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Universal Health Coverage: a shared vision beyond 2015?

Von Thomas Schwarz / Medicus Mundi International MMI

The existing fragmentation of the global health advocacy community is worrying. To overcome this situation people of the health community should agree on an overall understanding on what they want. Universal Health Coverage could work as a common, holistic concept for integrating the global movement for health, writes the author.

Why should nongovernmental organizations dealing with international health cooperation get involved in global health advocacy, in high politics, in debates on issues such as the reform of the World Health Organization or the development of a Framework Convention on Global Health?

As many other NGO representatives you might answer: "Good question. I do not know why I should. And now please let me continue my work."

I do not mind. I even do not mind if you ask me: "And anyhow, what do you think that we can change at a global level?" I also agree with you that it makes sense to share tasks among people and institutions working in different ways towards the shared vision of health for all.

Nevertheless, I do not like to ask those academics specialized in global health issues or that couple of highly professional lobbyists working for those few highly professional international NGOs to represent my voice and my interests in the global arena.

Also in smaller NGOs and NGO networks there are people interested and able to get involved in global health issues. Not following all the "hot" issues, but some of them. Not knowing everything, but trying to learn and share. Not getting always involved, but sometimes at least. I will do this - join me, if you dare.

Fragmented global health advocacy

Social advocacy aims at changing the “what is” into a “what should be” ¬- a more decent and more just society. In a globalized world, social change requires advocacy beyond countries’ borders: transnational advocacy and international advocacy, based on international networks and coalitions.

What really worries me is the existing fragmentation of the global health advocacy community: The HIV/AIDS people, the Mother and Child Health people, the Reproductive Health and Rights people, the Noncommunicable Diseases people, the Human Resources for Health people etc., all act as independent thematic lobbies on the global “market for attention”, mainly around events such as the recent World Health Assembly, the G20 summit and the Rio+20 conference, promoting and pushing particular interest only – and reporting back success stories such as “great, there is a sentence on … in the … declaration!”.

We can either accept this reality or only care for our niche in this market (let us say HIV/AIDS…), or we can undertake steps to overcome the fragmentation. For this we need an overall understanding on what we want and who are our allies. For me, a key part of the identity of the Medicus Mundi Switzerland and International Networks is that we see health in an integrated, holistic and systemic way, therefore focusing our attention on health systems and social and political determinants of health rather than on particular topics.

Universal Health Coverage

34 years after Alma Ata and its powerful call for “Primary Health Care” and “Health for All”, there might be a good opportunity today to create again an integrated global movement for health around the new slogan of “Universal Health Coverage”. With her speech at the World Health Assembly in May, WHO Director General Margaret Chan took herself the lead in the “UHC movement”:

"In my view, universal coverage is the single most powerful concept that public health has to offer. It is our ticket to greater efficiency and better quality. It is our saviour from the crushing weight of chronic noncommunicable diseases that now engulf the globe. Universal coverage is the umbrella concept that demands solutions to the biggest problems facing health systems. That is: rising health care costs yet poor access to essential medicines, especially affordable generic products; an emphasis on cure that leaves prevention by the wayside; costly private care for the privileged few, but second-rate care for everybody else; grossly inadequate numbers of staff, or the wrong mix of staff; weak or inappropriate information systems; weak regulatory control, and schemes for financing care that punish the poor. Universal coverage is the hallmark of a government’s commitment, its duty, to take care of its citizens, all of its citizens. Universal coverage is the ultimate expression of fairness."

This is not only enthusiasm, but also strategic speaking: In order to save health as a key development issue after the “decade of global health” (2000-2010) it makes sense that the World Health Organization goes for incorporating health as “universal health coverage” into the post-MDG framework. And there is nothing wrong with this.

The members of the Medicus Mundi Network share the vision of access to health and health care as a fundamental human right. We know that keep health care sustainable and affordable is a huge challenge, and we are convinced that a key strategy is to strengthen the health system as a whole. If “Universal Health Coverage” is the way our vision and an integrated strategy are promoted these days, let us be happy that things keep moving.

*Thomas Schwarz is Executive Secretary of the Medicus Mundi International Network and a member of the team of Medicus Mundi Switzerland. Contact:,

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