Global health governance after 2015

Abstract

The report of the High-Level Panel appointed by the UN SecretaryGeneral to advise on the global development framework beyond 2015 has been rightly acknowledged by Michel Sidibe and Kent Buse (June 22, p 2147) for its inclusiveness and its emphasis on global partnerships and accountable institutions. However, universal health coverage was not included as a goal or target, despite its emergence as a unifying theme among the global health community. The targets proposed by the High-Level Panel are expressed along specific health challenges, interventions, and diseases, which might further deepen the current fragmentation of health delivery platforms, already seen by many as an undesired side-eff ect of the current Millennium Development Goals. While we fully share the HighLevel Panel’s concern for sexual and reproductive health, why emphasise the notion of universal access with respect to one health area only? Would it not make more sense to invest in comprehensive health-care delivery platforms? We fear that the proposed targets will lead different advocacy networks to aim for clearer and more ambitious targets for the issues of their concern, and thus they will be pitted against each other, while universal health coverage anchored in the right to health would allow united advocacy. It has been argued that universal health coverage is difficult to measure. That might be true, but the same holds for several goals and targets proposed by the High-Level Panel. If we can fi nd good indicators for proposed target 1c—“Cover x% of people who are poor and vulnerable with social protection systems”—we should be able to fi nd good indicators for universal health coverage. One of the targets proposed—to reduce the maternal mortality ratio— could in fact be useful for universal health coverage. Why do we support universal health coverage? Simply because we share the High-Level Panel’s vision of a world where the principles of equity, sustainability, solidarity, respect for human rights, and shared responsibilities in accordance with respective capabilities, have been brought to life. And, as FuenzalidaPuelma and Scholle Connor concluded after examining the right to health in the constitutions of several countries for the Pan American Health Organization, the right to health would be better understood as a right to health protection, including two components: a right to health care and a right to healthy conditions. That is why we propose one health goal—the realisation of the right to health for everyone—and two targets: comprehensive universal health coverage anchored in the right to health and a healthy social and natural environment for all, as proposed in the recent Go4Health report.