Strengthening health systems and advancing universal health coverage in a changing world

On the margins of the 80^th Session of the United Nations General Assembly, the co-chairs of the Group of Friends of Universal Health Coverage and Global Health (Georgia, Japan and Thailand) convened their sixth annual ministerial meeting, in collaboration with UHC2030, the World Health Organization (WHO), the United Nations Foundation and UNAIDS.  

The event, entitled “Strategic investments for resilient health systems: Strengthening health systems and advancing universal health coverage in a changing world”, brought together senior government officials and other key health and development stakeholders to discuss reforms to global health architecture and financing amid mounting challenges. Across the board, speakers underscored that universal health coverage (UHC) is essential for equitable and resilient health systems, health security, and sustainable development.

The event was moderated by Dr. Cecilia Shah, Vice President for Global Health at the UN Foundation, who set the scene – noting key gaps in progress towards UHC and the increased risk of backsliding in the current context – before turning to the co-chairs of the Group of Friends for opening remarks.

Reaffirming the Government of Japan’s commitment to global health as a pillar of diplomacy, H.E. Mr. Iwaya Takeshi, Minister of Foreign Affairs, stressed the urgency of achieving UHC and building resilient health systems backed by sufficient investments. He highlighted the importance of reducing reliance on financial assistance and maximizing the use of domestic resources, as well as the necessity of engaging private sector and civil society to strengthen health financing. To ease the burden on health systems, he also called for greater emphasis on health promotion and disease prevention. As part of these efforts, Japan, in collaboration with WHO and the World Bank, will launch a UHC Knowledge Hub later this year to support countries in building financing capacity for health. 

H.E. Mr. Lasha Darsalia, Deputy Minister of Foreign Affairs of Georgia, emphasized that investments in UHC safeguard health security and contribute to social cohesion, economic stability and sustainable development. He shared Georgia’s progress since implementing UHC in 2013, which now covers over 95% of the population, noting that reforms to primary health care (PHC), the pharmaceutical sector, and reimbursement systems, have led to reduced out-of-pocket payments and improved financial protection. He stressed that building resilient health systems requires continuous investments, underpinned by strong partnerships, to ensure that progress is aligned with global commitments.  

Ms. Pinsuda Jayanama, Director-General of the Department of International Organization at the Ministry of Foreign Affairs of Thailand, acknowledged that while UHC has shielded many from emerging risks in the rapidly evolving global landscape, it continues to face significant tests. She shared Thailand’s “SAFE” approach – to make UHC financing sustainable, adequate, fair and efficient, highlighting their focus on health promotion, digital health solutions (e.g. AI, telemedicine), and the implementation of a decentralized approach of community health funds that can be invested to directly meet local needs. Stressing the importance of knowledge sharing and collaboration, Ms. Jayanama expressed Thailand’s interest in collaborating with the UHC Knowledge Hub in Tokyo through the future Prince Mahidol Conference (PMAC) Global Health and UHC Hub to be launched early next year in Bangkok. 

With 4.5 billion people lacking full coverage of essential health services, 1 billion people experiencing catastrophic health expenditures, and health aid projected to drop by 40% this year compared to just two years ago, Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, emphasized the pressing need to reform both domestic and global health financing systems. Amid rising inequality, shrinking aid and mounting debt burdens, he stressed that “building more self-reliant national health systems is essential, but so too is addressing the underlying power imbalances and global inequities that have historically shaped our international systems”. Dr. Tedros urged countries to prioritize health in domestic budgets, leveraging proven tools like health taxes and pooled procurement; align all funding with national priorities as per the Lusaka Agenda; and build a more effective and inclusive global health ecosystem. He welcomed the upcoming launch of the UHC Knowledge Hub in Tokyo and reaffirmed WHO’s commitment to supporting countries in transitioning to more sustainable, people-centered health systems.

An expert panel discussion followed, with speakers sharing insights and recommendations for leveraging the current challenges to build resilient, sustainable systems that more effectively advance health for all in the long term. 

While acknowledging the acute challenges resulting from sharp aid cuts, Dr. Pam Cipriano, Co-chair of UHC2030, noted that the underlying issues of fragmentation, inequitable access and unreliable funding have long existed. To this end, she advocated for UHC to serve as the “central organizing principle guiding our collective efforts”. Anchoring reforms in PHC and aligning efforts around country-led, cost-effective and inclusive approaches will be key to progress. She further emphasized that the solution is not only more investments, but also smarter investments, as well as reconceptualizing service delivery, including through supporting the health workforce and harnessing digital expansion. Dr. Cipriano concluded with a call for bold political leadership to turn commitments into concrete action – recognizing UHC as not only a technical goal but a social and political contract for delivering health for all.

Dr. Shyam Bishen, Head of the Centre for Health and Healthcare and Member of the Executive Committee at the World Economic Forum, shared his perspective on engaging the private sector as a strategic partner and recommended the scaling up of innovative financing models such as blended finance, health bonds and outcome-based approaches. Dr. Bishen also outlined several key areas for collaboration with the private sector, including expanding access to technology and infrastructure; strengthening logistics and supply chains; developing risk pooling and insurance solutions; partnering with employers to provide preventive and primary care coverage; enhancing efficiency and service delivery; and supporting research, innovation and local/regional manufacturing. Citing successful examples such as Gavi, the Global Fund’s private sector engagement, and the Novartis Access Program, he noted that while many viable solutions already exist, the key challenge lies in implementing these solutions at scale and, in this regard, multisectoral partnerships have a critical role to play.

Representing the Civil Society Engagement Mechanism of UHC2030 (CSEM), Ms. Nupur Lalvani, Founder Director of Blue Circle Diabetes Foundation, called for a whole-of-society approach to ensure health equity, particularly for the most vulnerable, stressing that “at the primary health care level, co-designing, implementing and monitoring programmes ensures the greatest returns on investments”. Acknowledging successful examples to strengthen social participation in Thailand and Madagascar, she outlined three strategies for governments: create robust, inclusive governance to ensure accountability and implementation of the WHA resolution on social participation; establish spaces for meaningful stakeholder engagement at all levels of the health system; and provide sustainable funding to support advocacy and stakeholder engagement, particularly in resource constrained environments, to drive successful local implementation.

Following the panel discussion, interventions from the floor were provided by H.E. Prof. Valentina Prevolnik Rupel, the Minister of Health of Slovenia, H.E. Dr. Ahmadou Lamin Samateh, Minister of Health of the Gambia, H.E. Mr. Timur Sultangaziyev, Vice Minister of Health of Kazakhstan, H.E. Dr. Jaime Urrego, Vice Minister of Health of Colombia, H.E. Ms. Karin Tegmark, Ambassador for Global Health of Sweden, H.E. Mr. Walton Alfonso Webson, Permanent Representative of Antigua and Barbuda to the UN, Ms. Angeli Achrekar, Deputy Executive Director of UNAIDS, and Dr. Mary-Ann Etiebet, CEO of Vital Strategies.

These interventions highlighted the critical role of PHC, community engagement and equitable access in achieving UHC, social justice and inclusive development. Both the need for fair pricing and debt relief to address global health inequities, as well as smart fiscal policies to boost domestic resource mobilization, were proposed as solutions to tackle current health financing challenges. Speakers consistently underscored the need for integrated and holistic approaches to health, as well as community leadership and social participation, in order to reach vulnerable populations and build collective resilience in the face of intersecting global challenges.