Development cooperation and universal health coverage: talking with CSOs
Health Civil Society Organizations (CSOs) from around the world met in Senegal in February 2014 to discuss universal health coverage (UHC) and the right to health; a conference organized by the network Action for Global Health. IHP+ asked Guy Aho Tete Benissan, Regional Coordinator of REPAOC, Senegal and Bruno Rivalan from Global Health Advocates about how this agenda links with effective aid and development cooperation.
Q. At your recent civil society conference on UHC, what issues arose for CSOs in relation to aid effectiveness and development cooperation?
Firstly, implementing UHC touches upon principles of democratic ownership and results. UHC policies should strengthen health systems to make them more equitable in delivering healthcare to everyone. Policies should be based on needs and governments and CSOs must work together to ensure these needs are met. Our discussions also focused on financing and coordinating and aligning behind country health plans. How else can governments ensure predictable sustainable financing? Mutual accountability and transparency is also vital, as all actors have roles and responsibilities in developing and implementing UHC policies, including governments, parliament, donors, CSOs, communities, and the private sector.
Q. How will improved aid effectiveness and development cooperation help UHC?
Aid effectiveness and development cooperation principles should guide the implementation and monitoring of UHC. Each country will define its own path towards UHC but if we try to summarize the key challenges when building UHC policies there are similar questions to answer. Who should be covered with what package of care? What financing system is appropriate? What governance and accountability should be in place?
For UHC policies to be equitable and truly universal those questions must be answered following aid effectiveness and development cooperation principles. UHC policies should be a development-led process with CSOs strongly involved to ensure that the needs of the population are addressed. All donors should be aligned behind one country health plan to avoid fragmenting the health care system and reimbursement schemes.
Applying aid effectiveness and development cooperation principles is a necessary condition for ensuring equity in UHC policies but on its own, it is not sufficient. Technicalities such as health system reforms, legal frameworks and insurance schemes go beyond aid effectiveness.
Q. What is the role of CSOs in UHC?
CSOs must be part of the process when defining health packages based on community needs. Creating demand for these services, holding governments and donors to account are critical functions. Service delivery by community organisations is also vital especially as they have the trust of key populations that are often excluded in health systems.
While we advance towards universal health coverage, we need also to acknowledge our commitments and duties as civil society to ensure the realisation of the right to health and the application of the principles mentioned above. We must commit to be as representative as possible, to be transparent about our debates, and to share information to citizens and to our political interlocutors.
Q. What challenges do CSOs face in aid effectiveness and development cooperation in health?
CSOs, especially health organisations working at global and regional level, have good knowledge about aid effectiveness and development cooperation. What might be missing is a concrete vision of how these principles can be applied at the district level for community organisations.
We should develop toolkits, share more practice and hold more workshops on the issues. But for truly increasing the capacity of CSOs in relation to aid effectiveness and development cooperation, the best learning comes with practice. For this to happen, governments and donors, including IHP+ signatories, must implement the commitments they have made and involve CSOs fully. Too often CSOs at national level are only consulted for a couple of hours, sometimes not even through face-to-face meetings. The selection of CSOs is often arbitrary and not representative. Donors and government should include CSOs as true partners when building health country plans and related sub-sector strategies. This would be the best way to develop CSO capacity in relation to aid effectiveness and development cooperation.
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