The 2023 UN High-level meeting (UN HLM) on universal health coverage (UHC) took place on 21 September 2023. It provided countries and stakeholders an opportunity to reinvigorate progress towards delivering health for all. A number of civil society events happening on the sidelines of the UN HLM between 18 to 22 September provided a plethora of opportunities to network with high-ranking officials, decision makers, advocates, academia, media and global and regional health institutions. This paper provides a brief summary of some the highlights captured in the sideline events. It also aims to provide insights to upcoming opportunities and agendas in the global health ecosystem.
1.The side event supported by PATH and other Partners was hosted by the African Union Commission, Africa CDC, African Union Development Agency (AUDA-NEPAD) and the African Continental Free Trade Area (AfCFTA). The topic for discussion at this side event was titled: Advancing Pandemic Prevention, Preparedness and Response (PPPR): Focusing on local manufacture of health products and technologies in Africa, leveraging the role of public-private partnerships. SAHTAC member organization PATH has been working closely with the office of the Presidency through Prof Olive Shisana to give guidance and talking points on a number of issues including the PPPR. Some of the points highlighted in the keynote speech were developed by PATH.
The keynote speaker President Cyril Ramaphosa highlighted that pandemic preparedness requires that we achieve our ambitious manufacturing goals. This needs to be a collaborative effort that brings together the Africa CDC, the Partnerships for African Vaccine Manufacturing, AUDA-NEPAD and the AfCFTA Secretariat with other relevant continental and global partners and the private sector. The presidented that we have a window of opportunity to maintain political will and investor interest to drive significant investments towards developing regional PPPR capacity. He highlighted the need to focus on a few critical areas:
Firstly, we need strong, sustainable, digitally empowered primary health care systems and we need community-responsive national public health institutes. Because outbreaks happen at the community level, information must travel faster than the pathogen. Health services must be able to reach vulnerable groups, including those in conflict settings.
Secondly, we need real-time surveillance and good cross-border cooperation.
Thirdly, we need a capable and fit-for-purpose workforce. We need to urgently establish the health workforce task team to operationalize health workforce development. With such a large young population, Africa can be the hub of health workforce production to close the global health workforce shortage.
Fourthly, we need equitable access to medical countermeasures, including vaccines, therapeutics and diagnostics, through local manufacturing and functional last-mile delivery of goods and services.
Fifthly, we need predictable financing for pandemic prevention, preparedness and response.
The Second address was done by Prof Olive Shisana who highlighted South Africa’s leadership and involvement in the ACT-A. There were challenges in the implementation of this initiative and there was a need to take stock and external evaluate the ACT-A. This evaluation was called the Johannesburg Process, and this provided a platform and opportunity for a number of countries and stakeholders to deliberate on the recommendations, to build a consensus among a coalition. This was to establish an interim global coordination mechanism platform for the medical countermeasure’s platform. The process started in Johannesburg complements the formal processes including those of the intergovernmental negotiating body as well as the working group of the international health regulation as well as the G7 and G20 processes. First meeting was hosted in Johannesburg in February bringing together over 114 in-person participants from LCMs and HEC different organizations and from 34 different countries. The focus was on four main areas assessing needs and gaps in dealing with pandemics, the end-to-end MCM ecosystems, MCM last mile delivery and the financing of this ecosystem. The is a need to strengthen regional manufacturing, build on the MNRA and build a network Networks.
2.The Civil Society Consultation on DIAGNOSTICS, EQUITY, and ACCESS on the sidelines of the UN General Assembly brought together close to 40 in person participants from civil society groups, academia, media etc. The discussions established that diagnostics are often not prioritized as compared to prevention and treatment.
The objective of the CSO Consultation was to discuss the resolution and identify how civil society can ensure its implementation at the national level. Based on the discussions, a Diagnostics Action Agenda will be drafted outlining advocacy activities towards increasing access to essential diagnostics in low- and middle-income countries, particularly to address health priorities at the primary health and community levels.
- The draft Action Agenda will be circulated for inputs by early November.
- The Action Plan will be ready to launch in November. More launch details will be shared in the coming weeks.
- Identify concrete opportunities for engagement around the implementation of the diagnostics resolution.
Agenda will be a living document to align our advocacy efforts and provide a platform for engagement around shared priorities and commitment to implement the diagnostics resolution.
It was agreed that this is a pivotal moment for diagnostics, and we must build on the momentum of the adoption of the Resolution to Strengthen Diagnostics Capacity at this year’s World Health Assembly.
3.UN High-level Meeting on Strengthening Pandemic Prevention, Preparedness, and Response. – how gender, equity, and the unique needs of marginalized populations are being addressed
- The focus of this meeting is on the intersection of climate, gender, health, and pandemic preparedness at key 2023 climate moments.
- Why is this topic important? A key reflection after the recent Africa Climate Summit in Nairobi: conversations about health were sidelined; the nexus between health and climate has been under-explored.
- In the Declaration that came out of the summit, health is barely mentioned.
- There is a lot to do if we want to shift the conversation at COP28.
- Discussion and Framing – Gender, Climate, Health, and Pandemic Preparedness —
Ana Catarina Pinho-Gomes – clinical lecturer in public health medicine at the Institute of Health Informatics at University College London, highlighted the following:
- It is a priority to look at the climate crisis through a gender lens, because as the COVID-19 pandemic showed, all crises have a gendered impact.
- When these impacts are not considered, the impacts will be exacerbated.
- Women and girls experience the greatest impacts of climate change, including in the areas of:
- Migration and displacement – people lose their jobs by suffering extreme weather events, and women are most likely to migrate and be displaced and are then exposed to violence and sexual exploitation.
- Conflict and violence
- Agriculture – women make up most agricultural workers and many women in low- and middle-income countries rely on subsistence agriculture, which is vulnerable to climate change.
- Disasters (especially floods and heat waves – women have less ability to cope with natural disasters because of societal gender inequalities but also biological differences.
- Maternal and child health – as we saw during the COVID-19 pandemic, some of the first healthcare services affected during disasters are maternal and child health services.
Women’s voices are rarely part of health conversations, and women are not meaningfully represented in discussions about climate change.
For example, at COP27, almost no women were present.
Participation of women in delegations to COPs increased until 2018, then decreased, particularly due to COVID-19
A study showed that when more women are in parliament, decisions are more climate friendly. A key finding of Pinho-Gomez’s recent research: the greater gender inequality is in a country, the less adapted the country is to mitigating climate crises (the more vulnerable to impacts of climate change and less ready to respond to risks and impacts).
- Closing & Next Steps
- Important to remember and consider the levels of exclusion that women, especially indigenous women, experience.
- Inclusions of commercial interest in ongoing climate negotiations shows what’s going wrong.
- Strategies for change include strengthening national systems for gender-balanced leadership, giving more space for women in national strategies, training local women in fundraising and advocacy, and an urgent need for women to demand their rights and participation in important decision-making processes.