Despite recent criticism, lack of funding and resulting weaknesses in some areas, the WHO is the multilateral institution with a legitimate mandate to address global health concerns.
In an era of increasing global pandemics such as Ebola and Zika; systemic problems such as market failure in the development and pricing of medicines; and continuing inequities in access to health systems and in health outcomes across the world, the role of the WHO and its annual assembly are more crucial than ever. And this year the newly agreed global Sustainable Development Goals provided a welcome focus on what can be achieved universally to improve health by 2030.
The Sustainable Development Goals formed the backdrop to the 69th World Health Assembly. Several themes of the SDGs were brought out in the WHO Technical Briefing on the subject: they are universal, covering all countries, both ‘developing’ and ‘developed’. The ‘Leave No one Behind’ mantra of the Goals suggests a clear and welcome focus on equity. Both of these factors are in stark contrast to the national average, poor country, approach of the Millennium Development Goals.
Despite the WHA’s focus on the target on Universal Health Coverage, outlined below, there are many targets and indicators relevant to health, from gender, to nutrition, to violence, to inequality. Policy coherence therefore was a key theme of discussions, but recognition of the need for a ‘health in all policies’ approach still needs further development to translate into practical policy recommendations.
Universal Health Coverage
Much of the discussion at the World Health Assembly focused on target 3.8 of the SDGs, which calls for the achievement of Universal Health Coverage. Indeed WHO Director General, Margaret Chan, described the UHC target as “the target that underpins all others. It is the ultimate expression of fairness that leaves no one behind.”
This is hotly disputed by some, such as the People’s Health Movement, to which Health Poverty Action is affiliated. They fear that the UHC agenda narrows the focus to financing and delivery of health services, at the expense of a more holistic Comprehensive Primary Health Care approach that includes social, economic and political determinants of health. And they argue that much of the momentum behind the current push for UHC come from institutions and donors such as the World Bank and philanthropic foundations, who wish to increase the role of private insurance in health financing, and private healthcare delivery.
The last-minute change to SDG indicator 3.8.2, which now sets insurance coverage (including private insurance) as a measure of UHC, underlines the need for the WHO to provide clear guidance and a vocal defence of the principles of equity and fairness which should underlie implementation of UHC. But, despite strong lobbying from civil society, the WHO secretariat were only able to hope for this indicator to be reviewed and amended next year.
Access to medicines and reform of the Research & Development system
Health Poverty Action has been closely following discussions on access to medicines and especially on the need to reform the way the development of medicines is funded, as part of our Missing Medicines campaign. An expert working group of the WHO met earlier in May to discuss action, and a resolution was passed at the World Health Assembly.
The text of the resolution is positive with a focus on R&D for public health need, not profit. The WHO will set up an Expert Committee to provide advice on prioritisation of health research, and establish a Global Observatory on Health Research and Development to collate data and provide information to identify gaps in research. No financial target was discussed, but the WHO secretariat has been tasked with presenting a proposal for a voluntary pooled fund which will be discussed at the next Executive Board Meeting and finalised at next year’s WHA.
Unfortunately the establishment of a global R&D agreement was not discussed but the resolution has called for another open-ended meeting to discuss R&D reform ahead of next year’s WHA. Overall the resolution has potential, but the question is whether any of these proposals receive the funding and genuine commitment to make them a reality, otherwise the whole approach could quickly become unstuck.