- The overriding goal of a post-2015 development agenda in health and healthcare should be achieving universal healthcare, accessible to all, with accountability of governments and institutions to their people for good health outcomes.
- Lack of equal access to healthcare is both morally wrong and macroeconomically inefficient. A healthy population is economically productive; disease and premature death cause poverty.
- Ensuring the right to healthcare for women and girls is critical.
- The lesbian, gay, bisexual and transgender community faces particular challenges in accessing adequate healthcare.
Speakers debated how to address the shortcomings in the current health Millennium Development Goals (MDGs) surrounding equity, human rights, financing and ownership.
MDGs 4, 5 and 6 directly address health issues, calling for reducing child mortality rates, improving maternal health and combatting HIV/AIDS, malaria and other communicable diseases. A number of countries have made significant progress towards these goals, but it has been spotty and inadequate. In formulating the post-2015 development agenda, speakers urged the world not to be timid, but rather to set bold and ambitious new goals.
Sustainable development cannot leave very poor and marginalised people behind. Lack of access to good quality healthcare is both wrong and inefficient in macroeconomic terms. In a vicious circle, poor health impedes poverty eradication, economic growth and sustainable development; while poverty causes poor health and premature death. Healthy populations are economically more productive. Basic living standards, particularly for women and children, must be achieved. People should not be dying from preventable diseases.
The World Health Organization (WHO) is committed to finishing the business of the MDGs, while looking to the post-2015 agenda. A key element of that agenda should be achieving universal healthcare (UHC). UHC requires good quality health services that are available to all persons without financial constraint. However, as no country can afford to provide all services to all people, it is critical to analyse what services are really necessary to address the important health issues in various countries and regions of the world.
UHC includes coverage of primary care, prevention, promotion, treatment, rehabilitation and palliative care. It rests on notions of equity and the right to health. UHC requires that governments and other institutions are held accountable to their people for health services and outcomes.
Achieving UHC should be the main thrust of the post-2015 health agenda, with a major focus on the health of girls and women. Females make up half the world’s population – and they make the other half. Women should not have to risk their lives in pregnancy and childbirth.
Senegal is moving towards a basic UHC programme, which focuses on using a solidarity fund to increase free access to healthcare; increased contributions to healthcare funds, and community healthcare funds to improve access to health services for the poorest and most marginalised people.
Civil society can play a major role in promoting and providing community healthcare and thus it should be supported and strengthened. However, civil society also needs to play an advocacy and watchdog role.
The post-2015 agenda must consider that members of the lesbian, gay, bisexual and transgender (LGBT) communities face particular problems in obtaining adequate healthcare services, including lack of knowledge of needs, poor quality of services where they exist, unavailability of services in many areas, and discrimination and stigma. A substantial majority of African nations criminalise same-sex relations. Admitting to being LGBT exposes individuals to arrest, harassment and violence. However, there is a growing gay rights movement in Africa, led by young people and supported by healthcare organisations and some government and religious leaders.
Promoting sexual and reproductive health is critical, but also controversial because some view it as containing hidden agendas to promote contraception, abortion and gay rights.
Technology and resources exist that can greatly improve health and healthcare. The major challenge is finding the political will. Donors have failed to meet funding commitments. Wealth has been created in developing countries, but it is not being channelled to the very poor, and income and wealth disparities are growing in developing countries. The European Union needs to advocate and promote social security for all.
Donor healthcare financing should be aligned with partner country policies and harmonised with other donors. Sustainable financing requires partner country participation and responsibility.