Global Health and Foreign Policy : An Inclusive Approach to Strengthening Health Systems

Who adopted this document and its mandates?

A Resolution of the General Assembly, under agenda item 126 Global health and foreign policy, published in 2019.

Who cites this mandate in the budget?

1 entity

Entity	(Sub-)Programme	Title	Total mandates cited	Expenditure
	Subprogramme 2	A comprehensive and balanced approach to counter the world drug problem	28

Historical expenditure covers the complete programme or subprogramme, not this mandate. For an overview of all UN entities and programmes, see UN entities and programmes.

Who cites this mandate in the budget?

1 entity

Entity	(Sub-)Programme	Title	Total mandates cited	Expenditure
	Subprogramme 2	A comprehensive and balanced approach to counter the world drug problem	28	—

Historical expenditure covers the complete programme or subprogramme, not this mandate. For an overview of all UN entities and programmes, see UN entities and programmes.

What subjects does this mandate have?

3 subjects

Health Policy Health Services Public Health

What’s in this document?

45 operative paragraphs

Calls upon Member States to strengthen health systems, notably in terms of primary health care, in order to provide universal access to a wide range of health-care services that are safe, quality, accessible, available and affordable, timely, clinically and financially integrated, people-centred, gender-sensitive and community-based, which will help to empower those who are vulnerable or in vulnerable situations in addressing their physical and mental health needs, enhance health equity and equality, end discrimination and stigma, eliminate gaps in coverage and create a more inclusive society;

Welcomes the high-level meeting on universal health coverage, held in New York on 23 September 2019, and reaffirms its political declaration, entitled “Universal health coverage: moving together to build a healthier world”;¹⁶

¹⁶Resolution 74/2.

Calls upon Member States to accelerate efforts towards the achievement of universal health coverage by 2030 to ensure healthy lives and promote well-being for all throughout the life course, and in this regard re-emphasizes the resolve:

To progressively cover 1 billion additional people by 2023 with quality essential health services and quality, safe, effective, affordable and essential medicines, vaccines, diagnostics and health technologies, with a view to covering all people by 2030;

To stop the rise and reverse the trend of catastrophic out-of-pocket health expenditure by providing measures to ensure financial risk protection and eliminate impoverishment due to health-related expenses by 2030, with special emphasis on the poor as well as those who are vulnerable or in vulnerable situations;

Recognizes that people’s engagement, particularly of women and girls, families and communities, and the inclusion of all relevant stakeholders is one of the core components of health system governance, to fully empower all people in improving and protecting their own health, giving due regard to addressing and managing conflicts of interest and undue influence, contributing to the achievement of universal health coverage for all, with a focus on health outcomes;

Calls upon Member States to ensure that no one is left behind, with an endeavour to reach the furthest behind first, founded on the dignity of the human person and reflecting the principles of equality and non-discrimination, as well as to empower those who are in vulnerable situations and address their physical and mental health needs which are reflected in the 2030 Agenda for Sustainable Development,¹⁷ including all children, youth, persons with disabilities, people living with HIV/AIDS, older persons, indigenous peoples, refugees and internally displaced persons and migrants;

¹⁷Resolution 70/1.

Also calls upon Member States to promote social protection mechanisms to ensure access to quality-assured and affordable essential health services, including medicines, vaccines, diagnostics, medical products and health technologies;

Further calls upon Member States to take measures to share and implement the vision and commitments of the Declaration of Astana, while reiterating the commitment of the Declaration of Alma-Ata, including to promote the empowerment of individuals and communities, in the context of primary health care;

Calls upon Member States to ensure the right of every human being, without distinction of any kind, to the enjoyment of the highest attainable standard of physical and mental health, while recalling that everyone has the right, individually or in association with others, to promote and strive for the protection and the realization of particularly this right, and encouraging leaders in all sectors of society and in their respective communities to express public support for it;

Encourages Member States to engage all relevant stakeholders, including civil society, the private sector and academia, as appropriate, through the establishment of participatory and transparent multi-stakeholder platforms and partnerships, to provide input to the development, implementation and evaluation of health- and social-related policies and reviewing progress for the achievement of national objectives for universal health coverage, while giving due regard to addressing and managing conflicts of interest and undue influence;

Also encourages Member States to mainstream a gender perspective on a systems-wide basis when designing, implementing and monitoring health policies, taking into account the specific needs of all women and girls, with a view to achieving gender equality and the empowerment of women in health policies and health systems delivery;

Calls upon Member States to promote more coherent and inclusive approaches to safeguard universal health coverage in emergencies, including through international cooperation, ensuring the continuum and provision of essential health services and public health functions, in line with humanitarian principles;

Also calls upon Member States to ensure that persons affected by sexual violence in natural disasters, humanitarian emergencies and armed conflicts have safe access to non-discriminatory health-care services;

Urges all Member States, as appropriate to local and national contexts and with the objective of the success of primary health care and the achievement of universal health coverage, to implement community health worker programmes in order to enable community health workers to deliver safe and high-quality care and to optimize community health worker programmes at the national level as part of national health workforce and broader health sector, employment and economic development strategies, in line with national priorities, resources and specificities;

Urges Member States to scale up efforts to promote the recruitment and retention of competent, skilled and motivated health workers, including community health workers and mental health professionals, and encourage incentives to secure the equitable distribution of qualified health workers especially in rural, hard-to-reach and underserved areas and in fields with high demands for services, including by providing decent and safe working conditions and appropriate remuneration for health workers working in these areas, consistent with the World Health Organization Global Code of Practice on International Recruitment of Health Personnel,¹⁸ noting with concern that highly trained and skilled health personnel continue to emigrate, which weakens health systems in the countries of origin;

¹⁸World Health Organization, document WHA63/2010/REC/1, annex 5.

Calls upon Member States to develop evidence-based training that is sensitive to different cultures and the specific needs of women, children and persons with disabilities, skills enhancement and education of health workers, including midwives and community health workers, as well as promote a continued education and lifelong learning agenda and expand community-based health education and training in order to provide quality care for people throughout the life course;

Encourages Member States to fulfil their commitment to, by 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes;

Calls upon Member States to strengthen efforts to address communicable diseases, including HIV/AIDS, tuberculosis, malaria and hepatitis, as part of universal health coverage and to ensure that the fragile gains are sustained and expanded by advancing comprehensive approaches and integrated service delivery and ensuring that no one is left behind;

Also calls upon Member States to further strengthen efforts to address non-communicable diseases, including cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, as well as kidney diseases, as part of universal health coverage;

Further calls upon Member States to take steps to promote actions to raise international awareness on the issue of waterborne diseases, in particular cholera and child diarrhoea, which can be prevented through safe drinking water and adequate sanitation and hygiene, engaging in partnerships with relevant stakeholders to implement projects aimed at scaling up access to safe water and sanitation in developing countries;

Encourages Member States to develop health- and nutrition-promoting environments, including through nutrition education in schools and other education institutions, as appropriate, and to scale up community-based actions that support children and families, through the promotion of maternal health and recommended infant feeding practices such as breastfeeding;

Calls upon Member States, in partnership with other relevant stakeholders, including international and regional organizations and academia, to consider scaling up research and knowledge dissemination on the correlations between health, notably its economic and social determinants, and nutrition and food systems to generate evidence and guidance on effective nutrition programmes and policies;

Encourages Member States and relevant organizations to reinforce immunization and vaccination as one of the most important ways to reduce the number of deaths caused by preventable diseases and also to reinforce in their societies the safety and efficacy of vaccines, aiming at eliminating vaccine-preventable diseases, and calls upon Member States to strengthen public health surveillance and data systems, improve routine immunization and vaccination capacities, including by providing evidence-based information on countering vaccine hesitancy, and expand vaccine coverage to prevent outbreaks as well as the spread and re-emergence of communicable and non-communicable diseases, including for vaccine-preventable diseases already eliminated as well as for ongoing eradication efforts, such as for poliomyelitis;

Calls upon Member States to scale up efforts to promote healthy and active ageing, to maintain and improve quality of life of older persons and to respond to the needs of the rapidly ageing population, especially the need for promotive, preventive, curative, rehabilitative and palliative care as well as specialized care and the sustainable provision of long-term care, taking into account national contexts and priorities;

Also calls upon Member States to increase access to health services for all persons with disabilities, remove physical, attitudinal, social, structural and financial barriers, provide quality standard of care and scale up efforts for their empowerment and inclusion, noting that persons with disabilities, who represent 15 per cent of the global population, continue to experience unmet health needs;

Encourages Member States to incorporate the health needs of migrants into national and local health-care policies and plans, such as by strengthening capacities for service provision, facilitating affordable and non-discriminatory access, reducing communication barriers, and training health-care providers on culturally sensitive service delivery, in order to promote the physical and mental health of migrants and communities overall;

Calls upon Member States to enhance cooperation at the national, regional and global levels to address antimicrobial resistance, using an integrated and systems-based one-health approach, including through health system strengthening, capacity-building, including for research and regulatory capacity, and technical support and ensure equitable access to affordable, safe, effective and quality existing and new antimicrobial medicines, vaccines and diagnostics as well as effective stewardship, as antimicrobial resistance poses a challenge to achieving universal health coverage, noting the work of the ad hoc inter-agency coordination group on antimicrobial resistance and its recommendations as contained in the report of the Secretary-General on antimicrobial resistance,¹⁹ and looking forward to the discussion thereof during the seventy-fourth session of the General Assembly, taking into account World Health Assembly resolution 72.5 of 28 May 2019;²⁰

¹⁹A/73/869.

²⁰See World Health Organization, document WHA72/2019/REC/1.

Also calls upon Member States to promote equitable distribution of and increased access to quality, safe, effective, affordable and essential medicines, including generics, vaccines, diagnostics and health technologies, to ensure affordable quality health services and their timely delivery;

Further calls upon Member States to improve availability, affordability and efficiency of health products by increasing transparency of prices of medicines, vaccines, medical devices, diagnostics, assistive products, cell- and gene-based therapies and other health technologies across the value chain, including through improved regulations and building constructive engagement and a stronger partnership with relevant stakeholders, including industries, the private sector and civil society, in accordance with national and regional legal frameworks and contexts, to address the global concern about the high prices of some health products and in this regard encourages the World Health Organization to continue its efforts to biennially convene the Fair Pricing Forum with Member States and all relevant stakeholders to discuss the affordability and transparency of prices and costs relating to health products;

Reaffirms the right to use, to the fullest extent, the provisions contained in the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement), which provides flexibilities for the protection of public health and promotes access to medicines for all, in particular for developing countries, and the Doha Declaration on the TRIPS Agreement and Public Health, which recognizes that intellectual property protection is important for the development of new medicines and also recognizes the concerns about its effects on prices;

Calls upon Member States to explore, encourage and promote a range of innovative incentives and financing mechanisms for health research and development, including a stronger and transparent partnership between the public and the private sectors as well as academia, recognizing the need for increasing public health-driven research and development that is needs-driven and evidence-based, guided by the core principles of safety, affordability, effectiveness, efficiency, equity and considered as a shared responsibility, as well as appropriate incentives in the development of new health products and technologies;

Also calls upon Member States to recognize the important role played by the private sector in research and development of innovative medicines, encourage the use, where appropriate, of alternative financing mechanisms for research and development as a driver of innovation for new medicines and new uses for medicines and continue to support voluntary initiatives and incentive mechanisms that separate the cost of investment in research and development from the price and volume of sales, facilitate equitable and affordable access to new tools and other results to be gained through research and development;

Urges Member States to improve the digital skills of all persons, including through working with civil society to build public trust and support for digital health solutions, and to promote the application of digital health technology in the provision of, and access to, everyday health-care services, with emphasis on health promotion and predictive testing and screening, while ensuring access to important clinical information, safety risks and protection of privacy;

Calls upon Member States to invest in and encourage ethical and public health-driven use of relevant evidence-based and user-friendly technologies, including digital technologies, and innovation to increase access to quality health and related social services and relevant information, improve the cost-effectiveness of health systems and efficiency in the provision and delivery of quality care in a manner that recognizes the need to build and strengthen interoperable and integrated health information systems for the management of health systems and public health surveillance, as well as the need to protect data and privacy and narrow the digital divide;

Also calls upon Member States to explore ways to consider integrating, as appropriate, safe and evidence-based traditional and complementary medicine services within national and/or subnational health systems, particularly at the level of primary health care, according to national context and priorities;

Further calls upon Member States to encourage engagement among Governments, international organizations, non-governmental organizations, academic and research institutions, philanthropic foundations and the private sector and greater policy coherence and coordinated actions through whole-of-government and health-in-all-policies approaches to find solutions to health challenges, such as the need for public health-driven research and development, improved existing and alternative frameworks to adequately reward innovation, pricing and affordability of health products, and leveraging innovative technologies, including digital technologies, and solutions for health;

Calls upon Member States to strengthen health information systems and collect quality, timely and reliable data, including vital statistics, disaggregated by income, sex, age, race, ethnicity, migratory status, disability, geographical location and other characteristics relevant in national contexts as required to monitor progress and identify gaps in the universal and inclusive achievement of Sustainable Development Goal 3 and all other health-related Sustainable Development Goals, while protecting the privacy of data that could be linked to individuals, and to ensure that the statistics used in the monitoring progress can capture the actual progress made on the ground, for the achievement of universal health coverage, in line with the 2030 Agenda for Sustainable Development;

Also calls upon Member States to set measurable national targets and strengthen national monitoring and evaluation platforms, as appropriate, in line with the 2030 Agenda for Sustainable Development, to support regular tracking of the progress made for the achievement of universal health coverage by 2030;

Further calls upon Member States to provide strategic leadership on universal health coverage at the highest political level and promote greater policy coherence and coordinated actions through whole-of-government and health-in-all-policies approaches, and forge a coordinated and integrated whole-of-society and multisectoral response, while recognizing the need to align support from all stakeholders to achieve national health goals;

Encourages Member States to enhance international cooperation and official development assistance for health, and to develop primary health care preparedness for health emergencies, to support and complement national and regional strategies, policies and programmes, and surveillance initiatives;

Also encourages Member States to ensure sufficient domestic public spending on health, where appropriate, expand pooling of resources allocated to health, maximize efficiency and ensure equitable allocation of health spending, to deliver cost-effective, essential, affordable, timely and quality health services, improve service coverage, reduce impoverishment from health expenditure and ensure financial risk protection, while noting the role of private sector investment, as appropriate;

Further encourages Member States to mobilize all relevant development cooperation partners and stakeholders from the health sector and beyond within their respective mandates, to ensure necessary and sustained financing for health system strengthening, including through the implementation of innovative mechanisms, enhancement of international cooperation and promotion of universal access to quality health-care services, including through partnerships with civil society, relevant research institutions and the private sector;

Encourages the Secretary-General to promote discussion among Member States and relevant stakeholders, in particular United Nations agencies, on appropriate policy options to promote access to medicines, innovation and health technologies in the context of strengthening health systems;

Requests the Secretary-General, in close collaboration with the Director General of the World Health Organization, to address, inter alia, the challenges and opportunities of inclusive approaches to strengthening health systems in the context of the progress report to be submitted during the seventy-fifth session of the General Assembly as requested in the political declaration of the high-level meeting on universal health coverage.

Who adopted this document and its mandates?

Who cites this mandate in the budget?

Who cites this mandate in the budget?

What subjects does this mandate have?

What’s in this document?

Table of contents

Who cites this mandate in the budget?