Applying a Health Systems Assessment in a fragile setting.
“Love, affection and trust reflect social justice. UHC is about social justice,” said Dr Githinji Gitahi, CEO AMREF Health Africa and co-chair of UHC2030.
This was one of the many vibrant messages spoken at the non-state actors side event organised during the 72nd World Health Assembly in May 2019. Civil society and communities shared their perspectives and elevated a call for governments and development partners to galvanize the political action and momentum needed to drive progress on UHC in the lead up to the High-Level Meeting in September.
The side event was organised by Save the Children and co-sponsored by UHC2030 and its Civil Society Engagement Mechanism (CSEM), International Federation of Red Cross and Red Crescent Societies (IFRC), Global Health Council, Action Contre le Faim and the Joint United Nations Programme on HIV/AIDS (UNAIDS).
This event brought together different voices from civil society, community-based organisations, representatives from member states and development partners, all exchanging their experiences, views and commitments towards achieving health for all and leaving no one behind.
Dr. Githinji, who was moderating the event, highlighted that this event was very timely as the zero draft political declaration for the HLM on UHC in September had just been released, and included many of the UHC movement Key Asks. Since last year, the UHC2030 constituencies have been working together to assist the co-facilitators (representatives from Georgia and Thailand) to gather different multi-stakeholder views for the final political declaration for UHC.
In his opening remarks, Emanuele Capobianco, IFRC’s Director of Health and Care, emphasized the importance of action and political and social accountability as elements which help establish the contact between government and communities. He said, “These two elements are key to help make sure that implementation of leaving no one being is actually happening and the government and other authorities are being held accountable for their promises”.
Testimonies from civil society and community organisations
Civil society and community organisations gave testimonies and shared experiences of their own work about how every day they are supporting progress towards UHC through their actions on the ground.
Ms. Albertha Freeman, Community Health Nurse Supervisor and youth representative in Liberia shared her experience working with vulnerable and rural populations in Liberia’s most remote areas. She highlighted the importance of building trust and interaction between communities and the health workforce as key elements, which enables delivery of community-based primary health care (PHC) to Liberians in the most remote areas. “If we continue to invest in quality and primary healthcare we can all achieve UHC. If you can promise to invest in the health workforce, I promise to continue working on the frontline every day,” she said.
Ms. Vicky Okine, Executive Director, Alliance for Reproductive Health Rights in Ghana, is leading a coalition of civil society organisations advocating for strengthening primary health care systems and financing as the foundation of Ghana's health systems towards UHC. She described how this coalition through different activities - such as capacity building, advocacy through social media, and using evidence-based data - is trying to build an approach to hold governments accountable in strengthening PHC and improving the quality of health services. She strongly emphasised that UHC is achievable with the right set of policies, systems and financing and political will, and if we all work together.
Mr. Pavel Bezhuashvili, Georgian Red Cross – community health volunteer, described the crucial efforts of community-based volunteers in reaching out to people living in remote places with limited access to quality health services. He explained the important role of community health volunteers in building trust between the people and the system. “Community health volunteers are trusted and accepted because we have a practical knowledge of the real vulnerability and inequalities. We have a big trust from people and it gives us the possibility to be the mediators between the community and government. Community-based volunteers are the real voice of the people and have a very important role in reaching out for better health,” he said.
Moderated panel discussion
Ensuring a meaningful participation of population, communities and civil society in holding governments accountable
A rich panel with participants from the Ministries of Health from Thailand and Tunisia and development partners from Japan International Cooperation Agency and the Global Financing Facility focused on tackling issues of action and accountability in different contexts.
Ms. Sonia Khayat, Director-General of International Cooperation at the Ministry of Health in Tunisia, shared experience from the Dialogue sociétal de la santé, a participatory and inclusive process that facilitates dialogue and the sharing of expertise and dialogue between citizens, health professional and policy makers. Since 2012 Tunisia has initiated a broad reform of its health system and placed multi-stakeholder engagement and collaboration at the core. The national health policy document will be presented in June and will conclude a long three-phase process. “In Tunisia, citizens are seen as full participants to health system governance,” said Ms. Khayat.
Dr. Pisut Chunchongkolkul, Director, International Health Policy Program, Ministry of Public Health, Thailand, highlighted people’s meaningful participation in the most important aspects of UHC. He said: “In Thailand UHC is about people, we honour our people and meaningful participation is one of the most important aspects of UHC.” He described also how the National Health Security Office which is the Thai UHC organisation, is set up in such a way that the voice of the civil society and people can meaningfully engage and have regular input into policy making.
The role of development partners in supporting country action for a holistic UHC approach
Dr. Takao Toda, Vice President for human security and global health at JICA, said: “UHC is not only about financing. In Japan, when we reached UHC in 1961 we were not a rich country. UHC is a nationwide building process which involves a lot of passion, commitment, love, affection and trust.” He emphasized that the role of development partners should not only focus on filling the financial gap to achieve UHC but also on setting up mutual learning mechanisms at global and county levels. These mechanisms can enable the sharing and comparing of experiences, failure and success stories which help fill information, commitment and learning gaps around UHC.
Ms. Katri Kemppainen-Bertram, Senior Partnerships Specialist at the Global Financing Facility (GFF), World Bank, spoke about some of the big challenges such as insufficient financing, fragmentation in service delivery, reaching out to the most vulnerable populations and difficult political contexts. She described how global mechanisms can strengthen the role of civil society in tackling these challenges and highlighted the importance of having civil society participation in global and country policy dialogues and implementation. “At the GFF, we are trying to put government and civil society in the lead and help prioritise and reduce fragmentation in service delivery; but also provide financing in a way where we can address the needs of those in the most remote areas.” she said
Dr. Agnes Soucat, Director of Health Governance and Financing Department at WHO, emphasized that UHC is technically and financially possible. “What we heard today from Tunisia, Thailand, Japan, Liberia is that UHC is possible [ …] We know is it technically possible. We also know that it is financially possible. The world has spent, in 2016, the latest year for which we have data, 7500 billion dollars on health. To reach UHC, through a basic set of primary healthcare services and essential services we will need to add just a small 5% on that amount […] There’s a need to increase financing in health through mobilization of domestic financial resources, and this is tax payers’ money. And that's why it is so important to mobilize people and civil society. When we talk about UHC it is about people, and about building platforms at country level for people to express their voice in policy making and express how they want their money to be used,” she said.