Behind-the-scenes with Wemos at the UN high-level meetings on health

Our global health advocate, Barbara Fienieg, attended the high-level meetings on health at the 78th UN General Assembly in New York.  She read out a joint statement by Wemos and our partner Akina Mama wa Afrika, during the meeting on universal health coverage (UHC), calling on member states to reform the international financial architecture to address unsustainable debts and illicit financial flows. The high-level meetings concluded with member states adopting three political declarations: one on UHC, one on pandemic preparedness, prevention and response (PPPR), and one on tuberculosis (TB). The high-level meetings provide a valuable advocacy platform for us, but the processes and mechanisms behind them can be complex to navigate. We interviewed Barbara, to hear about her experiences and gain a better understanding of the high-level meetings and their implications.

Barbara Fienieg speaking at the side-event: Accelerating Progress towards Health Equity: High-Level Commitments to address inequality gaps

What are the UN high-level meetings? Why are they important?

The UN high-level meetings are convened by the UN General Assembly, the UN’s main decision-making body, representing all 193 member states. These meetings are politically important as they reflect – or should reflect – the political will of countries to tackle issues together with an agreed-on course of action. The outcome is captured in a document called a ‘political declaration’ endorsed by heads of state. While not legally binding, a political declaration is significant because it outlines standards for member states’ conduct. 

This year, three high-level meetings on health took place: on universal health coverage (UHC), pandemic preparedness, prevention and response (PPPR), and tuberculosis (TB). Is it usual to have so many health-related topics on the agenda?

To have three high-level meetings on health during the General Assembly was unique and a first-time occurrence. It placed health at a prominent place on the global agenda, acknowledging we have pressing issues in global health that require joint and immediate action.

2023 marks the mid-point review of the Sustainable Development Goals 2030. Unfortunately, we see that the world is very off-track on most health and health system goals as detailed in the recent report of the World Health Organization and the World Bank. Over half of the global population still lack access to essential health services, and 2 billion people suffer financial hardship to pay healthcare expenses. Services covering reproductive, maternal, newborn and child health have seen minimal improvement in recent years. So, there is an urgent need for action to improve health worldwide.

There were discussions about the content of the declarations, for example about (refraining from) unilateral coercive measures. Nevertheless, the high-level meetings culminated in the adoption of the political declarations on UHC, PPPR, and TB. This helps to hold members states accountable for their actions on these topics. 

What advocacy opportunities do civil society organizations have at the high-level meetings?

The greatest opportunity for civil society organizations to influence these high-level meetings is by providing input on the political declarations, which we as Wemos did. My work around the high-level meetings has three components:  

1. Internal analysis: within Wemos, we analyze the challenges in achieving UHC, checking facts and figures and using what I call a health equity lens. The guiding question is: What should governments do to ensure everyone, everywhere, has access to high-quality and affordable healthcare?
2. Mutual learning with civil society organizations: we listen to partner organizations in our Make Way programme on sexual and reproductive health and rights and to other global networks we are part of. It is a mutual process of learning and alignment. Then we decide our main advocacy points and actions to influence the UN member states.
3. Advocacy: in partnership, we participate in various processes to advocate health equity. For the political declarations, we shared inputs for the draft texts and joined events such as the World Health Assembly earlier this year, and the high-level meetings during the UN General Assembly. In the meetings, I was able to sit together with representatives from UN member states, Ambassadors, and other non-state actors.

Beyond the high-level meetings, we also advocated in many open events, a rally, and closed-door meetings during the UN General Assembly.  

And you organized a side-event in New York, right?

That’s right. Together with Buky Williams, lead on sexual and reproductive health and rights from Akina Mama wa Afrika, I hosted the side event ´Accelerating Progress towards Health Equity: High-Level Commitments to address inequality gaps´. During the session we dove into elements that are needed to ensure equitable progress in UHC, such as strengthening public health systems that give access to quality services to all, policies that are informed by the needs of populations and their intersecting vulnerabilities, and the current barriers and solutions to raise sufficient domestic public finance.  

We deliberately planned the event ahead of the high-level meetings as we anticipated quite some discussion about what governments would be willing to commit to when it comes to reaching UHC, PPPR and health equity. A fantastic group of panelists helped us realise this. Wanja Ngure, from UHAI East African Sexual Health and Rights Initiative, brought in the perspective of communities and populations that are often excluded from essential health services. Buky Williams called on governments to assume the responsibility to make sexual and reproductive health services available for all. While, Jean Claude Mugunga, from Partners in Health and professor at the University of Global Health Equity Rwanda, described a country’s journey to build an inclusive healthcare and health financing system from scratch and by pointing at the problem of the severely limited overall public purse. Attiya Waris, UN independent human rights expert on debt and other financial obligations, argued for measures at macro and international level that would financially capacitate governments to raise sufficient public revenue.

We were lucky to have an active audience of over 30 in-person participants in UN Church Center, despite the extra security checks that the New York police had put up, and nearly 30 online participants, all joining in the conversation. The tangible fruit of our side event was a word cloud with heavily boiled down action recommendations to the leaders of the world that came out of the discussion with the audience. Being in the Big Apple, we gave it the shape of an apple.

During the high-level meeting on UHC you had the opportunity to give a statement. What was that like?

We did not expect to have a chance to speak, because the previous panels on PPPR and UHC had only allowed a handful of non-state speakers to come to the microphone. But to my surprise, I was invited to speak as a representative of the civil society in Panel 2 ‘Aligning our investments for health and well-being‘, and to upload our statement in the UN e-statements of that session.  Actually, I wish a representative of our partner Akina Mama wa Afrika would have been able to take the floor. But still, it was good to get our joint messages amplified once again! 

The time to make a statement in those UN rooms is quite short. How did you and Akina Mama wa Afrika decide which topics you wanted to spotlight?

The time to read our messages is very short indeed – only 2 minutes. If you go over, you risk being muted. We decided to focus on the central recommendations for action with two key questions in the back of the mind. First, which political commitments in UHC and PPPR are key to close inequality gaps in health access while promoting gender and health equity? And second, which of these political commitments had been crucially missing in the 2019 political declaration on UHC and were still missing in the draft 2023 UHC and PPPR declarations? 

What do Wemos and Akina Mama wa Afrika see as the priorities in the road towards UHC?

Governments and international actors must acknowledge that healthcare is a matter of public interest and public money. On the one hand, they must understand the needs of vulnerable groups and ensure to leave no one behind. One the other, they should strive to reform the international financial architecture and create frameworks for fair solutions to unsustainable debts and against illicit financial flows. 

Our joint statement with Akina Mama wa Afrika, is published on our website. There is also a video recording of me reading out the statement in the high-level meeting.