Addressing the elephant in the room: Why the UHC movement must talk about the importance of #TaxJustice for realising women’s health rights
By Sophie Efange, Christian Aid
For too long, tax policy has been overlooked as one of the most powerful tools for reducing health inequalities. Instead, it has often been deemed a technical matter best reserved for a handful of global elites and, more importantly, unrelated to the everyday challenges of health advocates around the world. However, we cannot talk about achieving Universal Health Coverage (UHC) by 2030 without also discussing how progressive tax policies are at the heart of how it will be financed and ensure health for all.
Sexual and Reproductive Health and Rights (SRHR) are the cornerstone of UHC
Target 3.7 of the Sustainable Development Goals (SDGs) calls for universal access to SRH services by 2030 and the need to integrate reproductive health into national strategies and programmes. Not only is sexual and reproductive health (SRH) a cornerstone of the right to health, but it is also an integral component for achieving UHC. However, poor and marginalised populations, particularly women and girls, continue to be excluded from equitable access to quality SRH services due, in part, to a lack of sustainable financing options. This exclusion is most apparent across sub-Saharan Africa where serious shortfalls in the implementation of global and regional commitments such as the Maputo Plan of Action (2016–2030), the International Covenant on Economic, Social and Cultural Rights, and the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) have grave consequences for African women and girls’ health rights. For example, a 2013 World Health Organisation (WHO) study identified that sixty-two percent of all global maternal deaths during the Millennium Development Goals (MDG) era occurred in sub-Saharan Africa. According to the WHO the eight countries with the highest prevalence of FGM (over eighty percent) are all on the continent. On every count, African women fall below the minimum standards of voice, choice and control advocated by the SDGs.
Funding mechanisms for SRH
Official development assistance figures demonstrate that funding for SRH and family planning has remained consistently low as a proportion of the total aid budget for health during the era of the MDGs. Sixty-six percent of this was committed to HIV/AIDS prevention with only twenty-two percent for basic RH services in 2011. More recently, this has been further exacerbated by the United States’ reinstatement of the Mexico City Policy which has denied all foreign aid funding to NGOs that promote or provide abortion services. This is expected to have far-reaching consequences in parts of the world where women and girls rely on NGOs for their basic health services including access to vital family planning services. Also of note is that whilst the role of, and reliance on public-private partnerships to provide essential health services like SRH is increasing, the private sector cannot be wholly relied upon to provide affordable and equitable health services for all.
Why tax policy is central to the discussions on SRH and UHC
Following the third Financing for Development Forum in 2015, it became clear that the SDGs, including the realisation of sexual and reproductive health and rights (SRHR), cannot be achieved without increased domestic resource mobilisation, of which tax is a key component. A 2012 report by the African Union and United Nations Economic Commission for Africa estimated that Africa loses approximately US$50bn of potential tax revenue every year due to illicit financial flows (IFFs). IFFs includes legal — but ethically questionable — multinational and individual tax evasion, drug and people trafficking, corruption and outright tax avoidance. This makes it very difficult for any developing country to effectively mobilise resources that would help fund UHC and instead encourages their governments to adopt simpler, but highly regressive, tax policies which disproportionately impact the poorest; typically, women. The correlation between the amount of money developing countries lose against the backdrop of already under resourced public services, mostly used by women, is extremely stark. SRH is a core example. How many maternal health units, SRH education classes and health professionals could US$50bn a year pay for in Africa?
To achieve UHC by 2030, health and tax justice advocates have to work collaboratively across their movements. Critically, demystifying tax policy and mainstreaming it within the UHC movement is the only certain way of guaranteeing health for all.
This blog is part of a series by the UHC Financing Advocacy Collaborative, a network of 50+ members which brings together multi-stakeholder representatives from civil society and development partners who support country and global level health financing priorities relating to universal health coverage. #Finance4UHC
 WHO, UNICEF, UNFPA, World Bank, and UN Population Division, 2014. Trends in maternal mortality: 1990 to 2013. Geneva: World Health Organization Press
 United Nations, 2012. The Millennium Development Goals Report, p.37. New York
 United General Secretary, 2014. Framework of actions for the follow-up to the programme of action of the International Conference on Population and Development Beyond 2014. p.197. New York
 United Nations, 2015. Addis Ababa Action Agenda of the Third International Conference on Financing for Development. New York
 UNECA and the AU, 2012. Illicit Financial Flow: Report of the High Level Panel on Illicit Financial Flows from Africa