Post-2015, the MDGs and Health – a lot done, more to do!

Eoghan Walsh Global Health, HIV & AIDS, Sexual and Reproductive Health

A remote health centre in Tsangano and the maternity clinicEvery so often, to give a voice to other people and other perspectives, DSW is delighted to host contributions on the blog from partner organisations. It gives us and our partners a chance to start a conversation on issues that are important for us. The opinions expressed in guest blogs do not necessarily reflect those of DSW.

logoThis week, Marielle Hart of the Stop AIDS Alliance, a partner of Action for Global Health, gives us an update on the post-2015 negotiations and the position of health and SRHR. Dive in!

For the past two years, Action for Global Health (AfGH) has been actively engaged in the myriad of official post-2015 UN consultations, Member States conversations and civil society discussions, advocating for a comprehensive global vision for health after the Millennium Development Goals (MDGs).  With less than 500 days to go until the MDGs expire, progress can be reported in each of the health goals (MDG 4, 5 and 6 – click the links to read more about what these mean) but it is uneven, and the most marginalised and excluded people continue to be left behind.

UN Open Working Group on post-2015

The UN Open Working Group on the Sustainable Development Goals, a group of UN Member States tasked with proposing the new development goals, recently finalized its work. It adopted an Outcome Document which will provide the basis for the intergovernmental negotiations among UN Member States in the coming year, ultimately leading to the adoption of the new post-2015 Development Framework in September 2015.

MDG500aThe Outcome Document shows that there is widespread agreement that the new post-2015 framework should build on the current health MDGs, advancing the unfinished business of MDGs 4, 5 and 6 with renewed and more ambitious targets while also addressing emerging health priorities, all under one overarching health goal. We are pleased with the Open Working Group’s formulation of the health goal, which is in line with AfGH’s messages around a health-outcome focused goal which is not too narrowly focused on access to services or health systems strengthening alone. Goal 3 in the Outcome Document proposes: “Ensure healthy lives and promote well-being for all at all ages” reflects the importance of placing health in a broader context and taking into account the social determinants of health.

Progress on UHC

We also welcome the inclusion of target 3.8 on Universal Health Coverage. AfGH has been a strong advocate on Universal Health Coverage in the past years, recognizing that all people, regardless of their social or economic status, should have access to the quality services they need. We strongly pushed for specific attention to marginalized and vulnerable groups while working towards Universal Health Coverage to ensure true equitable access and leave no one behind. To our great disappointment, while marginalized and vulnerable groups had been included as part of the UHC target in earlier drafts from the Open Working Group, it ultimately proved too contentious. There is still a lot of work ahead of us, as a network of civil society organizations concerned about realising the right to health and ensuring equity at all levels, to convince Member States that Universal Health Coverage can only be achieved if dedicated efforts are being made to reach the most marginalized.

Another key AfGH advocacy ask was to have a stand-alone goal on promoting equality in a broader sense (in addition to gender inequality and we are pleased to see the Open Working Group’s proposed goal 10
on reducing inequality between and within countries. In many countries across the world, at all income levels, certain groups of the population are excluded, marginalized and stigmatized, due to poverty, religion, disability, sex, ethnicity, sexual orientation and other factors. To ensure equal opportunities and reduce inequalities of outcome, it is vitally important that this goal is maintained in the final Post-2015 Framework with specific targets to address discriminatory laws, policies and practices, and promoting the social, economic and political inclusion of all people. This proved to be another contentious issue in the Open Working Group negotiations, as earlier proposed language on “the rule of law” and “ensuring equal access to justice for all” was not supported by countries like Russia and conservative religious States.

SRHR advocacy

We have been successful in our advocacy in joining forces with the SRHR community to ensure the proposed health goal includes a target on ensuring universal access to sexual and reproductive health care services, including for family planning, information and education (target 3.7). Whereas this target is not as strong as we wanted as it excludes a reference to sexual and reproductive rights (SRHR), it was a big struggle to get it included under the health goal at all. Many Open Working Group Members initially only accepted a reference to SRHR under the gender goal (goal 5) as target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights in accordance with the Programme of Action of ICPD and the Beijing Platform for Action), and even this was subject to considerable dispute and discussion among Member States.

wha66_20130520In the very last session of the Open Working Group in July, Nigeria protested target 5.6 and called for re-opening of the text for discussion, supported by many Arab States (e.g. Saudi Arabia and Egypt) and other African States (in particular Uganda, Chad, Sudan and Djibouti). Also Iran spoke several times against target 5.6, pointing out that if Muslim countries do not recognize a “concept”, how can they ever fulfil an indicator. Pakistan claimed that it supports women’s empowerment, but will need to put target 5.6 in “national context”. Finally it was agreed under strong leadership of the Open Working Group Co-Chairs (Kenya and Hungary) to keep target 5.6 while recognizing there would be further opportunities for discussion at the UN General Assembly in September 2014 and during the intergovernmental negotiations which will kick off then.

Where are we now?

In conclusion, we could confidently say that the Open Working Group proposals provide us with a solid basis for further advocacy in the coming year. What we have won and have to protect are:

–      A health outcome-focused goal

–      A target on Universal Health Coverage

–      A sexual and reproductive health target under the health goal and gender goal

–     A stand-alone goal on equality and a target promoting social inclusion for all

–     Reference to the rule of law, anti-discriminatory laws and human rights throughout the Outcome Document (a big improvement compared to the current MDGs which don’t mention rights at all)

What we have lost and have to fight for going forward are:

–       An explicit reference to marginalized groups as part of the health goal and other relevant goals, and in particular as part of the UHC target

–       The promotion of sexual and reproductive rights for all

–       Stronger language on the elimination of discriminatory laws, policies and practices and ensuring equal access to justice for all

We are half way there. Let’s continue the fight!

 

Marielle Hart is Policy Manager for the Stop AIDS Alliance, International HIV/AIDS Alliance U.S., a partner of Action for Global Health