Applying a Health Systems Assessment in a fragile setting.
“Credible, inclusive and vibrant.” This is how H.E. Ms. María Fernanda Espinosa, President of the 73rd Session of the United Nations General Assembly described the UHC2030 multi-stakeholder hearing which took place on 29 April in preparation for the UN High-level Meeting on universal health coverage (UN HLM).
Attended by passionate and determined representatives and advocates from over 600 non-state organisations - including public health organizations, civil society, foundations, academia and the private sector – the hearing allowed a range of partners to make their own specific statements about their hopes and ambitions for the outcomes of the UN HLM, and to take part in discussions with panelists. The meeting was convened by the President of the General Assembly, H.E. Ms. María Fernanda Espinosa, supported by the World Health Organization and UHC2030. The official summary of the event is here.
Many representatives from member states attended the hearing and were given a chance to interact with selected UHC2030 partners during a Luncheon on Voices from the UHC Movement which we co-hosted with the Group of Friends for UHC and Global Health. Ambassador Bessho, Permanent Representative to the Japanese Mission to the United Nations emphasized the importance of listening to the many voices of those leading the UHC movement.
Background to the UN HLM
The UN HLM UHC will take place on 23 September 2019 during the United Nations General Assembly (UNGA) high-level week. It is a great opportunity for all UHC champions and advocates to make their voices heard and help mobilise high-level political attention globally and in countries, especially to bring UHC to heads of state attention and identify and advance key policy and investment priorities that can accelerate progress towards UHC in countries. As our civil society constituency convincingly argues, this UN HLM must be a transformative process, leading to genuine action for UHC by governments and other partners.
Let’s make our power count
During the multi-stakeholder hearing participants made statements, shared diverse perspectives, experiences, good practices and lessons learned, and exchanged views on the key priorities to raise with Heads of States during the UN HLM, building on the Key Asks from the UHC movement which were developed with UHC2030 stakeholders through a consultative process.
The outcome of the meeting will be a summary prepared by the President of the General Assembly and circulated to all Member States and other stakeholders before starting the negotiation process of the political declaration.
H.E. Ms. María Fernanda Espinosa, President of the 73rd Session of the United Nations General Assembly opened the meeting highlighted that health is a human right, essential to the fulfilment of all fundamental human rights, and that improving health is at the heart of and essential to the delivery of the 2030 Agenda. She also emphasized inequities in health, stressing that women and girls suffer disproportionately in regards to sexual and reproductive health, as well as accessing other basic services. Other vulnerable groups, such as persons with disabilities, indigenous peoples, minorities and those living in rural areas are more likely to have poor health outcomes.
“If we look at the full impact – and cost – of poor health services, the case for prioritising universal health coverage is clear. Our aim in September, when the General Assembly holds the high-level meeting, must be to accelerate progress on coverage, including: financial risk protection; access to essential services; and access to safe, effective and affordable medicines and vaccines,” she said.
Ms Maria Luiza Ribeiro Viotti, Chef de Cabinet of the Secretary-General of the United Nations spoke reiterated that UHC is key to achieving the SDGs and recognized the importance of ensuring women’s, children’s and adolescents’ timely access to health services to build on current progress to improve women and children’s health. She also spoke about the importance of multi-stakeholder involvement for UHC and her optimism for the future, saying, “A strong outcome at the high-level meeting will underpin our efforts within the UN towards more collective action, more intersectoral work, more coherent accountability mechanisms for UHC – and a new era in global health.”
Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization made a speech via video-link while Dr. Zsuzsanna Jakab, Deputy Director-General, World Health Organization was present at the meeting.
Dr Tedros stressed that the pace of work on UHC needs to be accelerated for countries to achieve robust, end-to-end primary health systems, to prevent outbreaks and enable health promotion. “Making sure UHC works for all people and communities requires everyone’s involvement, and their full and long-term commitment. Looking ahead to September, it will be vital that heads of state push the agenda forward in an unprecedented way during the High-Level Meeting. Within our grasp is the chance to turn the vision of UHC into a reality – for everyone, including the most neglected individuals and communities,” he said.
Dr. Githinji Gitahi, Co-chair of UHC2030 and CEO of Amref Health Africa Foundation presented the UHC Key Asks with the overarching political advocacy message: Everyone, everywhere should have access to quality and affordable health services. We call on political leaders to legislate, invest and collaborate with all of society to make UHC a reality. “We must commit to design and deliver health services informed by the voices and needs of people observing gender equality and women’s rights while prioritizing the most vulnerable members of the world’s population. Let’s make today count. Let’s make our power count!” he said.
Dr. Alaa Murabit, Sustainable Development Goal Global Advocate argued that UHC has economic, social, environmental and cultural dimensions saying, “I prioritize UHC because it is essential. Our gains cannot be quantified by national percentages. An investment into healthcare is an investment into the achievement of the 17 SDGs. It will prompt the eradication of poverty, increase the literacy of families, greater environmental awareness. Think of it.” she said.
Dr. Adaora Okoli, Health for All Story Teller & Ebola Survivor, emphasised primary health care as the foundation to UHC, while noting that many people around the world lack access to it. She also spoke about her personal experience during the west Africa Ebola outbreak and why UHC matters. “Nigeria contained the outbreak in 93 days, but we absolutely dodged a bullet because Ebola came into through Lagos, in a private hospital that was well staffed and well financed and because the patient could afford it. If he could not afford a private hospital, his only other option would have been public hospitals whose doctors were on strike,” she explained. “UHC is the driving force for inclusive development, prosperity and equity and should be a priority agenda for us all. May we leave no one behind,” she said.
Session 1: UHC as a driver for inclusive development and prosperity
Moderated by Ms. Femi Oke, this session started with panelists sharing experiences from their own personal and family histories that inspired their commitment to UHC. They gave examples of how health outcomes differ dramatically when people have access to health services and when they do not.
The session focused on the need to contextualise the achievement of UHC within the broader development agenda and recognize UHC as not only the umbrella for delivering health targets, but also as a driver of social justice, human rights and inclusive economic growth.
Participants from the floor, and remotely through social media asked the panellists a range of questions including how we ensure that actionable commitments are taken to the HLM, what we have learned so far about what works and doesn’t work, whether there is trade off between health equities and economies of scale and how can institutions be more socially accountable? Participants also shared their organizational statements relating to the Key Asks, and what they expect and hope to come out of the HLM.
The discussion emphasised a number of issues, including: increases public financing, which prioritizes PHC interventions and health services to first reach the poorest and most vulnerable people in society; government’s responsibility to provide a strategic framework for UHC with clearer incentives for the private sector, regulation and oversight; the role of Parliaments through lawmaking, resource mobilization and oversight; meaningful engagement of civil society and community organizations, including youth, who can help to hold governments accountable.
In making their statements, participants highlighted a number of other issues: financial barriers to accessing essential medicines and products; shifting disease burden and increasing prevalence of NCDs; the growing challenge of antimicrobial resistance; prevention, promotion of healthy environments and mental health; addressing risk factors such as tobacco and alcohol; gender equality; access to sexual and reproductive health services; policy incentives, including intellectual property, to enable the development of breakthrough medicines and vaccines; greater investment in health workers in communities; and development cooperation that supports national health policies, priorities and systems.
The discussion was very rich and varied: you can watch it again here on UNTV.
At the end, the panelists each gave a closing statement with a call to action.
Ms. Amanda Glassman, Chief Operation Officer, Center for Global Development, Global Sustainable Development Report 2019 Expert Group said, “Focus on the bottom line and ignore the slogans. Ask the important questions: Is out-of-pocket spending going down? Is public money going to the neediest areas or not? Are people getting basic and cost-effective health care?”
Professor Srinath Reddy, President, Public Health Foundation of India (PHFI) said, “We need governments to increase investment in public health care but the key emphasis is on primary health workers, such as nurses and community health workers. They should be administratively empowered and technically enabled to do this."
Dr. Khuất Thị Hải Oanh, Executive Director, Centre for Supporting Community Development Initiatives and CSEM Advisory Group said, "We need to work together but each of us can make a contribution, each of us can have an impact in our own right. If a donor has not moved, if a development partner has not moved, if academia has not moved, we can still move. Let’s do something concrete."
Mr. Martin Chungong, Secretary General, Inter-Parliamentary Union said, “Parliaments have to address UHC. We'll continue to work with WHO for a UHC resolution that puts in place a roadmap for parliamentary action including lawmaking, oversight and resource mobilization.”
Session 2. Leave No One Behind – UHC as a commitment to equity
Moderated by Ms. Zain Verjee, this session highlighted actions needed to ensure that half of the world’s population is not left behind and that marginalized groups have a voice and access to essential health services. Issues addressed included how to move from commitment to action? How can things change so that one billion more people have access to quality health services? How do we ensure social accountability and improve monitoring and feedback?
As before, participants gave statements and asked the panelists a range of questions from the floor and remotely through social media. Discussion focused on the relationship between poverty and excessive healthcare costs and right-based approaches, including: culturally sensitive and people centric health services that respond to individual needs, particularly on those of marginalized and vulnerable groups, women’s empowerment, and their sexual and reproductive rights, particularly for adolescents, young women and girls engagement of young people and investment in the young health workforce, ensuring adequate pay and decent working conditions.
Each panelists made a final statement and call to action at the end of the session.
Ms. Harriet Adong, Executive Director, Foundation for Integrated Rural Development and CSEM Advisory Group said, “We should think about health holistically, beyond single disease interventions. Donors and governments need to be held accountable for their use of funds, which provides a strong role for civil society.”
Dr. Batool Al-Wahdani, President, International Federation of Medical Students’ Association said, “UHC needs grassroots involvement, bold action and innovative solutions. These are all synonyms for the word ‘youth’. Finally, keep two numbers in mind: 18 million people may be the shortage in health care workers, but 1.8 billion is the number of young people.”
Ms. Benilda Batzin, Expert on Health Citizenship, Centro de Estudios para la Equidad y Gobernanza en los Sistema de Salud said, “We must remember the power of citizens and the importance of involving indigenous people in planning, implementation, monitoring and evaluation of public policies.”
Mr Monthian Buntan, Chairperson of the Division of International Relations and Special Affairs, Disabilities Thailand Association said, “We need to see the intersectionality of differences, for those marginalized and excluded people and we should embrace common problems and issues. We need UHC that encourages true participation, and truly empowers communities.”
Session 3. Multi-sectoral and Multi-stakeholder Action and investments for UHC
Moderated by Ms. Zain Verjee, this session focused on how multi-sectoral and multi-stakeholder partnerships can unite partners behind UHC and empower the mobilization of domestic resources to ensure everyone is represented in the UHC movement.
Participants from the floor read out their statements relating to the Key Asks and their desires for the HLM, and again rich discussions took place. Panelists and participants discussed a number of issues: role of grassroots organizations to help reach the most vulnerable and marginalized populations; civil society role in holding governments accountable; regulation of the private sector and their willingness to check conflicts of interest; country led responses through domestic resource mobilization and progressive taxation, with spending targets such as 5% of GDP on health being suggested; progressive universalism and shift away from out-of-pocket payments to mandatory and fair contributions through tax; innovative financing models that can harness innovation
Panelists shared their final thoughts about the session’s topic.
Dr. Midori de Habich, Economist and former Minister of Health, Peru said, “Sustaining the UHC movement is a long-term endeavour but we also need to demonstrate results in short run. The health community cannot afford to do this on its own. Before the September meeting, we need to involve economic and social development organisations, and partners from education and social policy sectors and they too need to make the UHC movement their own.”
Dr. Justin Koonin, President, ACON and CSEM Advisory Group discussed the role of gender in achieving UHC. He said that the UHC key asks may not go far enough on gender and thanked the Alliance for Gender Equality and UHC for their “7th ask”. “Speaking about gender is not just women’s business. I call on the men in the room to champion women as well. Civil society and communities often tell governments what to do, but we also need to ask ourselves what we should be doing better to achieve UHC.”
Ms. Aida Kurtović, Chair of the Board, The Global Fund said, “There is no such thing as health security without protection against HIV, TB and malaria and there is no way these three epidemics will end without UHC. The Global Fund encourages disease components to be integrated to address the lack of sustainability associated with vertical programmes.”
Ms. Carmen Villar, Vice President Social Business Innovation at Merck & Co, and Private Sector Constituency for UHC2030 reminded participants to think about the social determinants of health. “This can be a framework for involving other sectors such as transport, nutrition, environmental safety and education and not just the private sector, but academic institutions, think tanks and many others who have been thinking about moving toward UHC.”
Close of meeting: “Your voice today matters”
H.E. Mr. Kaha Imnadze, Permanent Representative of Georgia to the United Nations made closing comments. “Today’s event marks one of the greatest milestones on our path towards achieving the universal health coverage in 2030. These sessions provided us with powerful insights. Most of all, we witnessed the spirit and willingness to move together towards building a healthier world. The inclusion of all key stakeholders demonstrated today is an encouraging sign that we all will be able to deliver as one.”
H.E. Mr. Vitavas Srivihok, Permanent Representative of Thailand to the United Nations said, “Your voice today matters. It goes without saying that, in achieving UHC, no government can do this alone. We need your support, your knowledge, your resources, your experiences and your strong will. Only collective multi-stakeholder actions and meaningful partnerships can bring us forward.”
H.E. Ms. María Fernanda Espinosa, President of the 73rd Session of the United Nations General Assembly, made closing remarks. “This has been a truly invigorating day! When I opened this meeting, I described universal health coverage as a “distant dream” for billions of people. But I have been greatly encouraged by our meeting today. Having over 600 representatives from key health constituencies really has made a difference – to the energy in this room, and to the quality of the discussions we have had. And what we have heard – from these stakeholders, from our panelists and from Member States – is that we can make the dream of universal health coverage a reality. This is what a credible, inclusive and vibrant process can achieve.”
Videos shown during the meeting
Nina’s happy and healthy family meal (UHC2030)
UN TV recording of meeting
Stakeholder blogs written after the meeting
Here are some blogs written after the meeting; all contributions welcome. Please let us know if you have written a blog and we can add it here.
Health for all at Universal Health Coverage 2030
Rachael Thomson, COUNTDOWNonNCDs
There is No Such Thing as Universal Health Coverage without…
Cassandra Nemzoff and Amanda Glassman, Center for Global Development
Of universal health coverage, power and promotion
Thomas Schwarz, Medicus Mundi
Civil society advocacy for UHC
Refiloe Mabejane, Civil Society Engagement Mechanism
On UHC and social contracts (fit for the 21st century)