26 September 2022

Investing in Health Systems Strengthening for Universal Health Coverage Through a Primary Health-Care Oriented Approach

Photo of meeting participants

On September 21, the Co-chairs of the Group of Friends of Universal Health Coverage and Global Health (Permanent Missions of Georgia, Japan and Thailand to the United Nations), the World Health Organization and UHC2030, on the margins of the 77th Session of the UN General Assembly hosted the third annual Ministerial Meeting on Universal Health Coverage, “Investing in Health Systems Strengthening for Universal Health Coverage Through a Primary Health-Care Oriented Approach.”

Recognizing that investments in health systems can have far-reaching impacts, UN leaders, ministers, universal health coverage (UHC) champions and other high-level speakers came together to take stock of the progress, gaps and challenges faced during COVID-19 and to recommit to the implementation of the 2019 Political Declaration on UHC. The event highlighted the need for stronger primary health care, maintenance of non-pandemic related health services during a health emergency, and integration of emergency preparedness, community empowerment and increased collaboration and coordination across sectors to support resilient and equitable health systems that leave no one behind.

The speakers kickstarted the thematic discussions leading up to the 2023 High Level Meeting on UHC by sharing their vision of Health for All and outlining clear objectives for UHC and global health security. They focused on financing, primary health care and the need to improve social participation, collaboration and accountability. They called for political action and leadership for sustainable domestic and global health financing, particularly in the contracted fiscal space for social spending resulting from COVID-19, including through debt suspension and relief for low- and middle-income countries (LMICs).

The speakers also encouraged commitments for strengthening national health systems through a primary health care approach to deliver integrated quality services through well-supported community-based systems. Many panellists, including Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, highlighted that 90% of essential health services can be delivered through primary health care. To quote Mr. Omar Abdi, Deputy Executive Director for Programmes, UNICEF, “community-based health systems are the equity arm of primary health care and community-based care yields a 10-1 yield return on investment.”

Other highlights include video messages from H.E. Mr. Csaba Kőrösi, President of the 77th Session of the UN General Assembly and H.E. Ms. Amina Mohammed, Deputy Secretary-General, United Nations, along with WHO’s video on social participation titled, “Health is all about people – it’s time to invest in social participation!”

Click here to watch the event recording.

Key Messages

High-level Opening Segment

The event started with opening remarks from the co-hosts, who focused on and provided examples of concrete actions to accelerate UHC goals, promote strong and resilient health systems and respond to and recover from the impacts of the COVID-19 pandemic.

Ms. Elisha Dunn-Georgiou, President and CEO of the Global Health Council, moderated and introduced the meeting by stating that “we are at a critical juncture in the need to accelerate action to achieve universal health coverage. As we look to the 2023 High Level Meeting on UHC it is an important time to take stock on the commitments made in the 2019 Political Declaration on UHC.”

H.E. Mr. Don Pramudwinai, Deputy Prime Minister and Minister of Foreign Affairs of Thailand, stated that we must make health for all the centre of the sustainability agenda and improve primary health care at the community level by empowering communities and through social participation. He stated that “more than 50% of world’s population does not have access to health care and many are driven into poverty due to out-of-pocket health spending. Additionally, countries who have achieved UHC are now finding it difficult to maintain their existing health schemes.”

H.E. Mr. Hayashi Yoshimasa, Minister of Foreign Affairs of Japan, emphasized the need to learn the lessons from COVID-19 and strengthen global momentum around UHC. “The spread of COVID-19 has exposed vulnerabilities in access to health care throughout the world, and with half of the world not having access to health, human security is threatened.”

H.E. Mr. Zurab Azarashvili, Minister of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia emphasized the need to maintain pandemic and non-pandemic health services and invest in health technology, particularly to expand telemedicine. He also mentioned that “strong partnership with WHO and the World Bank will help mobilize the technical assistance needed to strengthen primary health care, decrease out-of-pocket spending, and address non-communicable diseases.”

Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, stated that when health is at risk, everything is at risk, highlighting the compounding existential crises of climate change, food insecurity and armed conflict. “The WHO’s top priority for the next five years is to make a radical reorganization of health architecture towards primary health care and universal health coverage.” He continued by recognizing that economies are tight, and inflation is rising, but “unless we all move with intention down the road for UHC, we will not make progress.”

Ministerial Segment

Co-sponsors shared their experiences, priorities and efforts towards achieving UHC. They also called for international and multilateral collaborations and global leadership to build equitable health systems.

Hon. Ms. Kamina Johnson Smith, Minister of Foreign Affairs and Foreign Trade of Jamaica, highlighted that the COVID-19 pandemic has exacerbated issues and brought weaknesses in health systems, including systemic vulnerabilities, to the fore. She emphasized that, “many LMICs and SIDS try to make progress on investments in health. However, due to debt repayments, they have had to cut back on these investments. It is necessary to address debt servicing issues and reform donor financing architecture so that countries can focus their resources on local sustainable development efforts.”

H.E. Mr Péter Szijjártó, Minister of Foreign Affairs and Trade of Hungary, called attention to three key issues: “First, everyone must have access to clean and safe water, sanitation and hygiene… Second, health should not be politicized… Third, health and health services should not be denied to individuals fleeing unsafe countries.”

H.E. Mr. Sanjay Verma, Vice-Minister for Foreign Affairs of India, focused on the need to take a holistic approach to achieving UHC and increasing access to quality medical education. He stated, “it is critical to increase financing for health systems to achieve UHC. Equity is critical for global health and we must address the barriers individuals face to accessing health services.”

High-Level Remarks from Key Stakeholders

Key stakeholders shared the impacts of COVID-19 on achieving UHC and the need to go beyond the status quo to build resilient and inclusive health systems that leave no one behind.

H.E. Ms. Amina Mohammed, Deputy Secretary-General of the United Nations, stated that health is the cornerstone of sustainable development and COVID-19 has dramatically halted and reversed progress, with 92% of countries mentioning interruptions in at least one essential service. She made a call to unite multilateral action and work collectively to strengthen governance around health and accountability. “We have an opportunity to go beyond the status quo and we must do so by building resilience for current and future pandemics. We need stronger and greater investments in primary health care as access to essential services will increase populations’ life expectancy.”

Mr. Jagan Chapagain, Secretary-General of the International Federation of Red Cross and Red Crescent Societies (IFRC), emphasized that inclusion should be central to efforts to achieve UHC and that we must act in the interest of the most vulnerable people. “We must support country-focused groups before the 2023 High-Level Meeting in order to elevate the situations that are happening on the ground.” He continued by saying, “when formal health systems are overburdened, it is the NGOs and volunteers that come forward. We must empower and support communities.”

H.E. Mr. Csaba Kőrösi, President of the 77th Session of the UN General Assembly, emphasized that health is a right and we must finance health coverage and ensure equitable access to health services. “A holistic view on health is essential and we must align these discussions with landmark political declarations on health.”

Technical Discussion

Experts highlighted the need for social participation to achieve UHC and investments in community health workers, as they often reach the most vulnerable individuals and are critical to building trust between populations and health systems.

Mr. Omar Abdi, Deputy Executive Director for Programmes of UNICEF, stated that progress on achieving UHC is slow, and we are missing critical opportunities. “Governments need to provide robust support and heavily invest in community health workers as they provide curative and preventive services to people. Community-based health systems are the equity arm of primary health care and community-based care is a cost-effective model, which has a 10-1 yield return on investment.”

Dr. Mandeep Dhaliwal, Director of the Health Group of UNDP, highlighted that we need climate resilient health systems, and we must do a better job integrating climate and health responses. She continued by mentioning how COVID-19 has reversed progress on UHC in 92 countries. “We must act differently and develop new, strong partnerships. The way we work on the ground needs to be thought of differently, especially in terms of scaling, funding and developing partnerships with countries.”

Ms. Anamaria Bjar, Director of Public Policy Engagement of Gavi, highlighted that the impacts of COVID-19 have reversed progress on childhood immunizations and now 18 million children, (an increase of 5 million since 2019) do not have even 1 routine childhood immunization. These children tend to be part of the most neglected groups and often lack access to clean water and sanitation as well. “Governments and CSOs must meet the needs of the most vulnerable children. We must work together as a social sector to address these inequities, as these are not only health issues but also social issues.”

Ms. Amy Boldosser-Boesch, Senior Technical Director and Practice Area Lead for Health Policy, Advocacy and Engagement and Integrated Health Care of the Civil Society Engagement Mechanism for UHC2030 (CSEM) reminded the group that “health systems are accountable to the people they serve.” In the 2019 UHC Political Declaration, Member States committed to acknowledging social participation. However, there has been little to no integration of CSOs in the COVID-19 response. CSOs and communities need to be engaged in and integrated within the health system and in decision-making processes from the beginning for effective health responses and to establish and strengthen trust with communities.” She also called for improved collaboration at the global level between governments, civil society and communities, the private sector and donors.

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