IDDC reaction to the High Level Meeting and the Political Declaration on Universal Health Coverage
Political Declaration on Universal Health Coverage that marks some steps
forward, but demonstrates the weaknesses of global decision-making in
delivering on health equity
Universal Health Coverage (UHC) has stagnated and is backsliding. 4.5
billion people were not covered by essential health services in 2021. Two
billion people had financial hardship in 2019 because they had to spend out of
pocket on health (WHO, 2023). Persistent
health inequities mean that persons with disabilities face, on average, much
poorer health and functioning than the general population. Persons with
disabilities have 2.4-fold higher mortality rates than those without
disabilities and they are missing 10 to 20 years of life expectancy (WHO,
As a group non-governmental organisations and
organisations of persons with disabilities that are members of the
International Disability and Development Consortium (IDDC), we have joined
forces to advocate for concerted action toward UHC. We have called to tackle
inequalities across the continuum of care, with increased investments in inclusive
health systems that are people-centred, community-based, and founded upon
primary health care and whole-of-society approaches.
We welcome that a new Political Declaration was finally adopted at the High Level Meeting on September 21st, despite the bumpy path of negotiations ahead of the High Level Meeting.
Political Declaration on UHC marks some important steps forward in comparison
with the previous 2019 Political Declaration, which we welcome, namely:
language on health inequities experienced by persons with disabilities, as well
as on the empowerment, participation and inclusion of women, children, youth,
older people, and persons with disabilities. A specific call to ensure
availability of and access to health services for all persons with
disabilities, to enable their full participation in society and achievement of
their life, in line with the Convention on the Rights of Persons with
to advancing comprehensive approaches and integrated service delivery, with
specific reference to the situation of persons with psychosocial disabilities.
on primary health care, to bring health services closer to where people live
and make them more affordable.
language on scaling up action to meet the growing needs of the rapidly ageing
population, including noting the United Nations Decade of Healthy Ageing.
language on rehabilitation, including via recognition of the increasing and
largely unmet needs, in line with the Resolution adopted at the World Health
Assembly earlier this year.
recognition of assistive technology as part of health technologies, and of the
challenges to access them.
language on the need for long-term care and support, including home and
community care services.
However, we are concerned that, while Member States
jointly expressed deep worries regarding the lack of progress and the
increasing inequity, the commitments in
the Declaration are not sufficiently “action-oriented” to effectively tackle
inequities and expand access for all, and it will be difficult to track
progress in the implementation phase. While the Political Declaration anchors
key principles to realize the right to health for all, concrete actions must
now be taken by governments, donors, and other stakeholders, in order to
translate these principles into reality.
We are also deeply concerned that consensus on such a pivotal topic was not reached on multiple occasions
during the negotiations due to contentious issues that are geopolitical in nature,
the current financial and economic crises, and diverging views over sexual and
reproductive health and rights. As a result, language on burning and
controversial issues was watered down, and in too many areas the 2023
Declaration simply reiterates the agreed text from 2019.
Furthermore, the adopted Declaration demonstrates that
health systems continue being geared solely around the reduction of mortality
and morbidity, lacking a comprehensive
approach to health and well-being. Thus, it is unfortunate that the notion
of “functioning” (the WHO-recognised health indicator, alongside mortality and
morbidity) is absent in the text.
It is also deeply regrettable that the mechanisms for
participation of civil society in the multistakeholder hearing and in the High
Level Meeting were neither effective, nor inclusive. Voices from the Global South and of marginalized groups, including
persons with disabilities, were underrepresented, due to the last-minute
approval of registrations (not allowing sufficient time for visa requests), the
in-person format (with high costs for travels and stay), a lack of clarity on
the modalities to present statements, and the limited consultations at country
and global levels. These non-inclusive modalities were not in line with the UN
Disability Inclusion Strategy. In a global context of shrinking space for civil
society, we expect that UN processes, such as UHC, are exemplary and genuinely
inclusive to facilitate the role that civil society should play in delivering
We should learn from the shortcomings of this process
and build on the renewed commitments that it frames. Universal health coverage
is essential for realising human rights, sustainable development, social
justice and inclusion. It is clearly
time to act, beyond political divisions and with the meaningful participation
of individuals and groups who are still left behind.
Please also see our requests and statements for inclusive UHC here: More than 70 organisations call for world leaders to deliver health equity for persons with disabilities and older people in progress towards UHC – IDDC (iddcconsortium.net)