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In the light of the COVID-19 global pandemic, how can the global health community come together behind a joint vision for resilient health systems, and identify priority actions for both emergency preparedness and universal health coverage (UHC) goals?
This is the focus of the new UHC2030 discussion paper on health emergencies and UHC. It was launched at an event convened by UHC2030 and the Global Health Centre, Geneva, with a diverse audience of over 350 people. María Fernanda Espinosa, President of the 73 United Nations General Assembly described the paper as excellent and vital reading for everyone in global health.
The paper was developed by UHC2030, with inputs from WHO, the World Bank, OECD, Unicef, and other UHC2030 members and constituencies, to stimulate thought, discussion and action on what COVID-19 means for health systems now and in the longer term. How do we need to think differently, and what do we need to do differently, to be better prepared for emergencies as well as make progress on UHC? How can we make health systems sufficiently resilient to manage shocks in ways that protect everyone?
Health systems face dual challenges of responding to the outbreak and protecting other essential services. The paper examines implications for the core health systems functions of service delivery, health financing, and governance. Preliminary conclusions are to: place greater emphasis on public health actions as part of UHC; invest more and better in health; seize the moment for changes that benefit both UHC and health security; and unite behind shared health goals. A potential action agenda is proposed, building on the ‘Key Asks’ from the UHC movement.
Ilona Kickbusch, Co-Chair, UHC2030 and Chair of the International Advisory Board, Global Health Centre chaired the meeting and opened by making the case for UHC in the context of health emergencies. “With COVID-19, the call for UHC is truly a global call and this means a social contract in all countries.”
A first panel discussion focused on public health actions and ‘common goods for health’, making the case for finance resilient health systems, and building resilience in both health systems and populations.
Agnès Soucat, Director for Health Systems Governance and Financing, World Health Organization said, “We neglected the fundamental functions of health systems. The COVID-19 pandemic is a collective failure in this respect. Common goods for health such as public health institutes, laboratories and surveillance systems require collective action and public interventions”.
Feng Zhao, Program Leader in the Health, Nutrition and Population Global Practice for Europe and Central Asia, World Bank Group described how the World Bank’s contribution to the COVID-19 response is helping to build resilient health systems and emphasized that “We need to have a clear set of arguments and investment cases for investors and those who provide the financing.”
Francesca Colombo, Head of the Health Division, Organisation for Economic Co-operation and Development said, “As well as resilient health systems, we also need to build resilient people, move away from silos in health sector, think about health and social care together and build integrated systems.”
A second panel built on these messages and highlighted the vital importance of building trust and engaging communities.
Midori de Habich, Economist and former Minister of Health, Peru said, “We need the right balance of care along the spectrum from community to hospital care, the right balance of emergency care and providing essential services, and the right balance of relationships of stakeholders and decentralised functions, with engagement of communities, private and public stakeholders.”
Githinji Gitahi, Global CEO, AMREF Health Africa and Co-Chair of UHC2030 emphasised that supply-driven health systems in many countries have shifted to supply-driven COVID-19 systems, but people’s health needs beyond COVID-19 have not changed. When it comes to health services and the response to COVID-19, “Trust can only be gained by being earned” he said.
Anamaria Bejar, Director of Advocacy, International Planned Parenthood Federation and speaking on behalf of the UHC2030 Civil Society Engagement Mechanism (CSEM) announced a call to action from the CSEM on health emergencies and UHC. “We need locally owned responses and health systems. Primary health care is absolutely essential, and including communities in decision-making is critical,” she said.
Stefan Peterson, Chief of Health, UNICEF said, “Community engagement and involvement play a crucial role in both a health care and community mobilisation sense. Our UHC and PHC needs to start at the community level.”
The event concluded with discussion of how to bring everyone together behind a set of priority actions for stronger and more resilient health systems.
María Fernanda Espinosa, President of the 73 United Nations General Assembly said, “What is the post COVID-19 scenario? We need a checklist that is agreed by the world on how we do not repeat the same mistakes. […] Health should be conceived of and treated as a global public good. We need a new social pact.”
Ilona Kickbush concluded the meeting by calling on the meeting participants to discuss, critique and use the paper. She said, “There is a real danger of a new vertical approach of health security. The debate that UHC2030 has started in this discussion paper is critical to counteract that new verticality. If we go wrong now, the world will pay a very heavy price – and as always the most vulnerable will pay the most.”
Read the discussion paper
Photo: © WHO / Jonathan Perugia