A new framework for performance analysis
On 9 July 2020, WHO, the Group of Friends of UHC and Global Health and UHC2030 co-organized an official side event of the High-Level Political Forum, “Investing in Health: The Key to Building Back Better from COVID-19 and Accelerating Progress for Universal Health Coverage and Sustainable Development.”
The event was co-hosted by Dr. Nata Menabde, Executive Director of the WHO Office at the UN and the three co-chairs of the Group of Friends of UHC: Ambassador Srivihok of Thailand, Ambassador Imnadze of Georgia, and Ambassador Ishikane of Japan.
H.E. Mr. Vitavas Srivihok, Permanent Representative of Thailand to the UN, opened the event by highlighting many of the challenges that COVID-19 has brought to light, particularly the need to build resilience and invest in universal health coverage (UHC), through fulfilling the commitments of last year’s historic Political Declaration on UHC.
The UN Deputy Secretary-General, H.E. Ms. Amina Mohammed, shared a video message stressing the impact of the pandemic on our social, economic and health systems, particularly for vulnerable groups. She noted that we are at a critical junction, where the Decade for Action and Delivery for Sustainable Development is now more important than ever, as the pandemic threatens to reverse progress made, especially where there have been disruptions to routine childhood vaccinations and women’s, children’s and adolescents’ health services, and in light of stalling action on non-communicable diseases and increased mental health burden. She promoted the need for multilateralism and the comprehensive approach spearheaded by the UN system, including the development of a UN Secretary General’s Policy Brief on universal health coverage.
Dr. Tedros, the Director General of the World Health Organization, provided a video message, calling on world leaders to fulfill their commitments made in last year’s Political Declaration of UHC. Dr. Tedros noted that even before COVID-19, the world was not on track to meet the health-related SDGs and that now, more than ever, we need to invest in patient-centered and community-based health systems, common goods for health, health education and literacy, increased health human resources, and leveraging new technologies for surveillance and monitoring.
Dr. Gro Brundtland, Member of The Elders and UHC Movement Political Advisory Panel of UHC2030, issued a strong call for public financing, including the need to eliminate health service access fees in order to ensure that all people can access health care for free at the point of service, and the reallocation of budgets toward primary health care. With COVID-19 spreading around the world, Dr Brundtland stressed the need for a coordinated and global response to public health, increased funding for WHO, and innovation and resourcefulness to achieve UHC and the wider SDG agenda, alike.
Dr. Keizo Takemi, WHO Goodwill Ambassador for UHC, addressed COVID-19 in the context of human security, drawing on Japan’s national experience achieving UHC while rebuilding from the destruction of WWII and recognizing the role of UHC in creating a stable educational and economic system that empowered all generations in Japan. Dr. Takemi encouraged an interdisciplinary and collaborative approach to combatting COVID-19, stressing that the new normal must be founded in a holistic, human-centered notion of human security. In this regard, Dr. Takemi proposed the establishment of a panel to discuss the evolving notion of Human Security against the backdrop of the pandemic.
Dr. Nata Menabde, Executive Director WHO Office at the UN, moderated a panel discussion with government representatives and experts, to share national experiences, lessons learned and best practices from across regions. Dr. Menabde stressed that this is not the first, and won’t be the last, global challenge we will face, and that health systems need to be resilient and robust enough to respond to challenges. She also shared WHO’s recent announcement of the establishment of an Independent Panel, to be chaired by Helen Clark and Ellen Sirleaf Johnson.
H.E. Dr. Eteni Longondo, Minister of Health of the Democratic Republic of Congo, shared the DRC’s unique experience in managing the overlapping outbreaks of Ebola and COVID-19, and the ways in which the DRC has capitalized on the experience gained from the Ebola response, such as: redeploying field equipment and laboratories, as well as human resources, trained and experienced from previous Ebola outbreaks, to respond to COVID-19. The government has also activated the Ebola multisectoral response team to respond to COVID19. Notable lessons learned, include: the benefits of decentralizing labs, engaging communities in on-the-ground response, addressing public security and conflict reduction, and engaging a whole-of-society response. The government has subsidized medical care for patients of Ebola and COVID-19 in order to encourage people to turn to health centers for care and is reviewing its UHC plan to ensure it includes management of epidemics and other health emergencies.
H.E. Mr. Román Macaya Hayes, Executive President of the Costa Rican Social Security Fund, provided an overview of the emerging challenge in Costa Rica and credited a strong primary health care (PHC) system for the early identification of cases and access to care. Dr. Macaya outlined the epidemiological surveillance strategies that have been employed, including: identifying and isolating cases and their close contacts; a case visualization dashboard; surveillance and testing at borders, health care centers and high-density vulnerable communities, which is then mapped to geographic information systems. He highlighted effective national interventions in affected communities, such as: inter-institutional coordination to address the needs of vulnerable populations, establishment of medical units for continuous monitoring of quarantine cases, updated safety guidelines, streamlined drug and PPE procurement, telemedicine and provision of home delivery of medications. Dr Macaya further addressed R&D and access to medicines, calling for the establishment of a global patent pool on COVID-19 technologies and country contributions to help ease potential access issues for a future vaccine.
Dr. Tamar Gabunia, Deputy Minister of Health of Georgia, shared the resource challenges posed by the outbreak in the context of their ongoing UHC efforts (since 2013), requiring a reallocation of capacities, particularly toward strengthening PHC, laboratories and surveillance. In light of this, she noted that Georgia is pivoting to new modes of PHC delivery, including telemedicine, online consultations, home-based monitoring and care. Given that 85% of health facilities in Georgia are privately owned, Dr. Gabunia highlighted that the government is revisiting the Public-Private Partnership agenda to best leverage both private and public healthcare facilities. Coordinated measures to contain the spread of COVID-19 include: timely testing, contact tracing, social distancing, equal access to quality diagnostics and ensuring a safe and hygienic health care environment. Dr. Gabunia advocated for a strong national coordinating body, continuity of essential services during pandemic response, and investments in interventions that take long-term development into consideration.
Dr. Sakchai Kanjanawatana, Secretary-General of the National Health Security Office of Thailand acknowledged the contribution of the national UHC scheme – built on equity, efficiency and participation – in contributing to strengthening the health system and global health security, including Thailand’s COVID-19 response. Thailand’s success in combatting the pandemic stems from a combination of public health and social measure, such as: active surveillance and screening, state and local quarantines, effective communication strategies, enhanced social safety nets, and awareness raising campaigns. Dr. Kanjanawatana drew attention to the Community Health Fund, which supports health programs tailored to local needs, and the Village Health Volunteers, who (during COVID-19) monitor people’s movements, conducting house visits and check-ups, and contribute to continuity of care through home delivery of medicines, among others.
Ms. Mamta Murthi, Vice President of Human Development at the World Bank Group, shared the global economic outlook of the greatest economic crisis of our generation and the deepest global recession since WWII. Growth for advanced economies is expected to contract by 7% and for developing economies by 2.5%, which will significantly impact global efforts to reduce poverty. The World Bank estimates that around 70-100 million people will be pushed back into poverty. Ms. Murthi further stressed that due to COVID-19 disruptions of essential services, an expected additional 13.5 million people (mostly children) will not be immunized this year, resulting in an expected additional 250,000 child deaths. The World Bank also expects a doubling of deaths from TB, Malaria and HIV, a 10 trillion-dollar income loss for the generation of children who have missed out on educational opportunities and an estimated 8 million unintended pregnancies. Because national and local governments will face a severely constrained fiscal space for essential expenditures, increasing in efficiency will be key. Ms. Murthi highlighted that the World Bank has provided its largest and fasted crisis response ever, serving over 100 countries – 70% of the world population – and providing USD 160 billion in grants, to manage the immediate health impact, bolster health systems, maintain essential social services and lay the groundwork for future economic recovery. In closing, Ms. Murthi noted that the estimated pre-COVID financing gap of USD 160 billion to achieve UHC in developing countries will have significantly widened as a result of the crisis, calling for global solidarity to defeat COVID-19.
Dr. Roopa Dhatt, Executive Director of Women in Global Health, addressed three key gender dimensions of the pandemic, calling for women to be better represented in leadership positions, safe working conditions for healthcare workers which take into consideration the particular needs of female workers, and gender-responsive health services that include the continuity of sexual and reproductive health and rights. Dr. Dhatt noted that despite female nurses and community health workers making up 70% of frontline workers, women’s expertise and leadership are systematically sidelined: in planning and leadership, women make up only 15% of national task teams and only 25% of health leaders.
H.E. Mr. Kaha Imnadze, Permanent Representative of Georgia to the UN, moderated a brief Q&A, with notable interventions from Spain and Turkey, regarding financing models to ensure necessary spending for public health and emphasizing the importance of multilateralism and global solidarity, respectively.
H.E. Mr. Kimihiro Ishikane, Permanent Representative of Japan to the UN, provided closing remarks, encouraged by the renewed commitment to the Political Declaration on UHC to tackle this human security crisis. Ambassador Ishikane lent his support to the development of the SG policy brief on UHC and called the Group of Friends to consider a joint statement of endorsement.
Photo: WHO / NOOR / Sebastian Liste