CSEM advocates for the following:
1. Leave No One Behind
Civil society is often best placed to gain access to, represent, and prioritize the most marginalized key populations. To leave no one behind, civil society is a critical voice to ensure that: people have the necessary access to equitable health services; they are informed of health policies; can input into their country’s health systems strengthening efforts.
2. Increase Public Financing for Health
- National governments should progressively increase their investment in health by either moving towards allocating at least 15% of their annual budget to health, or up to 5% of their annual GDP as government health care expenditure, as contextually appropriate. This increased budget for health should be raised through mandatory and fair pooling mechanisms (such as improving tax revenue collection, setting up social health insurance) with everyone receiving services according to their need. These services should be free at the point of use.
- National governments should give priority to primary health care linked to essential care packages that are defined by country-level needs and priorities required to meet SDG target 3.8.1, with a concrete plan to ensure the removal of direct cash payments as an urgent measure.
- Donor governments should provide funding in alignment with countries’ plans, the aid effectiveness principles and the WHO recommendation of funding levels not below 0.1% of GNI. This is critical in fragile and conflict-affected settings, where much of the health system is supported by foreign aid. Donors should further support low-income countries to bridge significant finance gaps. The international community should support countries to grow their fiscal space by tackling undermining practices like tax evasion and avoidance, and lifting harmful macro-economic policy conditions.
3. Improve Involvement of CSOs and Citizens, Transparency and Accountability at All Levels
4. Invest in Health Workers
Calls to Action
To achieve our advocacy targets and ensure that advocacy for leaving no one behind happens at every level, from local to global, we will build the constituency of the CSEM: increase the number of organizations that are part of the CSEM, particularly mobilizing actors who work for health equity and reaching out to the underserved; integrate them into our work; collaborate with other constituencies and sectors. Together, we will call for:
- Global Monitoring Report – The next Global Monitoring Report on progress towards UHC – due in 2019 – should focus on the ‘leave no one behind’ principle. It should underpin commitments and progress made, and challenges faced in meeting this principle, including in some of the most difficult settings.
- Data on Vulnerable and Marginalized Populations – At country level, national health plans and policies need to assess which populations are currently left behind, and have insufficient access to health services and explicitly target those populations most in need. Furthermore, they should identify scale up plans for access to promotive, preventive, curative, rehabilitative and palliative health services.
- Accountability – Country health plans and policies need to be underpinned by a healthcare financing strategy, which is supported by each country’s Ministry of Finance. This guarantees the resources to implement the national health plans and policies and cements the role of civil society in holding governments to account for what they have promised to deliver.
- Financing for Health – All UHC plans need to include specific action points to abolish patient fees/direct patient payments for the reduction and progressive abolition of out-of-pocket expenses. Governments should progressively increase their investment in health, moving towards allocating at least 15% of their annual budget to health, or at least 5% of their annual GDP as government health care expenditure, as contextually appropriate. Priority should be given to primary health care linked to essential health services packages, and where they exist, free health care policies need to be effectively implemented.
- Donor Support – International funds, institutions and bilateral donors can and should assist in enlarging a country’s pool of financial and technical resources for the health system and UHC, including when a government’s budget for the health system falls short, despite steps to raise more domestic revenue for health. This should include helping countries to grow their fiscal space by tackling harmful practices like tax evasion and avoidance.
- Private Sector Participation – When the private sector participates in financing, developing and delivering health products and services, we call for government regulation, to ensure adequate ethical safeguards to prevent conflict of interest and mitigate potential excessive profits, as well as ensuring that public funding and policies safeguard equitable, quality public services as a right.
- Health Worker Investment – Wherever possible, UHC policies, plans and reports should include a focus on investing in the health workforce, especially at primary level. Community and frontline health workers are under-resourced and insufficiently trained in some of the diseases and health issues most frequently faced by the poorest groups, yet they play a key role in linking the most marginalized communities to the health system. Whenever the role of HWs is essential in a country’s health care response, any investment allocated and made to build their capacity should be made explicit.
Recommendations to Civil Society:
CSEM recommends that all civil society health advocates adapt political messages around UHC alongside disease-specific messages. This will reduce fragmentation and competition among health initiatives, which can get more government buy-in to prioritize SDGs.
- When arguing for action on your specific health topic, also call for UHC that increases domestic and donor resources for health and commits to leaving no one behind
- Encourage other civil society health actors to learn about UHC core messages and how to influence governments on this, in line with their respective topic
- Take part in global and country campaigns for International UHC Day on 12 December
- Facilitate citizen engagement on health, and empower people and communities to hold governments accountable for their health commitments
- Prepare your arguments from equity angle and part of the benefit packages of UHC
- Promote comprehensive, people-centered primary health care rather than creating silos
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