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A sense of impatience, urgency and need for action was felt sharply at the UNGA meeting on UHC in emergencies: how can all stakeholders, and the development-humanitarian nexus work to ensure UHC in fragile and conflict settings.
Co-hosted by the Governments of Switzerland and Afghanistan at UNGA on the 27 September 2018, the meeting highlighted the importance of UHC in emergencies as a component of the Agenda 2030 for sustainable development and mobilized political commitment for progress by promoting the ‘Call to Action on Universal Health Coverage (UHC) in emergencies’.
Over the last years, the international community has given more attention to the provision of health in situation of emergencies, with the indivisible link of SDG3 and SDG16 in the 2030 Agenda and in resolution 2286 of the Security Council (2015) relating to the protection of healthcare in armed conflict. A framework exists at the international level, yet important challenges remain on the ground. There is a lack of respect for the existing internationally agreed principles governing UHC.
More coherent approaches and stronger commitments to expand UHC in armed conflict, fragile settings and other emergencies are urgently needed. Efforts must be enhanced to prevent and mitigate attacks on health care in all emergency settings, to ensure the delivery of health care, to protect health systems, and promote the right to health for all. Ensuring UHC in emergencies also requires bringing together humanitarian and development actors to strengthen and support national health systems, building resilience to scale-up and sustain core public health capacities.
During the World Health Assembly in 2018, Switzerland and Afghanistan initiated the process to develop a multi-stakeholder Call to Action on Universal Health Coverage in Emergencies. This event at UNGA was a follow up to maintain momentum on the call to action with all stakeholders.
The event was moderated by Prof. Ilona Kickbusch, Director of the Global Health Centre, Graduate Institute of International and Development Studies, Geneva and co-chair of UHC2030 Steering Committee. She spoke about UHC in emergencies, reminding everyone of the need for coherent and evidence-based approaches in the humanitarian-development nexus and to engage all stakeholders. “We should not just talk to each other but reach out to wider political processes,” she said.
H.E. Alain Berset, President of the Swiss Confederation gave a keynote speech, emphasizing that, “UHC in emergencies is an integral part of the SDG agenda, and we must get political commitment to make progress.” He urged a coherent and inclusive approach extend UHC in armed conflict, fragile settings and other emergency settings. Commitment should focus on three main areas for UHC in emergency settings:
1. To strengthen national health systems, build resilience, and support basic public health functions.
2. To work for the full implementation of human rights, UN Resolutions and the SDG 2030 agenda. Internationally, each one of us must implement norms everywhere.
3. To ensure continuity in health systems and access to services without interruption.
Mr. Peter Maurer, President of the International Committee of the Red Cross (ICRC) gave another keynote speech, noting, “We are seeing the deadly effects of conflict on health systems and health care.” He identified seven key areas for action and called for us to transform our outrage into new ways for collective connected actions.
1. The international community should do more to prevent collapse of health systems and protect citizens. We need flexible mechanisms for rapid responses in life or death situations, then have to start to work more focused on the humanitarian – development nexus.
2. We need to make the invisible visible and design solutions with people who face particular challenges such as women, children, elderly, disabled people who require specific approaches. Trained local health workers are key frontline deliverers.
3. Concrete steps to protect systems and services accessible to communities are critical and still awaiting.
4. With the radicalization of religious and political ideologies we have forgotten the principle to allow impartial treatment to all victims of hostilities and fighters on all sides.
5. We must consider all action within the continuum of care.
6. We must increase quality support to address mental health and psychological support needs, as well as NCDs in conflict settings.
7. We must limit destruction – in urban conflict especially – and urge all parties to take feasible precautions to protect civilians and avoid the use of weapons.
During a panel session, H.E. Sigrid Kaag, Minister for Foreign Trade and Development Cooperation, the Netherlands spoke about the importance of UHC and the need to focus efforts on speed, quality and continuity, not one-off interventions. She said, “We want to spearhead a true focus on mental health and psychosocial support.”
H.E. Professor Jacek Czaputowicz, Minister of Foreign Affairs, Poland endorsed the Call to Action and spoke about core objectives of access to care in emergencies and armed conflicts and evoked the memory of the turbulent 20th century, which reminds us all of the value of healthcare during conflict. “There is still much to be done; such as improvements on health financing, promoting UHC in national health systems and ensuring universal access to quality health services. We need to mobilize humanitarian and development actors as well as the private sector to achieve UHC for all even in fragile and conflict situations.”
H.E. Dr. Pierre Somse, Minister of Public Health and Population, Central African Republic shared the challenges that the country faces in relation to health care including insecurity, attacks on health infrastructure and workers, lack of drugs, and health professionals especially in rural areas and areas controlled by armed groups. Its maternal and child mortality is among the worst in the world, thus the government’s priorities. There are also difficulties of coordination with a multiplicity of actors, and lack of accountability, especially in the public sector. How is it possible to achieve UHC in this context? “First, we need to re-establish government leadership and strong especially in the humanitarian context. The humanitarian response believes they are a group apart and do not have to deal with government, as their role is to care for people and they do this better than government. It may be true, but the lack of coordination creates unnecessary tension and is a missed opportunity.” He reiterated that “Health is an incubation to peace.”
Dr. Tedros Adhanom Ghebreyesus, Director-General, WHO shared examples of joint efforts through the DARES Partnership between WHO, WBG, WFP and UNICEF in countries in conflict such as Yemen, and made a powerful statement of political commitment. Health can be a bridge to the peace and bridge humanitarian and development actors. “WHO is in a unique position to help countries ease the impact of conflicts through health and UHC. We are developing a new support mechanism to integrate systems strengthening and emergency responses, and aim to ensure access to services for the most vulnerable in the population. Yet, political commitments alone are not enough to make a difference. We must all put our money where our mouth is and invest to ensure that the most vulnerable are not left behind.”
H.E. Dr Emais Roberts, Minister of Health, Palau spoke about the impact of the country’s 2010 health care act, which has been successful in improving access to services. “We want to move towards preventative care,” he said.
H.E. Ms. Agneta Karlsson, State Secretary for Health Care, Public Health and Sport, Sweden strongly endorsed the call for action, and said, “This initiative to introduce UHC as an important strategy for health during emergencies is very timely.”
H.E. Amb. Elisabetta Belloni, Secretary-General of the Ministry of Foreign Affairs and International Cooperation, Italy spoke about humanitarian crises becoming more frequent, complex and challenging. “A lack of basic health services leads to the spread of otherwise avoidable diseases. We need to bring together humanitarian and development actors to strengthen systems in fragile contexts,” she said.
Dr. Seth Berkley, CEO, GAVI spoke about the protracted situations in emergency settings, with over 50% of children under-immunised. “We are committed to working with you for the successful implementation of the call to action,” he said.
H.E. Amb. Mahmoud Saikal, Permanent Representative to the UN, Afghanistan made concluding remarks, and argued for the urgent need for coherent, inclusive approaches that strengthen health infrastructure and build local capacities. “Expanding UHC to those in armed conflicts and other humanitarian crises is important. This call to action is an initiative to create momentum on this agenda, and we reiterate our full support to work at national, regional and international levels.”
The co-sponsors of the event were:
The Governments of Central African Republic, Italy, Finland, Luxemburg, The Netherlands, Poland, Somalia, Spain, Sudan, Sweden, GAVI, the Vaccine Alliance, International Federation of Red Cross and Red Crescent Societies, International Health Partnership for UHC 2030 (UHC2030), the World Bank Group (WBG) and World Health Organization (WHO)