December 2017: Participants at the Global Universal Health Coverage (UHC) Forum adopted the Tokyo Declaration, noting that UHC contributes to progress on all SDGs, and reiterating the importance of SDG target 3.8. Japan announced a US$50 million contribution to the Global Financing Facility (GFF) in support of the Every Woman Every Child initiative. In addition, the World Bank and the World Health Organization (WHO) assessed UHC progress in a new monitoring report.

The Global UHC Forum convened from 12-15 December 2017, in Tokyo, Japan, with participation from Japan’s Prime Minister Shinzo Abe, UN Secretary-General Antonio Guterres, World Bank President Jim Yong Kim, WHO Director-General Tedros Adhanom Ghebreyesus, and UN Children’s Fund (UNICEF) Executive Director Anthony Lake, as well as heads of state and ministers from 30 countries. The Forum was convened by the government of Japan and co-sponsored by the Japan International Cooperation Agency (JICA), UHC2030 (the leading global movement advocating for UHC), UNICEF, the World Bank and WHO.

Aimed at accelerating progress towards SDG target 3.8 on UHC (Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all), the Forum was the culmination of events in over 100 countries. At the close of the Forum, the co-organizers released a commitment to action titled, ‘The Tokyo Declaration on UHC.’ Signatories recognize the integrated and indivisible nature of the SDGs, noting that UHC contributes to progress towards all SDGs. Reiterating the importance of target 3.8, the Declaration says action must include preventive, curative, rehabilitative and palliative health services, as well as safe, effective, quality and affordable essential medicines and vaccines.

The Declaration also reinforces the principle of Leaving No One Behind, which it says requires special effort, in order to design and deliver health services informed by the voices and needs of people, while prioritizing the most vulnerable members of the world’s population, particularly children and women, refugees and migrants, and marginalized, stigmatized and minority populations. The text notes that by 2023, the midpoint towards 2030, the world needs to extend essential health coverage to 1 billion additional people and halve to 50 million the number of people being pushed into extreme poverty by health expenses.

Also through the declaration, the co-organizers of the Forum:

• Commit to monitoring progress towards UHC as part of the SDG review process by issuing global monitoring reports regularly, and reviewing key findings both at the subsequent UHC Forum and in the context of the UN High-level Political Forum on Sustainable Development (HLPF) and the UN General Assembly (UNGA);
• Commit to jointly mobilizing political leadership around the world so that countries develop their own roadmaps towards UHC, with clearly indicated targets, indicators and specific plans; and
• Call for expanded financing and increased alignment to support UHC by all development partners, particularly multilateral development banks and Global Health Initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) and Gavi, the Vaccine Alliance, and foundations such as the Bill and Melinda Gates Foundation.

During the Forum, the Government of Japan announced a US$50 million contribution to GFF, which is a country-led model of development finance that brings together multiple sources of financing to support countries’ priorities. Contributions to the GFF Trust Fund will help countries close the financing gap for reproductive, maternal, newborn, child and adolescent health and nutrition, accelerate progress on UHC, and reach the SDGs by 2030. The World Bank and the UN launched the GFF at the Third International Conference on Financing for Development, in Addis Ababa in July 2015, in support of Every Woman Every Child, and as part of the efforts to finance the SDGs.

Each year, large numbers of households are pushed into poverty by health care costs.

Also during the Global UHC Forum, the World Bank and the WHO launched a report titled, ‘Tracking UHC: 2017 Global Monitoring Report,’ which shows that at least half of the world’s population cannot obtain essential health services. In positive progress, the 21st century has seen an increase in the number of people able to obtain some key health services, such as immunization and family planning, as well as antiretroviral (ARV) treatment for HIV and insecticide-treated bed nets to prevent malaria. In addition, the publication reflects, fewer people are now being tipped into extreme poverty than at the turn of the century. However, the publication notes, there are wide gaps in the availability of services in Sub-Saharan Africa and Southern Asia. Moreover, in Eastern Asia, Latin America and Europe, a growing number of people are spending at least 10% of their household budgets on out-of-pocket health expenses. Each year large numbers of households are pushed into poverty because they must pay for health care out of their own pockets.

In December 2017, the UNGA officially proclaimed 12 December as International UHC Day to raise awareness of the need for strong and resilient health systems that leave no one behind. UNGA will hold a high-level meeting on UHC in 2019. [Universal Health Coverage Forum 2017] [World Bank Press Release on Forum] [Tokyo Declaration] [World Bank Press Release on Japan’s Contribution to GFF] [Tracking universal health coverage: 2017 Global Monitoring Report] [SDG Knowledge Hub story on International Day and 2019 High-level meeting]