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UHC anchored in the right to health- Are we there yet? Goals and Governance for Health (Go4Health) at the Prince Mahidol Award Conference

By Rachel Hammonds
on February 4, 2016

After spending over three years tracking the evolution of the health related Sustainable Development Goals (SDGs),  the Go4Health Consortium Team (a.k.a. Gophers) held its final dissemination seminar at the Prince Mahidol Award Conference ( PMAC ) in Bangkok.

This year’s theme, “priority setting for UHC”, provided a focus for our end of project reflections and session entitled “projecting implementing priorities”.

However, our session was complemented, or perhaps even overshadowed, by the ‘opening night’ dinner debate which saw Gopher Prof. Larry Gostin debate Prof. Dean Jamison on the resolution “This House believes that cost-effectiveness is more important than human rights considerations for setting priorities in health in real life situations.” Before examining what we learned from that debate I will reflect on the session and conclude on where Gophers will focus post-Go4Health.

In actively engaging with the post SDG process Go4Health advanced two goals, UHC anchored in the right to health and a healthy environment. Of the many themes tied to these goals that emerged in the final session I will focus on two: the role of local participation in developing the SDGs (and in particular, the challenge of linking local priorities to global decision making)  and the rise of the global health security agenda – does it displace or complement the right to health agenda championed by Go4Health?

Go4Health researchers engaged with communities that are marginalized in different regions of the globe, including Latin America, sub-Saharan Africa and South East Asia. The importance of addressing government accountability for action, or non-action on realizing health rights was a common theme that emerged from all regions. Claudio Schuftan of the People’s Health Movement challenged our findings as being more of the same and asking why we did more research when we know the problem? The ensuing heated debate showed he had struck a chord, with discussion ranging from how activist should academics be, when is there enough evidence and when do activists become arrogant? Most agreed that if beggars are to become rights claimants, more human rights education is needed and that engaging with marginalized communities that are marginalized is a tool for education and empowerment.  As several Gophers from BRAC’s James P Grant School of Public Health in Bangladesh argued, communities know their rights but holding those responsible accountable for violations and changing policy remains a huge challenge.

In the presentations surveying the evolution from the MDGs  to the SDGs several Gophers noted how challenging it was to research a moving target – i.e. the post-2015 MDG negotiations merging with the Sustainable Development Agenda. Who are the relevant policy makers to interview?  When you add the Ebola and Zika pandemics into the mix, tracking the pivot towards the global health security agenda and its impact on global health governance (including questions about WHO’s effectiveness) creates a real headache for researchers. Larry Gostin, one of the most plugged in people on the global health planet, clearly finds it exciting and challenging and stressed the need for UHC to go beyond health care – or as Lisa Forman, of the University of Toronto, elegantly termed it, “think outside the UHC box” and address issues like trade, taxation, macro-economic policies and  the environment.  Larry reiterated his call for civil society inclusion in global health governance – tying nicely to the earlier sessions – and the importance of different global health constituencies working together and not siloeing.

Lawyer versus economist

Which brings me to the opening dinner debate where Larry convinced the PMAC crowd that a rights based approach to advancing UHC brings more than a purely cost effectiveness approach.  In Thailand, the result was not surprising as Thais know that “for the triangle to move the mountain” (i.e. to launch UHC) you need to appeal to the public and politicians to solve seemingly intractable problems. So, Larry’s ‘victory’ in this debate was not surprising. Having said that, cost effective technocrats and human rights lawyers are increasingly learning how to work together, in the SDG health era. Or so we hope.

 

Beyond Go4Health

So where does Go4Health go now? The G.O. behind Go4Health – Gorik Ooms – has shifted his attention and energy to defending human rights defenders. As he noted in the Go4Health session, every wave, every gust of wind is part of your path to your final goal. Go4Health demonstrated that medical doctors , lawyers and political scientists can work together and learn from each other. The product of such collaboration can be very rich. So, even though 29 February 2016  is the formal end date of the project, Gophers have found numerous ways to continue working together and will continue to attack disciplinary silos. Finally, many Gophers will now look at the impact of global health security concerns on global health policy and governance. Accountability , inclusion, legitimacy and social justice will remain key concerns and critically engaging with the UHC 2030 Alliance and its work on a UHC accountability framework one entry point. Go4Health thus continues, but in a different form because we are not there yet. UHC is not yet anchored in the right to health.

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