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Countries adopt new Political Declaration on UHC

In the bustling corridors of global diplomacy at the United Nations General Assembly, a profound conversation unfolded—one that transcends borders and politics, and centers on the critical imperative of strengthening health systems. On September 21, the United Nations Member States adopted the Political Declaration of the High-Level Meeting (HLM) on Universal Health Coverage (UHC), serving as an opportunity for countries and stakeholders to reinvigorate progress towards health for all. 


Following the September 2019  adoption of the Political Declaration on UHC, partners in the UHC movement considered the September 2023 meeting a moment to hold world leaders accountable for commitments made. Investing in and strengthening community health systems world-wide is an integral component to achieving UHC; we looked to world leaders attending the HLM on UHC for concrete next steps in this goal. 


The finalized September 2023 Political Declaration on UHC includes language on the importance of community health and the community health worker (CHW) workforce in relation to achieving UHC. Section 31 reads “...that 90 percent of essential interventions for universal health coverage can be delivered using a primary health care approach, including at the local community levels.” Community health and the community health workforce remains the paramount provider of primary health care in last mile communities. To achieve UHC, we must prioritize investments in community health to sustain primary care services. 


The Political Declaration also states we must “continue to scale up efforts and strengthen cooperation to promote the training, development, recruitment and retention of competent, skilled and motivated health workforce, including community health workers”. Investments in health systems for training and professional development of the healthcare workforce is crucial. Further emphasis of the professionalization of the community health workforce, including CHW remuneration and supervision, is lacking. It is encouraging to see the language on CHW strongly reflected, however how they will be integrated into the health system was not clear. 


We applaud the UN’s mention of the gender leadership and payment gap in the CHW workforce in stating we must “provide better opportunities and decent work for women to ensure their role and leadership in the health sector [...] and address inequalities, including the gender pay gap, by appropriately remunerating health workers and care workers in the health sector, including community health workers.” Women comprise over 70 percent of the community health workforce in low-and-middle-income (LMICs) and it is crucial we close gender disparities in the community health workforce.  

Countries highlight importance of community health at HLM

Many world leaders shared their invaluable insight and experience for the call to strengthen community health systems in their own countries and beyond. Over 25 countries voiced their support to achieving UHC; in our coalition’s target countries, our government partners also shared their remarks on investments to the community health workforce and achieving UHC. These countries cited the immediate need to invest in their community health workforce, implement training and supervision protocols to professionalize the CHW workforce, and extend human resources on health. Uganda’s representative spoke broadly of “strengthening…healthcare providing” by “community healthcare professionals” as Rwanda’s speaker specified that over 90% of the country’s Malaria efforts are managed by CHWs. While the role of CHWs may vary country to country, over 15 participating countries found that CHWs play a critical role to “promote UHC”, highlighted by the Ethiopia representative. 


Challenges encountered at HLM

While the Political Declaration included strong rhetoric on health workforce,, many advocates concluded the HLM on UHC was a missed opportunity for change. In the weeks leading up to the meeting, many health advocates found that drafts of the political declaration lacked specifics aligned with goals to achieve UHC and the potential for changes was fading. Health advocates also thought this of the HLM on Pandemic Prevention, Preparedness, and Response (PPPR), believing that world leaders were not taking bold enough actions to ensure the world is better positioned for future pandemics.


Next Steps for Advocates

In next steps, the campaign will work with our members to organize and support networks to track progress on the commitments to community health . Political will is important but developing implementation strategies and funding plans to achieve UHC are equally so. If you are working on advocacy in any of the following countries please contact us at We would like to connect advocates and networks working in the same countries to ensure collective advocacy efforts. 

Authored by: Lindsey Brown, Global Advocacy Fellow, Living Goods

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