Recognising the resolution WHA 74.14 (2021) on protecting, safeguarding and investing in the
health and care workforce, which calls for a clear set of actions for accelerating investments in
health worker education, skills, employment, safeguarding and protection to 2030. The
resulting Working for Health 2022–2030 Action Plan was adopted for implementation with
resolution WHA 75.17 (20221)
Recalling the Global health and care worker compact, which provide technical guidance on
how to protect health and care workers and safeguard their rights, and to promote and ensure
decent work, free from racial and all other forms of discrimination and a safe and enabling
practice environment.
PP11. Recognize the need to tackle health inequities and inequalities within and among countries
through political commitment, policies, and international and intersectoral cooperation, including
those that address social, economic, environmental and other determinants of health, and further
recognize that reported averages of global, regional and national progress on universal health
coverage often mask inequalities; Call upon member states to collect data and measure
inequalities within countries and regions.
PP13. Recognize the consequence of the adverse impact of climate change, natural disasters,
zoonoses, extreme weather events as well as other environmental determinants of planetary health,
such as clean air, safe drinking water, sanitation, safe, sufficient and nutritious food and secure
shelter, for health and in this regard underscore the need to foster health in climate change
adaptation efforts, underlining that resilient and people-centred health systems are necessary to
protect the health of all people, in particular those in vulnerable situations, including those living in
small island developing States;
SERVICE COVERAGE
PP17. Recognize the increasing gap between life expectancy and healthy life expectancy for older
persons and note that many health and social systems continue to be inadequately prepared to
respond to the needs of the rapidly ageing population;
PP19. Express concern that persons with disabilities often face health inequities, stigmatization
and discrimination and with many likely to die20 years earlier than others, and experience higher
health care costs and gaps in service availability, including for primary care and specialized
services;
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PP20. Recognize that migrants, and refugees and internally displaced persons often face barriers
of legal, cultural, linguistic and institutionalized discrimination that limit their access to health
services;
PP21. Express concern that the unmet health needs, in particular among households that cannot
afford the cost of health services, face poor transportation opportunities, poor housing, work
absenteeism policies and/or cultural/discrimination barriers can result in increased morbidity
and mortality due to lack of or delayed or episodic care accesses;
PP23. Express serious concern over the disparity between developing countries and developed
countries in terms of the distribution of the COVID-19 vaccines, which prevents the entire
international community from achieving the completion elimination of COVID-19 as soon as
possible and also further hampers progress in the realization of the 2030 Agenda for Sustainable
Development, noting that, since the beginning of the vaccine roll-out, the majority of all vaccines
administered were concentrated in high-income countries, while low-income countries lagged
behind in gaining access to equal standard COVID-19 vaccines;
PP25. Recognize that health inequalities, within and among countries, continue to be pervasive and
can only be countered through intersectoral governance, global solidarity and concerted action;
PP26. Recognize the fundamental role of primary health care in achieving universal health
coverage and other health-related Sustainable Development Goals and targets, as envisioned in the
Alma-Ata Declaration and the Declaration of Astana, and further recognize that primary health
care, including community-based services, brings people into first contact with the health system
and is the most inclusive, effective and efficient approach to enhance people’s physical and mental
health, as well as social well-being, noting that primary health care and health services should be
high quality, safe, comprehensive, integrated, timely, accessible, available and affordable for
everyone and everywhere, noting the work of the World Health Organization on the operational
framework for primary health care;
PP28. Recognize the importance of community-based high quality health services delivered by
multi-disciplinary teams as a critical component of primary health care and as a means of ensuring
universal and equitable access to health for all which can be instrumental in achieving universal
health coverage, particularly when delivered in low-resource areas; (source WHO & UNICEF
Operational Framework for Primary Health Care – Transforming Vision Into Action)
HEALTH WORKFORCE
PP31 c (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) This is wild guessing without any solid proof and worse any differentiation if the waste is
avoidable or not. Further as it is written it immediately triggers the reflex that no further investment is
necessary.
PP33. Recognize the need to invest in education, training, developing, recruiting, and retaining, a
competent, skilled, and motivated health workforce, including doctors, nurses, midwives and
community health workers, as fundamental to strong and resilient health systems, and improve
working conditions and management and planning of the health workforce to ensure the safety,
well-being and protection of health workers;
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PP34. Further recognize gender and youth disparities and inequalities in particular that women
comprise 70 per cent of health and care workforce, but face a 24 percentage point pay gap
compared to men across the health and care sector, and continue to face significant barriers in
taking leadership and decision-making roles;
POLITICAL LEADERSHIP & GOVERNANCE
OP1B. To stop the rise and reverse the trend of catastrophic effects of out-of-pocket health
expenditure by providing measures to ensure financial risk protection and eliminate
impoverishment due to health-related expenses by 2030, with special emphasis on the poor as well
as those in vulnerable situations;
SERVICE COVERAGE
Strengthen national health plans & PHC
OP4. Strengthen national health plans providing a comprehensive evidence based nationally
determinded package of health services supported by a based on primary health care approach to
support the provision of a comprehensive, evidence-based, nationally-determined package of health
services, with financial protection, to enable access to the full range of integrated, high quality,
safe, effective, timely, affordable and essential health services, medicines, vaccines, diagnostics,
and health technologies needed for health and well-being throughout the life course;
OP6. Implement the most effective, high-impact, quality-assured, people and patient -centred,
gender- and disability- responsive and evidence-based interventions to meet the health needs of all
throughout the life course, and in particular those in vulnerable situations, ensuring universal access
to nationally determined sets of integrated high quality health services at all levels of care for
prevention, health promotion, diagnosis, treatment, rehabilitation and care including palliative
care in a timely manner;
OP7. Continue to explore ways to integrate, as appropriate, safe and evidence-based traditional and
complementary medicine services within national and local health systems, particularly at the level
of primary health care, according to national context and priorities; Medicine has developed out of
traditional care by adding evidence and science. What is evidence based therefore is part of
medicine. And what is evidence based is not ‘complementary` but scientific medicine. Therefore,
this paragraph is misleading and should be deleted.
OP8. Ensure safety is a key priority for the health and well-being of all patients and the health
and care workforce, and in this regard, note the importance of clean water, sanitation, and hygiene,
sterilization technology, effective management of healthcare waste and continuous energy
supply in health facilities, including in community health facilities, and infection prevention and
control strategies for the prevention of health care- associated infections and for reducing
antimicrobial resistance;
Essential Services & Disease Specific Issues
OP9b. injuries and deaths, including those related to road traffic accidents and drowning, through
preventive measures as well as strengthening trauma and emergency care systems, including
essential and emergency surgery and anesthesia capacities;
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OP15. Mainstream a gender perspective on a systems-wide basis when designing, implementing
and monitoring health policies, taking into account the specific needs of all women and girls, with a
view to achieving gender equality and the empowerment of women in health policies governance
and health systems delivery;
OP17. Increase access to health services for all persons with disabilities, remove physical,
attitudinal, social, structural and financial and language barriers, provide quality standard of care
and scale up efforts for their empowerment and inclusion, noting that persons with disabilities, who
represent 16 per cent of the global population, continue to experience unmet health needs;
OP18. Scale up efforts to promote healthier and safer workplaces and improve access to
occupational health services, to promote healthier and safer workplaces, reduce occupational
hazards, prevent work-related illnesses and injuries, and improve the overall well-being of
workers;
OP19. Address the particular needs and vulnerabilities sensitivities of vulnerable groups such as
migrants, refugees, internally displaced persons, indigenous people, minority groups (ethnicity,
sexual orientation, etc which may include assistance, health-care services and psychological and
other counselling services, in accordance with relevant international commitments, as applicable,
and within available resources and national contexts
Innovation & Digital Health
OP26. Invest in and encourage ethical, equitable, and public health-driven use of relevant
evidence-based and user- friendly technologies, including digital technologies, and innovations to
improve the cost- effectiveness of health systems and efficiency in the provision and delivery of
quality care, recognizing the need for equitable, and responsible health data governance, while
safeguarding data privacy, ownership, and security to protect data and privacy;
OP27. Strengthen capacity on health intervention and technology assessment, standardized and
transparent data collection, sharing and analysis, while respecting patient privacy, confidentiality
and promoting ensuring data protection, to achieve evidence-based decisions at all levels on
universal health coverage, and to build and strengthen interoperable and integrated health
information systems, around a set of common standards for the governance of health data, for
the management of health systems and public health surveillance;
OP28. Take measures to address the negative impact of misinformation and disinformation on
public health measures as well as people’s physical and mental health, and to counter mis- and dis-
information, especially on social media platforms, in the context of universal health coverage and to
foster trust in those who provide health and care , the health care systems and vaccine
confidence, while recognizing that the effective engagement of stakeholders requires access to
timely and accurate information;
Maximizing Investments – Health Promotion and Disease Prevention
OP35. Promote and implement policy, legislative, regulatory and fiscal measures, as appropriate, to
prioritize health promotion and disease prevention, aiming at minimizing the exposure to main risk
factors of non-communicable diseases, and promote healthy diets and lifestyles, consistent with
national policies, noting that price and tax measures can be an effective means to reduce
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consumption and related health-care costs, when implemented within a package of interventions
(such as educational campaigns, community involvement, increase access to healthy foods) and
represent a potential revenue stream for financing for development in many countries, recognizing
that investing in prevention is more cost-effective when compared to the cost of treatment and care;
HEALTH WORKFORCE
OP37. Continue to scale up efforts and strengthen cooperation to promote education and training,
development, recruitment and retention of competent, skilled and motivated health and care
workers, including community health workers and mental health professionals, guided by target 3.c
of the 2030 Agenda;
OP38. Encourage incentives to secure the equitable distribution of qualified health workers and
community health workers, especially in rural, hard-to-reach and underserved areas and in fields
with high demands for services, including by providing decent and safe working conditions and
appropriate and timely remuneration for health workers working in these areas, consistent with the
World Health Organization Global Code of Practice on International Recruitment of Health
Personnel, avoiding active recruitment from the 55 countries facing the most severe health
workforce vulnerabilities,1 while ensuring that bilateral labor agreements entail proportional benefit
for both countries of origin and destination and protect migrant health workers, noting with concern
that highly trained and skilled health personnel continue to emigrate, which weakens health systems
in the countries of origin;
New between OP 38 and 39
Develop, implement, monitor, finance and enforce the necessary laws, regulations, and
policies to implement decent working conditions for health and care workers, which includes
to protect and safeguard their health, safety, and human rights; offer supportive and enabling
work environments with life long learning and career development, adequate and timely
remuneration, equipment and manageable workload and ensure their participation in the
regulatory and governance process.
OP39. Address gender and youth disparities and inequalities within the health and care
workforce. Provide better opportunities and decent work for women to ensure their role and
leadership in the health sector, with a view to increase the meaningful representation, engagement,
participation and empowerment of all women in the workforce at all levels, and take measures
towards fair employment practices and to eliminate gender biases and address inequalities,
including the gender pay gap, by appropriately remunerating unpaid and underpaid health and care
workers, including community health workers;
MONITORING, ACCOUNTABILITY AND MULTI-STAKEHOLDER ENGAGEMENT
OP44. Set measurable national targets and strengthen national monitoring and evaluation
platforms, as appropriate, in line with the 2030 Agenda for Sustainable Development, to support
regular tracking of the progress made for the achievement of universal health coverage and the
health workforce by 2030 at global, regional and national levels; particularly data that enable to
reflect within country inequalities.
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OP51. Request the Secretary-General to continue engaging with Member States to sustain and
further strengthen the political momentum on universal health coverage and, in close collaboration
with relevant United Nations agencies and other stakeholders, including regional organizations, to
strengthen existing initiatives that are led and coordinated by the World Health Organization to
provide assistance to Member States, upon their request, towards the achievement of universal
health coverage and all health-related targets of the Sustainable Development Goals; and to
support/provide guidance on intersectoral collaboration and policies.
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