Today, the High-Level Panel (HLP) submitted a report to the UN Secretary-General saying what should be in any post-2015 development agenda to replace the Millennium Development Goals (MDGs). Overall, there is much in the report to welcome, especially on extreme poverty and disaggregation of targets by income. We are delighted that there is a clear commitment to end all preventable child mortality. However, on health, we are disappointed that the panel has not provided a framework that could transform health inequalities in poor countries.
Concerns about health
An extensive health consultation run by the HLP produced a report recommending a new approach. It said that countries should set targets to improve health in all life stages, based on national analysis of the major causes of death and poor health, and recommended that the health sector should tackle these through the principles of universal health coverage (UHC). UHC is a wonderfully simple concept – that everyone is entitled to essential healthcare – which is fast gaining traction around the world.
We therefore expected the HLP to use this framework in proposing their targets. Although they say clearly that they support it, they chose instead to propose targets that follow on from the previous health MDGs. Continuing targets on HIV, child and maternal mortality, sexual and reproductive health are supplemented by vaccination, neglected tropical diseases and non-communicative diseases. All of these are extremely important, but UHC is the framework within which we expected to see them discussed.
Donors are much more comfortable talking about specific health topics than comprehensive health systems and the HLP report reflects that. It also takes on board all the lobbying by various groups and as one of those groups, Save the Children is pleased that many of our priorities have been reflected. However, we very much wanted UHC incorporated as the framework for the health sector, ending the discrimination that leaves so many of the poor without access to quality care – even in cases when their health issues are themselves priority areas for the MDGs.
Plenty to play for
The HLP is the start of a long process and the baton now passes to the Open Working Group for the Sustainable Development Goals. There is a growing consensus on the importance of UHC; we need the next stage of the process to be more ambitious and put it at the very centre of the debate.