Universal Health Coverage’s evolving location in the post-2015 development agenda: Key informant perspectives within multilateral and related agencies during the first phase of post-2015 negotiations

Abstract

In 2001, technocrats from four multilateral organizations selected the Millennium Development Goals mainly from the previous decade of United Nations (UN) summits and conferences. Few accounts are available of that significant yet cloistered synthesis process: none contemporaneous. In contrast, this study examines health’s evolving location in the first-phase of the next iteration of global development goal negotiation for the post-2015 era, through the synchronous perspectives of representatives of key multilateral and related organizations. As part of the Go4Health Project, in-depth interviews were conducted in mid-2013 with 57 professionals working on health and the post-2015 agenda within multilaterals and related agencies. Using discourse analysis, this article reports the results and analysis of a Universal Health Coverage (UHC) theme: contextualizing UHC’s positioning within the post-2015 agenda-setting process immediately after the Global Thematic Consultation on Health and High-Level Panel of Eminent Persons on the Post-2015 Development Agenda (High-Level Panel) released their post-2015 health and development goal aspirations in April and May 2013, respectively. After the findings from the interview data analysis are presented, the Results will be discussed drawing on Shiffman and Smith (Generation of political priority for global health initiatives: a framework and case study of maternal mortality. The Lancet 2007; 370: 1370–79) agenda-setting analytical framework (examining ideas, issues, actors and political context), modified by Benzian et al. (2011). Although more participants support the High-Level Panel’s May 2013 report’s proposal—‘Ensure Healthy Lives’—as the next umbrella health goal, they nevertheless still emphasize the need for UHC to achieve this and thus be incorporated as part of its trajectory. Despite UHC’s conceptual ambiguity and cursory mention in the High-Level Panel report, its proponents suggest its re-emergence will occur in forthcoming State led post-2015 negotiations. However, the final post-2015 SDG framework for UN General Assembly endorsement in September 2015 confirms UHC’s continued distillation in negotiations, as UHC ultimately became one of a litany of targets within the proposed global health goal.

Stakeholders’ views on the strengths and weaknesses of maternal care financing and its reform in Georgia

“…For example, one of the participants of the focus group discussion mentioned that her mother had to pay all expenses for the last pregnancy. Moreover, epidemiological surveillance of maternal mortality done by the NCDC of Georgia showed that maternal mortality is higher among lower middle and low income groups because lower income groups utilize fewer maternal care services due to direct and indirect cost [21]. This is found in our study as well.…”

Persistent inequity in maternal health care utilization in Nepal despite impressive overall gains

“…The Sustainable Development Goals (SDGs) are an attempt to follow up on the successful creation of a united direction shaped by the Millennium Development Goals (MDGs). [1] The third SDG deals with health and places an emphasis on universal health coverage (UHC),[1] implicitly encompassing the notion of an equitable distribution of health services and outcomes. SDG 3.1 specifically mentions maternal mortality reduction.…”

Global health governance in the sustainable development goals: Is it grounded in the right to health?

“…As a consequence, WHO is constrained in terms of policy and direction, and there are equivocal perceptions of its capacity to drive the global health agenda. This was most recently evident in the critiques of its executive role in and leadership response to the Ebola outbreak (Gostin et al, ), and again in its failure to secure UHC as the overall SDG health goal (Brolan & Hill, ). At the same time, recognition of the centrality of WHO to global health governance is evident in proposals for a Committee C which would allow WHO to more effectively engage civil society, formalizing civil society's current significant contribution to global health governance (Kickbush et al, ).…”