This Beyond 2015 position paper for the thematic UN consultation on “Health in the Post-2015 Development Agenda” was drafted by a broad team of health advocates from various backgrounds. We have focused here on how to advance and value health equity, the right to health and sustainable health systems within the four core dimensions of global sustainable development proposed by the UN System Task Team3: inclusive social development; environmental sustainability; inclusive economic development; peace and security.

Both the framing of the health goal itself as well as related targets should explicitly require reductions in health inequities. These targets should address both coverage and health outcomes, as well as financial risk protection; a target could be minimizing disparity across health services between top and bottom income quintiles, gender, age groups, disability status, rural/urban location, ethnicity and minority population groups, etc.
Given the power of indicators to drive programming, the UN should strongly consider including health indicators across all dimensions of development, which would capture critical dimensions of health otherwise missed, establish health as a multisectoral issue with multisectoral solutions, and develop an understanding on how improvements in health impact upon poverty reduction, economic development, social development, and environmental sustainability.

Targets and indicators should incorporate policy measures, in addition to measures of health service coverage, and indicators related to the capacity and effectiveness of the state at enforcing policies. A key set of health indicators for use in other sectors will be very relevant to implementing the HiaP approach. Health impact assessments could be included as criteria in other sustainable development goals.
Strategies should be included to ensure accountability, at all levels, and measures that enable people to claim their rights. Building a strong accountability process is key, including independent monitoring by civil society and other third actors, including on human rights.
At global level, measurable indicators are essential to improving governance for global health, clarifying responsibilities of different actors, including for example access to essential medicines and to technological innovations, compliance with the WHO Global Code of Practice on the International Recruitment of Health Personnel, as well as human rights and health obligations under the International Covenant on Economic Social and Cultural rights.

Summary with key messages

The UN consultation on the post-2015 development agenda provides a crucial opportunity to reflect on the kind of future we want and how to get there. In this Beyond 2015 position paper, prepared by a drafting team of health advocates, we envision a future in which everyone enjoys the right to health.
While acknowledging the progress made on global health outcome indicators that are part of the current MDG framework, we highlight a number of weaknesses in this framework that need to be addressed in order to progress further and ensure that the benefits of globalisation are distributed equitably.

The heavy emphasis in the MDGs on development assistance and need for reforms in low-income countries should be balanced by equal attention to the need for high-income countries’ reform in areas such as climate change, global trade and finance, to avoid the erosion of gains made in wellbeing. Secondly, the focus on a few measurable outcomes has led to the neglect of other important aspects of development, not all easily measured, such as participation and democratic governance. Thirdly, global targets were set that were not sufficiently aligned to local needs and not disaggregated for different population groups. As a consequence we have seen the fragmentation of health systems, an uneven allocation of Official Development Assistance (ODA) and increased inequity.

We call for a post-2015 framework, that:

• Addresses the root causes of poverty and structural power imbalances, has universal applicability and is not only applicable to low- and middle-income countries;
• Recognises health as a right in and of itself and seeks to reduce inequities in health and other aspects of development, including through the use of disaggregated data in the design, implementation, monitoring and evaluation of health programs;
• Ensures broad participation in its preparation, monitoring of processes and outcomes and includes systems of accountability and governance that strengthen the building blocks of health systems in a comprehensive way;
• Establishes a clear financing framework that moves beyond ODA, is based on social justice and addresses the illicit outflow of funds from developing countries;
• Takes due attention to the three R’s (Regulation, Rights, and Redistribution) as principles for the global governance for health in policy domains within and beyond the health sector;
• Includes health and equity as outcome indicators in non-health development goals.

Beyond 2015

Beyond 2015 is a civil society campaign pushing for a strong and legitimate successor framework to the Millennium Development Goals. The campaign is built on a diverse, global base, brings together more than 380 organizations and ranges from small community based organizations to international NGOs, academics and trade unions. Whilst Beyond 2015 participating organizations have a range of views regarding the content of a post-2015 framework, the campaign is united in working to bring about the following outcome:

• A global overarching cross-thematic framework succeeds the Millennium Development Goals, reflecting Beyond 2015’s policy positions.
• The process of developing this framework is participatory, inclusive and responsive to voices of those directly affected by poverty and injustice.

How to ensure a process and outcome that is relevant to civil society?

We strongly believe that the consultation process needs to be more inclusive, and therefore should slow down to allow time for participative country consultations. The post-2015 agenda cannot be finalized without a wider consultation.

While preparing this paper, a call for organising civil society health consultation meetings has been issued. These consultations are to be organised on very short notice, so that it is not clear (1) how representative these can or will be and (2) how the different inputs will ultimately be collated and dealt with. Clarification is needed on how different processes and the inputs resulting from them will be brought together, both within the post-2015 process and between this process and other global consultations (such as Rio+20 follow-up and ICPD+)
We propose that a separate civil society committee – or multiple committees representing different regions – be formally involved in the UN negotiations. Their consent could be a prerequisite for UN adoption of the goals.

Furthermore, taking into consideration that communities and many smaller civil society organisations (CSOs) may be unable to participate in these consultation processes, we would like to stress the need for the adaptation of targets, timelines and indicators to national contexts, through an inclusive participatory process that includes marginalized populations. This would be a way to enable communities and local civil society to have input in and take ownership of post-2015 goals/targets and indicators.

The consultations should not be simply about extracting information to help define global goals. They should be used to put in place mechanisms of continuous community engagement, including a constant feedback loop that will enable people to effectively engage in the entire process and hold their governments to account for their promises. We call for community consultations, public hearings and public forums on sustainable development, not as a one-time information collection effort, but as a first step towards democratic global governance.