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The Global Network of People Living with HIV (GNP+) congratulates member states of the United Nations for the commitment made yesterday through the adoption of the Political Declaration on Universal Health Coverage (UHC) made in New York during the High Level Meeting, but calls for an accountability mechanism to hold all actors to account in achieving UHC, to be established.

GNP+ believes that a strong accountability mechanism is the missing piece from the current Political Declaration. Without an accountability mechanism, real progress towards Health For All will remain limited and undescribable. We urge member states and United Nations agencies to expand the use of World Health Organization annual reporting system to capture progress beyond the two SDG indicators currently monitored for UHC. Commitments without clear global, regional and national targets will result in minimum progress and maximum self-congratulatory celebrations.

“Global commitments enshrined in a Political Declaration will only have meaning if translated into policies, actions, and financing at the country level. Clear, coherent, and communities-and civil society- inclusive accountability mechanisms that build upon national, regional, and global processes are needed to move the Political Declaration on UHC from mere rhetoric to reality.” said Rico Gustav, Executive Director of GNP+.  “The Political Declaration should be accompanied by an accountability framework that establishes targets through which all stakeholders – including key and affected communities – can hold countries to account. These should include specific indicators to assess the extent to which Universal Health Coverage is ‘putting the last mile first’ and meeting the needs of the poorest and most marginalised.”

True universal health coverage, that leaves no one behind, has to start with placing the needs of the poorest and most marginalised members of society at the start and center. While acknowledging that there will always be a debate on how to define which groups are most marginalized, we insist that this debate does not only highlight those who are challenged by geographical or economic barriers, but also the key populations that are highly stigmatized and marginalized. These key populations are often criminalized, even when doing so means member states are violating their human rights, and endangering their access to health services and programs they need to protect themselves and improve their health. Continuing to criminalize HIV transmissions, men who have sex with men, sex workers, drug users and transgender communities will mean leaving these communities behind, as past decades have proven. 

Universal Health Coverage requires wide-ranging and well-run systems for health. These go beyond government-run and facility-based health systems to incorporate community-led and based systems for the delivery, management and monitoring of health education, prevention, support and treatment services. Community responses complement other sectors. They bring unique added value– notably their reach to, and acceptability among, those most marginalised and vulnerable who have specific needs that are unmet by others. Community responses are dynamic– able to respond to immediate challenges and actual needs, and to make the best use of available resources. To be effective, UHC strategies must be based on diverse and multi-sectoral systems for health – which integrate and resource  community responses as an essential component, rather than an ‘optional extra’.