Universal health coverage: a game changer for HIV?

By David Ruiz Villafranca, Marielle Hart

By David Ruiz, Stop AIDS Alliance's senior policy advisor, and Marielle Hart, Stop AIDS Alliance's policy lead.

Could the World Health Organization’s (WHO) focus on universal health coverage finally get governments to live up to their obligation to invest in the right to health?

<p>Winnie Nyawira is a young sex worker who used to use drugs. She is now enrolled on the methadone program at Malindi general hospital. Here she walks through the compound of KANCO in Watamu where she visits daily for lunch, support and other services offered by the KANCO team for people who use drugs. Winnie has been on the methadone programme for over a year and continues to do well.&nbsp;</p>Winnie Nyawira, a young sex worker who used to use drugs, walks through a healthcentre in Watamu, Kenya, to receive methadone and other services © Corrie Wingate for the Alliance 2017

At the 71st World Health Assembly (WHA, 21-26 March), the first under the leadership of the new Director-General Dr Tedros Adhanom Ghebreyesus, member states will endorse the World Health Organization’s (WHO) new 2019-2023 General Program of Work. Universal health coverage (UHC) is one of three key priorities named in the strategy.

Recently, Dr Tedros wrote to every head of state asking them to make three concrete commitments towards achieving UHC, such as providing unwavering political support, using domestic resources to invest in UHC's implementation, and devising a strategic national health plan with UHC as its focus. Each country has been asked to report on its progress at the WHA.

Simply expanding health coverage is not sufficient from a human rights perspective. For UHC to be effective, and to truly deserve the description of ‘universal’, it must be anchored in the right to health and serve marginalised and key populations. It is crucial that quality health services not only exist but that everyone, without discrimination, can reach them.

For UHC to be effective, and to truly deserve the description of ‘universal’, it must be anchored in the right to health and serve marginalised and key populations.

Recognising barriers

The new WHO strategy recognises that “persistent barriers to accessing health services” act as the main challenge to making progress towards UHC, and that efforts to support UHC “must focus on reaching those whom services are not reaching, such as marginalised, stigmatised and geographically isolated people…”. Crucially, the strategy recognises that “equity of access” is central to UHC.

As the UHC movement now goes beyond biomedical approaches to address accessibility, non-discrimination and equity, it has become a progressive force, similar to the HIV movement itself.

Connecting health and rights

The global HIV movement has been a leading influence in connecting health and rights. From the onset of the epidemic, the effort of the HIV movement to control and eliminate HIV and AIDS has been anchored in human rights. From day one, civil society and communities have demanded access to HIV treatment and services, calling for the human rights of people most affected by HIV to be respected, and for community-led HIV services to be supported.

Concepts such as the Positive Health Dignity and Prevention approach, which places a person living with HIV at the centre of managing their own health and wellbeing, are typical of the transformative thinking and action that is a trademark of the AIDS response. Crucially, the AIDS movement has been party to mobilising unprecedented amounts of international and domestic resources, leading to serious progress in increasing the number of people on treatment and in bringing down AIDS-related deaths. The world is now on track to get 30 million people living with HIV on treatment by 2030, but the last push will be the hardest, reaching the most marginalised populations and truly leaving no one behind.

Concepts such as the Positive Health Dignity and Prevention approach, which places a person living with HIV at the centre of managing their own health and wellbeing, are typical of the transformative thinking and action that is a trademark of the AIDS response.

Inadequate funding for human rights

Despite these amazing gains the AIDS response, and the UHC agenda as a whole, are still being held back by persistent barriers to health such as discrimination, stigmatisation, criminalisation, and structural issues such as gender inequality.

In addition, although the AIDS movement has been successful in mobilising funding, very little of this has gone towards human rights. Programmes devoted to rights in the HIV response are still abysmally low, estimated by UNAIDS as less than 0.13% of total annual global HIV spending. Ironically, very little funding is also being invested in local civil society and community-led action, which comprised  1% of total global resources for the HIV response in 2016, short of the 4% recommended by UNAIDS.

So will the UHC movement become a game changer for the HIV response? Will governments live up to their obligation to invest in the right to health for all under the UHC agenda? Will they invest in effective and friendly services for communities most affected by HIV, including sex workers, people who are lesbian, gay, bisexual, transgender or intersex, and people who use drugs? These answers will determine whether UHC succeeds or fails.

So will the UHC movement become a game changer for the HIV response? Will governments live up to their obligation to invest in the right to health for all under the UHC agenda?

Make UHC a reality

So far, the new WHO strategy and Dr. Tedros’ leadership is encouraging. But it is now up to the member states to take action and make UHC a reality. They can do this by realising:

  • A person-centered UHC that focuses on the health (and overall wellbeing) of all individuals rather than on diseases alone.
  • A human rights-based UHC that enables equitable access to health services for marginalised populations and removes all socio-political, cultural and economic barriers to accessing these services such as stigma, discrimination and fear of arrest.
  • A community-based UHC which considers community and civil society participation as essential for the success of UHC and significantly increases investment in community-based and community–led health services, advocacy, and mobilisation.

If this happens, huge steps forward on many health issues, including HIV, will be made and millions of people’s lives will be better as a result.

Follow the World Health Assembly on Twitter via the hashtag #WHA71.