A letter to The Lancet from Ms Gabriela Cueva and Dr Justin...
A year ago in September 2019, world leaders came together to endorse the Political Declaration on Universal Health Coverage (UHC), representing the most ambitious set of commitments in global health in history. Less than four months later, the world has been faced with a global health and human security crisis unparalleled in recent history, the health and socioeconomic implications of which pose a significant threat to progress made toward the achievement of the Sustainable Development Goals (SDGs).
On 8 October 2020, a high-level event commemorated the anniversary of the High Level Meeting (HLM) on UHC with more than 650 participants from a range of organisations from around the world and highlighted the urgency for countries to fulfill the promise of quality health coverage for everyone, everywhere.
Ministers speaking during the event all emphasised the importance of reaffirming the commitment to UHC in the face of the COVID-19 pandemic, with strong messages that UHC is important for both health security and overall social well being. Investment in resilient health systems is a priority for strengthening health security and preparedness for future crisis, with people and community actions as key for success.
The meeting came one day after the UN Secretary General released a policy brief emphasising the critical importance of UHC in the context of the COVID-19 pandemic.
UHC2030 co-chairs welcomed the UN Secretary General’s policy brief, mentioning in a statement that “Health is a profoundly political choice. To respond to this crisis and build a safer and healthier future, leaders must urgently invest in health systems. It is in their interests to do so: COVID-19 shows that under-investment in health can have a devastating impact on societies and economies. They must also build trust and accountability by widening participation in health governance and decision-making.”
Ambassador Elizabeth Cousins, President and CEO of the UN Foundation moderated and introduced the meeting by saying, “All around us, we see the devastating consequences of inequitable access to quality health care. Health systems and the societies they serve are struggling under the strain of COVID-19. The pandemic is exposing fractures in our societies in the most brutal ways, among the most vulnerable populations suffering the most severe consequences. Against this stark backdrop, the case for UHC is self-evident and it is urgent. How can we learn from this experience and work together to build robust health systems that serve and protect everyone, especially the most vulnerable?”
Welcome remarks from the co-chairs of the Group of Friends of UHC and Global Health
H.E. Mr. Motegi Toshitisu, Minister of Foreign Affairs, Japan said, “To tackle the COVID-19 pandemic, it is important to aim at leaving no one behind and achieve UHC while taking a stand for the principle of human security […] We have to generate an enabling environment to be resilient against infectious diseases, to ensure health security and to improve primary health care. […] Japan overcame the turmoil and poverty following world war two, and adopted a nationwide health insurance system, thereby achieving UHC. As a result we achieved economic development, favourable health status and longevity. In tackling COVID-19, the resilient health system of Japan has proven instrumental.”
H.E. Mr. Don Pramudwinai, Deputy Prime Minister/Minister of Foreign Affairs, Thailand said, “Less than a year after the HLM on UHC, COVID-19 serves as a powerful testimony to the value of UHC. It enables people access to affordable health care in their time of greatest need. We in Thailand established UHC almost two decades ago. We have the firm belief, then as we do now, that UHC would contribute to a social safety net that ensures basic human rights […] UHC and health security are one and the same. Investing in health systems allows us to strengthen and support UHC. People and community actions are key to achieving UHC. People’s engagement leads to community resilience and strong health systems that are crisis ready. We must never cease to promote healthy lives. Health promotion and prevention programmes, as part of Thailand’s UHC play a critical role in our COVID-19 response.”
H.E. Mr. David Zalkaliani, Minister of Foreign Affairs, Georgia said, “In Georgia, everyone, no matter who they are, or where they live, has access to the free-of-charge testing and treatment they need for COVID-19. Georgia is one of the most successful examples in the fight against COVID-19 as evidenced by many international assessments. Its success mainly relies on the UHC reforms initiated by the government of Georgia in 2013. We believe that UHC is the best way to achieve global development goals and is an important mechanism to expand access to high quality health services.”
H.E. Mr. Antonio Guterres, Secretary-General of the United Nations said, “Today, the COVID-19 pandemic has shown that our health systems are inadequate. Weak health systems and unequal access to health care are major reasons why COVID-19 has killed over 1 million people and infected more than 30 million around the world. COVID-19 has made the need for UHC, outlining the strong political declaration that emerged from last year’s meeting, more urgent than ever.”
Dr. Tedros Adhanom Ghebreysus, Director-General of the World Health Organization said, “Investing in health is not an optional extra. It is the foundation of strong, stable, prosperous and peaceful societies and economies. When we promote and protect health, we also promote and protect jobs, businesses, economies, education, gender equality, peace, sustainability and more. The COVID-19 pandemic is a crisis unlike anything any one of us has experienced in our lifetimes. But it must also be a turning point for all of us, a catalyst for making UHC a reality and not just an aspiration.”
The first panel shared national experiences of UHC and COVID-19.
Speakers highlighted action taken by their governments to take forward the Political Declaration on UHC and lessons learned from the pandemic, notably the importance of integrating public health measures in COVID-19 responses.
H.E. Raychelle Omamo, Cabinet Secretary for Foreign Affairs, for the Republic of Kenya said, “Kenya affirms and supports the political declaration of the HLM on UHC. UHC is an integral part of our government’s agenda as we strive to meet SDG3. Health shocks are the biggest cause of poverty and the weakening of family structures in our society. We strive to provide our citizens with primary health care, without them experiencing financial hardship.”
H.E. Mr. Amadou Ba, Minister of Foreign Affairs, Senegal said, ”the current pandemic and its devastating impact on all aspects of our lives demonstrates our collective vulnerability. Solidarity and international cooperation have become the unique alternative to address effectively global issues, particularly in health and emergencies. Effective engagement of everyone is needed for effective research on the COVID-19 vaccine and when available, for an equitable, safe and affordable access. This makes a strong case to have UHC in the fight against COVID-19.”
H.E. Kwaku Agyeman-Manu, Minister of Health, Ghana said, “Ghana has prioritized the achievement of UHC as an important national agenda and part of a social contract. The development of a national UHC roadmap is indeed a symbol of our ownership of UHC […] to ensure that all people in Ghana have time access to quality health services irrespective of ability to pay at the point of use. We will reach people with a comprehensive UHC package of health services.”
H.E. Dr. Daniel Salinas, Minister of Health, Uruguay spoke about the key features of Uruguay’s response, which were critical to achieve credibility and raise the awareness of the population. It translated into a recovery of the economy at 95% of its previous level before the pandemic. “We have based our approach on multi or transdisciplinary action by all ministries and all the forces in our country [...] We have also maintained honest and daily communication about the situation, carrying out a campaign through the National Coronavirus Plan, and emphasising public good.”
H.E. Dr Harsh Vardan, Minister of Health and Family Welfare for India said, “India has been working towards making UHC a reality for its citizens. COVID-19 brought home to us several lessons. It has made us realise the importance of resilient and strong public health systems. COVID-19 has also ensured that we now need to focus on accelerating actions related to integrate public health surveillance and data sharing in primary and secondary health care. This has spurred design reforms.”
H.E. Mr. Jean-Baptiste Lemoyne, Minister of State for Tourism, French Nationals Abroad and Francophonie, France said, “I have learnt three lessons from this COVID-19 crisis for achieving the objective of UHC. First, healthcare personnel provide the cornerstone of our health systems. Second, equitable access to essential healthcare must remain a priority. Third, I want to stress the importance of jointly financing common goods for health which underpin the basic functions of our health systems such as monitoring, preparation and R&D. These are the first step on the path to UHC”
H.E. Ms. Wendy Morton, Minister for European Neighbourhood and the Americas, United Kingdom said, “The pandemic reminds us that diseases do not respect borders. We have seen it affects access to basic rights and services for the poorest and most vulnerable, especially women and girls as their education, health and livelihoods are disrupted and gender-based violence increases. More than half of countries surveyed by UNICEF have seen immunisations and child health checks disrupted. This is why UHC is fundamental to a fairer future.”
Ms. Marjeta Jager, Deputy Director-General, European Union said, “As a result of COVID-19, progress towards UHC has clearly suffered a severe setback on a global scale and we need to bring it back as a matter of priority. Today’s situation reinforces what we have known for a long time. In the face of the pandemic UHC is the best way to secure the health of all individuals and especially the health of the most vulnerable populations.”
The second panel presented perspectives from partners.
This provided an opportunity for UHC2030 private sector and civil society partners to raise the voice from these important constituencies.
Ms. Sylvana Q. Sinha, CEO and Founder of Praava Health, and Member of the UHC2030 Private Sector Constituency said, “The private sector has the opportunity to innovate in different ways to serve our particular communities and there are also ways to partner with governments to fill in capacity where needed. We need to promote more coordination between the public and private sectors […] and come to the table with openness, not competing with each other and innovate together."
Dr. Khuat Thi Hai Oahn, Executive Director, Center for Support Community Development Initiatives and Advisory Group Member of the UHC2030 Civil Society Engagement Mechanism said, “Governments have made the promise of UHC. Now how do we hold them accountable? UHC should be monitoring and reported on. The political declaration promised protection of the most vulnerable and this promise needs to be delivered. In December 2020, UHC2030 is launching a State of UHC Commitment report in order to support accountability processes at country level.”