Universal Health Coverage - Technical briefing at WHA72
Table of Contents
- Excellencies colleagues friends I would like with what the end of the video...
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00:15
excellencies colleagues friends I would
like with what the end of the video
actually what we said there let's create
the healthier future together
and that's very important and that's why
we are here in this meeting and as you
know universal health coverage is a
human right issue and end in itself
00:48
but at the same time it's a means to
development so no one should become poor
because of poor health but we all know
that the reality today is very different
and James had already said it and half
of the world's population lack access to
quality essential services every year
more than 800 million people incur
catastrophic health expenses and 100
million people are pushed into extreme
01:20
poverty by out-of-pocket payments more
than 50 countries like the
infrastructure they required to provide
universal health coverage they're short
of skilled as workers quality medicines
and medical products and even basic
amenities such as water and electricity
but we know what works we have many
examples from all over the world of coke
of countries getting it right and many
champions of primary health care and UHC
01:52
and several of them are with us today
importantly we have the political
commitment to move the agenda forward
the political momentum for UHC has never
been higher with the g20 the g7 and the
UN high-level meeting on UHC later this
year countries that make progress toward
the center cellulous coverage will all
will also make progress toward cell
security and healthier populations today
02:23
a few countries will share their
experience
their own journey toward this in
Versailles coverage including Columbia
Estonia India Kenya and the Philippines
they will tell us that there is no
blueprint each country is unique and has
its own context and specificities but
there is a common principle all these
countries have met a political choice
this is our joint vision our common goal
02:53
and my commitment for whu-oh one way to
support this vision is through the UHC
partnership where six donors have agreed
to support whu-oh in a flexible way I
would like to personally thank the UAC
partnerships growing community of donors
for this flexibility currently the UAC
partnership is active in 66 countries
and it will soon reach more than 100
countries thanks to the financial
support from the European Union Japan
03:24
Luxembourg France Ireland and the UK and
many others that are willing to join the
UHC partnership and finally I have just
one ask please ensure the participation
of your heads of sets and heads of
government in the high-level meeting in
September this year thank you all for
your support and commitment and I look
forward to working with all of you make
universal health coverage a reality in
03:56
all countries because all roads should
lead to in their service coverage thank
you so much
thank you very much dr. Terrell so when
we think about universal health coverage
we have that visual of the umbrella not
only bridging us all together to make
sure that it really is an inclusive
reality but also an inclusive approach
towards that reality but we also think
of the umbrella protecting us from from
ill health or or other inequities that
we as humanity continue to face
thank you dr. Ted Raza and fond that
04:33
we're going to jump into a moderated
panel discussion we always say this that
the ministers come with big statements
from their advisors but we encourage
them to look away from that and also to
listen to each other and to respond to
it so we can have a dialogue that truly
makes sense we are going to begin with
Francisco Duque of the Philippines he is
the Secretary of Health in fact to many
of you he will be familiar this is his
second term as Secretary of Health or
05:03
the Philippines but much more so than
that he has an overarching look at the
challenges that come with UHC being the
former chairman of the government
service insurance system which is the
biggest public sector pension fund in
the Philippines and he was also during
his first term as secretary one of the
pioneers of the formula one for health
reform paradigm so he really has that
overall look he's been part of that
process
he's been the architect of the different
05:35
steps along to UHC so dr. Duque let's
begin with you and let's look at UHC
from the angle of a sustained process
from the legal process how do you get to
that point that leads to your UHC law
how do you look at the challenges and
what would you tell the different
countries here in this room you got to
watch out for that that's going to come
up on your Road as well
well thank you very much should I say
dr. cow I'm sorry anyway my profuse
06:16
gratitude and appreciation to the
organizers of this side event for
inviting the Philippines the universal
health care law is a landmark
legislation that aims to transform the
Philippine health system so we can serve
our people the Filipinos batter the
almost three decades implementation of
the Philippine local government code
which devolved health service delivery
06:48
to the local government units provided
valuable lessons which were greatly
reflected upon and considered in the
crafting of this Act Ministry of Health
the Philippine Department of Health push
for the enactment of this law confident
that this is the right path to affect
change in the Philippine health system
we got inputs from the discussions of
07:19
universal health coverage in various
international fora and meetings such as
these health assembly as well as the USC
stop taking that we conducted local and
international partners we looked into
the experiences of other countries which
have achieved you exceed ahead of us
such as Thailand and Japan the UHC law
07:51
is a product of concerted efforts of
parliamentarians and health stakeholders
led by the Department of Health two
years of dedicated technical as well as
political work and indeed we are blessed
to have our UHC champions at both houses
of Congress
and these touch an unwavering support of
our president president de Gaulle
already tired there the vibrant civil
08:23
society and the w-h-o also helped us
advocate for the passage of this law the
law is said to be the first you will see
of its type in the western Pacific
region and the law may not perfectly
address the weaknesses in the Philippine
health system but it is the best chance
we have now to move the Philippines
towards a game-changing UHC as we are
08:54
crafting the implementing rules and
regulations we are encountering legal
and implementation impediments along the
way we will start small through our
advanced implementation sites of which
we 33 sites to date after six years of
implementation that is going to be an
evaluation to see if the reforms under
the UNC law can be scaled up nationwide
09:25
the road may be long and difficult but
we are steadfast in our resolve to make
us a reality for my people and that is
ensuring then the access to quality
affordable health care with sufficient
financial risk protection thank you
thanks very much to the secretary we
10:03
also thank dr. Ted Ross for joining us
today I believe dr. Ted Ross you have
another commitment waiting for you and
once dr. Tara leaves we invite Peter
Salama to take a seat in the meantime
we're going to go over from Asia to
let's jump to Latin America to Colombia
to dr. or Ebay the minister whom we all
heard from in the opening technical
briefing yesterday and dr. eBay is a
surgeon by training when we look at your
10:34
country we look at 50 million people 50
million people who want to live the best
life that they can you're very close to
achieving UHC with the same benefit of
packaged applied to all your population
and also low out-of-pocket payments but
tell us about how you're going to close
that gap because we keep on talking
about leaving no one behind and it
sounds great but in reality has become
quite an overused term what does that
really mean in reality to you as Health
11:04
Minister when you look at the urban
areas when you look at the rural
countryside how is that going to happen
thank you James and thanks to everybody
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11:41
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12:13
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12:45
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Modelo colombiano y todos son distintos
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13:15
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13:47
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Columbia Y quiero result are more Apple
14:19
meant a Ellen Mensa reto Ella
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cuando el salón Oh nos tropez en tiendas
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continual attention que los medica
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14:51
personal de salud STI e la gusta da ma
attention por que vemos como in colombia
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los días dependiendo a la calidad del
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que estar a lado de este compromiso
pero es ante tone reto al-amin Aaron que
15:23
si Nommos los servicios para los
ciudadanos en que intend mo su suspect
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los puestos e centros de salud y los
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15:55
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[Applause]
eBay I think you highlighted so many
other critical issues over here quality
16:27
is sometimes as important or more
important than just quantity alone and
when we look at the sophisticated and
intricate responses that we now need to
put in place to achieve UHC we also
think about innovation we think about
technology we have the technical
briefing in this room this morning where
some of the scientific presentations
were looking at mental health bots where
they're able to read and use audio to
pick up on the emotions that you're
feeling perhaps to prevent you from
16:56
suicide and and other other forms of
mental health conditions cancer
screenings and so and so forth so
clearly innovation is going to play a
key role in the fact that we're being
live-streamed here shows how much the
world has changed in just a couple of
years let's go then on that strand to
dr. Hillel Armen who is the head of
Public Health and the Ministry of Social
Affairs in Estonia and when we think of
that intricate process where is
innovation going to play its part and
how is it playing a part in your own
work thank you very much I'm very happy
17:30
to share some of our experiences when we
are talking about universal health
coverage then we have to admit that it's
a challenge for most of countries it
doesn't depend is it a high income
country or low income country most of
countries are insurance with it it
doesn't depend even is it a small
country or a big country the core
18:04
question is actually what is already
said in several times that we need
political will behind it
the second issue what I would like to
bring out is that we need also clear
information and understanding who is the
core population group which we should
target there and then we should also
have
kind of toolbox to implement and coming
18:35
now to do the innovation then innovation
can be seen as a kind of lens through
which we should look all these tools
what we have in this toolbox universal
health coverage is a challenge also to
Estonia which is a high-income country
but we are moving towards it one of our
challenge is high out-of-pocket payment
19:09
as well
remarkable share of out-of-pocket
payments made in Estonia are caused by
high prices of medicinal products
remotely share of out-of-pocket payments
are caused by prescribed medicines it's
around 20 percentage and 15 percentage
buy over the counter of medicines
19:41
it's tremendous actually and to lower
this out-of-pocket payment of medicinal
products in Estonia we have implemented
a system where people can have
supplementary benefits for medicinal
products such kind of supplementary
benefits are meant for people who are
insured and who are paying over a
certain amount of euros per year until
20:15
2017 the amount was 300 euros per
calendar year and people were forced
actually to write also a kind of
application and send it to the Estonian
health insurance fund and this system
didn't work at least not so well as we
were expecting
the problem was that only 1/3 of all
20:48
those people who were rights to have
such kind of supplementary benefits
didn't actually applied for it applied
only that kind of supplementary benefits
and when we analyze this situation then
we pointed out two core ratios one issue
could be that the reason behind it is
21:19
low awareness of such kind of
possibilities and the second one is that
this application system is somehow too
difficult and then we tried to look this
through this lens I said before
innovation and what we changed in this
system through this looking through this
innovation lens these were mainly two
21:52
aspects we starting from 2018 we allow
it Luud decreased the maximum amount per
calendar year and it was 100 euros
instead of 300 euros which were asked or
obliged before it was able to apply for
supplementary benefits for medicinal
22:24
products and the second aspect what we
changed was the system and we change the
system so that when people are have
rights to have such kind of
supplementary benefits for many
medicinal products then it is received
automatically as they are purchasing
their medicines in pharmacy so
22:56
don't have to apply anything it is
automatically what we have achieved
through this changes in 2018 more than
134 thousand persons received their
prescribed medicine our products much
more cheaper than before the number of
people who paid more than 300 euros for
a prescribed discount medicines
23:29
decreased from 17,000 to around 100
persons and what is the most important
is that receiving this discount does not
depend anymore on the awareness of
people or their digital literacy and
this is something what makes such kind
of supplementary benefits more
accessible to all people thank you let's
24:05
push on here because we've had Asia
that's how we opened up and then we
moved over to Latin America we've just
heard from Europe and let's take another
picture this time from Africa from Kenya
where dr. Cicely karaoke is the cabinet
secretary for health and there's so much
fascinating steps being taken in this
one country alone they're ready into
their road testing they have a road map
UHC road map which is going to wind up
in 2022 and they're ready in the second
year so you're almost at the halfway
24:35
point over here when you look at it now
because a lot of countries wouldn't be
at your stage as of now what would you
say are some of the refinements that you
would have put in place that you've
garnered over this last 24 months and
you say you know you can leapfrog and
learn from what we've done over here
thank you very much I perhaps will start
by making a correction we have only
commenced the pilot phase of UHC as a
25:10
in Kenya from December 13th we are
hardly five months into this process
however the interesting lessons that you
have picked and I'll share a handful of
them but let me take a reverse gear and
and just put this in context at the end
of 2017 the President of the Republic of
Kenya pronounced himself on four
priority development agenda items one of
which was affordable health care uhit
25:41
see affordable housing food and
nutrition and manufacturing with aim of
creating jobs particularly targeting the
youth that is unemployed now if you look
at these four-point agenda development
had indirectly been speaking to the
social determinants of health as it were
so we already had that rich environment
in terms of the political commitment
that was pronounced and the next steps
were to take in terms of planning and we
26:14
took round about 1 year planning and 2
questions had to be answered when we
anticipated affordable sorry you had C
to ride on the existing national health
insurance infrastructure which has
existed for the last 40 years and where
we have about 20 percent of the
population today being served through a
to the next conversation that we needed
to have was to whether we needed to feel
26:44
confident enough that we could start the
UHC journey by covering the entire
country or we needed to do it in phases
it was apparent six months later that we
could not take on the existing
infrastructure ecosystem because of
weaknesses lack of efficiencies as well
as governor governor's framework and the
legal framework under which this
institutional framework was sitting upon
number two it was abundantly clear
27:14
checking with our colleagues in the rest
of the world that no one-size-fits-all
and that we had to define our own
journey
our own journey of you hate cement that
we then begin at pilot level pick
mistakes that we were able to pick and
fix before we went to scale up and so it
was decided on the 10th of December last
year would start by focusing our
attention in four of the 47 pilot
counties for reasons that we agreed
through our public participation as we
27:44
were doing the planning the current
approach therefore which we took was
informed by a readiness assessment that
we did and which identified for us the
gaps that were obtaining at the point of
beginning at the pile of phase these
gaps included and were not limited to
the following that we picked shortages
in terms of availability of health
commodities other lower level the lower
you moved to the community the more the
gaps and therefore they're larger the
28:15
confidence gap that there was with the
people who are being served it meant
then we had to focus on ensuring there
is a hundred percent of essential and
tracer commodities available at the
lowest level and number two HR for
health again the gaps as deep as they
are across the country across the globe
and it was amber and to us that if we
were disciplined enough to invest an
additional twelve and a half percent
year-on-year we'll be able to then cater
for the HR gaps moving forward on
28:48
service delivery the assessment told us
that we needed to facilitate access to
health services from the lowest level at
the community level that was not
happening so that we then had to make a
referral system work from the community
all the way to the tertiary and
secondary level facilities it was amber
and it was eminently clear that the
basic primary health infrastructure was
in a lot of cases not functional a legal
framework that would help the
implementation or support implementation
29:19
of unit C and its sustainability still
had issues that we needed to fix we
needed to modernize we needed to bring
to the fore so how the planning journey
started was in much
last year we put together through my
office panel of experts that we defined
to help us with definition of a benefits
package and that would then be the
promise that we made to Kenyans the
29:51
panel did it work
they defined a set of Korea that was to
be utilized to define the entitlements
and they started with what would be
basic entitlement to all they ideal and
that is what we are aiming at going and
moving forward this was viewed to be
cost-effective it focused on burden of
disease but it also focused on
feasibility of delivery come December
last year and we go out and the
president tells Kenyans here the promise
comes it comes by way of pilot we have
30:22
since in the last five years witnessed
an increase of outpatient attendance
ranging from 22 percent to 40 percent
meaning that we were keeping Kenyans
away from attending to health facilities
and therefore accessing care because
they could not afford we have upwards of
30 percent of out-of-pocket spend today
in Kenya and the journey has been one
that has been exciting but also one that
helps you then ask the next question for
Kenyans when are you ready for scale-up
30:55
the issue of equity the issue of
ensuring that we are not too long on the
pilot the fact that we have learned some
of the vital lessons that you have
learned means for us that we see
ourselves moving forward but utilizing
data that we are going to be getting
through our National Health Observatory
and a UHC dashboard both investment and
infrastructure have been set so that we
have evidence for decision making
we have enjoyed partnership with the
w-h-o and other partners in developing
31:26
this and we think it will count for much
because then we'll be able to make
decisions that are more precise and
there are more responsive to what
Kenyans are looking for we are careful
that was you as we go to scale-up the
entitlement is defined as it as it were
and that we are able to live to the
promise of what it is that will be
defined we are careful that these
entitlement will be anchored around
primary health care level so that we can
then be able to release resources to
cover the rest of the country
31:57
particularly the hard-to-reach
populations in our country we are
conscious as we walk the journey in the
four pilots we have a couple of months
to go to December we are also dealing
with system strengthening in the rest of
the counties the 40 43 of them we
ensuring priority interventions such as
operation autonomy or facilities around
issues governance we ensuring that
timely flow of funds to the facilities
to fix what they need to we are being
careful to ensure that Rick recites
32:28
tough and strong lead leadership and
governance precedes the scale-up
processes it doesn't sound as rosy as
that but we are confident that we'll get
where we are going I thank you so thank
you very much and when we look at this
pilot that you're talking about its
being road tested in four counties as
you said in consumer machakos in the
area and also in Yolo so we're going to
stay with Africa and link not just stop
33:01
the geography but link up to W at this
point dr. Rebecca Moretti is the
Regional Director and we can see from
this one example of Kenya alone but
there are many more examples that this
embracing of primary health care and
also universal health coverage is very
strong throughout the continent can you
tell us though about what whu-oh is
doing to support those steps and those
steps could be very different for
33:32
different countries who are at different
stages dr. Moretti
thank you very much James one day I will
teach you to say matzo diesel so you
don't have to call me Rebecca okay thank
you for this privilege to share with you
what has been happening at the regional
level and with the support of WTO on
universal health coverage with a
particular focus on primary health care
we have a transformation agenda which I
initiated when I took office as a
34:08
Regional Director in 2015 which places
universal health coverage as the highest
priority of our work in WTO in which we
are going to support our countries with
an focus on on equity on financial risk
protection improving access a very high
emphasis on integrated service delivery
within our countries and also addressing
health security so we have the teams
working on health systems and those
working on outbreaks and public health
emergencies working closely together I
34:41
believe we've gone a long way with the
support and collaboration of our
partners to support our countries put
the policy basis in place including at
the highest political level we've had
heads of states at the African Union
summit discussing financing for health
endorsing universal health coverage as a
principle as a program so I think we're
in good shape as far as those
commitments are concerned our work
supporting ministers of health is to see
this translated into improved domestic
35:11
financing for health and also action and
demands for accountability for progress
in the work that the ministers are doing
we've also established we've have have
had in fact for over a decade a regional
partnership for health called the
harmonization for health in Africa for
which w-h-o is a secretariat and the one
theme that we have in common among a
range of partners including UN agencies
working on health some of the pilot
roles that are supporting health
strongly in our region and the African
35:43
Development Bank and the World Bank is
on universal health coverage so we are
together working to support countries in
our different ways to advance on
universal
marriage in the region we've established
a flagship program on universal health
coverage and here again had the
ministers of health in 2017 adopt a
framework for health development in the
context of UHC which focuses very much
on the approaches of UHC that wh o is
promoting and part of the work that
36:13
we've done in supporting countries is to
carry out assessments what we call
scoping missions really assessing their
readiness to move forward and where they
are as far as the various aspects of
universal health coverage are concerned
we target some countries but are in the
process of developing tools that can be
available for the rest of our 47
countries we have 47 sub-saharan
countries within the African region of
Africa and so far we've been able to
carry out this analysis with 14 member
36:44
states this is work that started about a
year and a half ago and another seven
are to be supported to do this in the
next couple of months so they have their
roadmaps updated revised about how they
are going to move forward with universal
health coverage
we've also benefited from the UHC
partnership and and the capacity for the
region to support policy dialogue has
really improved and I think placed these
countries in a good position to be able
to move forward with universal health
coverage certainly the partnerships are
37:16
better organized the fragmentation of
contribution is reduced in these
countries they are able the government's
and their partners to jointly define
priorities and I think we're learning
now that we need to support countries to
overcome the challenge of actually
implementing what has been agreed with
partners I just like to give a couple of
examples because we don't have a lot of
time to illustrate the dynamic in fact
the adoption of this work by ministers
37:46
of health I have the privilege which is
a rare privilege of hosting in
Brazzaville our regional headquarters a
few months ago five ministers of health
recently appointed ministers of health
to provide them with a briefing on
health and because we're 47 member
states it's quite rare to be able to sit
around a table for two days
with five ministers and get into quite
in-depth discussion about what they're
doing how it is going what challenges
they're encountering I I learned several
things first there is a real dynamic and
38:17
enthusiasm and determination to move
forward with universal health coverage
in the region
all of these ministers were working on
updates in their financing for health
strategies and looking at how to adopt
what we normally propose taking into
account the fact that the majority of
the population in countries in our
region are not employed in the formal
sector they're in the informal sector
there are very low income households and
therefore how to organize health
insurance schemes with households that
38:48
are largely unable to contribute or
where the income is not predictable and
regular and then I found a great deal of
work in of thinking in innovating around
how to first of all define who is poor
in an African country I was astonished I
thought we had World Bank standards that
are applicable everywhere in the world
and the discussion with these ministers
made me understand there is need to
understand better what we regard as
poverty in the context of the social
solidarity in Africa but still
39:19
recognizing that people have to
contribute we also had the opportunity
in in Cote d'Ivoire
the last example I'll give to which is a
country which has reasonably it's called
why is now a middle-income country has
been for a number of years they have
well-established health care system at
least as far as hospitals are concerned
with some very sophisticated university
university hospitals I think there's
several of these in Abidjan I asked our
39:49
lab to look at the maternal mortality
figures in Abidjan and in Cote d'Ivoire
which are high which are much higher
than some of the surrounding much poorer
countries and we understood that there
was a need in this country to improve
access to basic essential services for
the population in addition to having
people have access to sophisticated
well-equipped hospitals in the capital
and in some regional capitals through
the advocacy of the WHU or
representative based on using this
evidence
and the mobilisation of partner several
40:21
key decisions have been taken by the
government first to invest in the
effectiveness of their districts
something which was off the radar screen
in the country including changing the
leadership of districts so that we have
appropriate people now running the
districts and to invest in primary care
services in Cote d'Ivoire we have in the
last year or so had the WH Horeb
supporting the Minister of Health to
conduct visits to the periphery with all
the partners and have mobilized there's
40:51
no partners to support this move by the
country on UHC I recently was in the
country where they held a high-level
dialogue on financing for health with a
view to universal health coverage and
this is just an example of the way in
which African countries addressing the
financing challenges that they are
facing are looking at making progress on
universal health coverage we are very
encouraged by this interview so we see
our role very much as providing policy
41:20
support technical support data to enable
the country to know how they are moving
we've established several national
health accounts we have a regional
health observatory and we're very
encouraged by the fact that our
governments not only are adopting at the
political level but I'm working at the
operational level on universal health
coverage thank you very much so thank
you dr. Moretti for providing that
regional picture and how it fits into
41:52
the global setting as well you mentioned
a couple of times the UHC partnership
and we're going to provide an explainer
on that shortly but before we go to that
we're going to switch up the rhythm a
little bit and show you a video because
we keep on using words like integration
financing services funding but
essentially what UHC is about is of
course us all of us together which by
2030 will be eight billion of us
everywhere so what does UHC look like in
reality and particularly what does it
42:25
look like when it gets it right
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44:10
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45:19
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callate yeah yeowch
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so that's just a story of one person
accessing dummy which is a primary
health care center close to where he
lives I think he said just 10 minutes
away from his home so I think that
bridges us very nicely to the next part
where we're going to look at the UHC
partnership then we're going to get the
floor open so that you can get your
voice into that as well so let's go now
45:53
to Peter Salama he's the new executive
director of UHC life course and he's
going to break down some of the
intricacies and nuances of that Peter
thank you so much James and welcome to
everyone today I want to really answer
this question of what does a new UHC
partnership look like in the context of
what's been said today by our panelists
and I took away 10 points the
challengers us as a partnership but also
46:24
that provides an answer to a question I
was asked only this morning which is
what's really new about all this what's
new about UHC what's new about PHC as a
primary foundation for UHC or is this
just old wine in new bottles and I think
the the actual panelists from their
country experience gave us the most
articulate answer so if things I picked
out that are relevant for for our
partnership firstly the inextricable
link between coverage of essential
46:54
services and financial systems and
protection that that link is absolutely
critical to the way we go forward that
the planning needs to be bottom-up
through a carefully tailored package of
services that's contextualized to the
local disease burden and the system
constraints and includes a bottleneck
analysis of what really is stopping
progress including as our colleague the
Secretary of Health from Kenya mentioned
infrastructure practical things like
47:24
infrastructure a concrete focus on
realistic but measurable results that
outcomes fourth an accompanying
investment in measuring those outcomes
and this is why we have for example in
the
hc' partnership a live monitoring
capacity but an acknowledgment that
averages and aggregates are not enough
as my colleague from Columbia mentioned
the importance of the sub-national level
the importance of disaggregated data if
47:57
we're going to address equity equity in
terms of coverage but also equity in
terms of finances today we can't tell
you from our data our female-headed
households more vulnerable to financial
catastrophic expenditures or not we
assume they are but we don't have data
and evidence to support that and we
can't monitor and track it 6 quality as
a human rights issue very well
articulated by our panelist 7 the
importance of the social contract with
48:29
citizens which entails an understanding
of both the needs and the perceptions of
citizens 8 the need for a new refreshed
toolbox which includes activities that
whu-oh supporting such as such as the
UHC menu but also innovations in the
digital realm in products in programs
and in systems a 9 a focus on the demand
side in a technical briefing next door
we're discussing an issue around vaccine
48:59
hesitancy but that issue of the demand
side the loss of confidence in
immunization around the world is just as
relevant to this session in here how do
we ensure that people understand their
own health can participate in it and
actually own their health services at
community level and one of the
accountability mechanisms to support
that and finally the investment in
implementation science my colleague from
the Philippines focused on this the fact
that we need to learn as we go
49:31
documented and share best practices and
learning with each other I think all of
that are actually the key principles of
what we're talking about in terms of
what is truly new wine in new bottles
and a real new global momentum for UHC
with pH C as the core and it also
provides the framework for the UHC
partnership
an innovative new partnership and I
really want to thank again the key early
adopters of this partnership were
represented here by EU colleagues but
50:03
Japan Luxembourg France Ireland and the
UK who are providing the flexibility to
allow whu-oh and our partners to support
bottom-up planning at country level in a
flexible manner and that really is a
critical at the critical front of how
we're going to be able to tailor our
work we also have of course important
other aspects of a renewed partnership
the SDG action plan and the key UN and
global funding organizations involved in
50:36
that and I'm really pleased that Peter
sands is here from the Global Fund to
address those issues but finally and
ultimately it's about a multi sectoral
partnership involving private public
sectors in their full capacities to
support countries an impact on the
ground and that's why UHC 2030 has been
so important to provide that platform
for all partners thanks James
thanks very much Pete and you mentioned
there Peterson so we're going to hear
51:11
from very shortly but we'll listen to
also some other friends we want to open
this up and we want to ask them about
their experiences from their particular
position so quick feedback on what you
think of the UHC partnership do you
think it's valuable where you are why or
why not we'll start off with Kevin
McCarthy you represent six donors from a
whole basket of multi donor community
and the EU pioneer the UAC partnership
51:43
but I suppose the question is now in a
very complex geopolitical landscape is
the UAC partnership important to the EU
and is it going to be as important going
forward thank you James the short answer
is yes the long answer may take a little
while but I think Peters already
highlighted the core aspects that we've
tried to address in the support of the
partnership if you know anything about
52:12
policy where development is concerned in
the health sector you can trace back our
support and our stance on health system
strengthening and UHC before 2010 now
the partnership grew from 2011 2012 very
small but small is beautiful and now
today we're talking about 66 countries
it started off very small with only 10
countries but we have that built into
our policy documents it's part of our
DNA within the development sector and
52:43
within the health sector in particular
we see that in the European consensus on
development which is the Member States
coming together and setting out their
policy for the implementation of agenda
for sustainable development now our
approach has always been to look at the
whole health system whether it be
qualified health workers whether it be
affordable medicines will it be adequate
financing whether it be health security
but with the aim of moving towards
universal health coverage with quality
53:15
health services accessible and
affordable for all we've
those key words this morning we've heard
them throughout the assembly what is
important for us is that we need to
foster partner countries ownership of
their own development policies in
particular health and their the Paris
principles implementing aid
effectiveness principles that address
root causes and provide the context in
which we can address those constraints
is critical to us now we've grown from
53:45
those countries ten to sixty-six whu-oh
has reached out to a whole range of
donors we've seen and I don't think I
represent all six donors but we have
worked very closely with Luxembourg
Ireland and France have joined the
partnership but we've seen that merge
into a multi donor partnership if I can
call it to a group that will support
stability o in a flexible way and here
I'm talking also about Japan and the UK
and even Germany who is supporting this
work it's important it was that those
54:19
country objectives are determined
through a bottom-up approach again Peter
said this has been said this morning but
they need to be followed through and
this is where we see how whu-oh can be
strengthened through the country offices
in the countries to actually turn that
into reality in that way we also assist
whu-oh in fulfilling the health systems
governance agenda and this is important
this is critical yes we see that
it's a flexible approach but we don't
just sit back we want to see what has
54:51
been produced and this means while
allowing budgetary discretion financial
discretion and tailing the choice of
countries in the follow of those
countries we need to see the monitoring
of those countries and the technical
reporting the live monitoring tool that
Pete referred to the multi donor
committee the technical meetings the
regular contacts it's not just once a
year it's usually once a week if not
every few days and this is in addition
to our global initiatives our support is
55:22
both bilateral through country offices
our country offices delegations as well
as global initiatives whether it be the
Global Fund
Gavi UNFPA or the GFF it's roughly 1.3
billion to both global and then another
1.3 to the countries and then we mirror
our approach at country level but also
in the global agenda and I think we look
forward to the SDG three global action
planned to really produce something that
55:53
can galvanize the agenda and I'm glad
today that we have Peter sands with us
that can tell us a little bit more about
that we are not stopping there because
there's an actual fact the partnership
has has been maintained in our new
program on health systems and we will
shortly be engaging in a hundred million
euro health systems program with w-h-o
it's part of our overall approach and we
will be incorporating the UHT
partnership and I think the word that
dr. Tetris underlined is they were doing
56:24
it together thank you thank you again to
Kevin McCarthy we're gonna cross now to
Japan to dr. Chico Ikeda who is one of
the global health leads that the
Ministry of Health and labor and if we
look at the example of Japan the lead
example of it in the world we see the
political will we see the demonstration
of political leadership the Prime
Minister Shinzo Abe has really made UHC
56:57
central to the global political mandate
he's pushed it very hard at the g7 he
wrote a piece as many of us know for The
Lancet and then Japan as a whole has
been one of the creators of the group of
friends of UHC so on multiple levels
Japan has been the witness but also the
innovator behind this movement the
Global Fund and Gavi also were
originally created to support
cost-effective health interventions
57:30
during the NDG era and how many of us
remember at the time people saying it
couldn't really be done we couldn't
really deliver on these MDGs and the
success of that now multiply to the SDGs
shows that there is proof
for hope there is evidence that you can
succeed so dr. yukata when we look at
Japan when we look at UHC what's going
to connect for your country thank you
James and thank you thank you for giving
58:00
us this opportunity to listen to the
efforts and the progress at the country
level in different countries that's
something that I have sometimes
difficult found difficulty if you're
based in Tokyo and as you know that
Japan is sort of the contributing to
building up USC momentum through various
occasions why because we haven't we have
experienced economic growth since 1970s
58:31
and one of the reason is that we have
achieved USC at the very early stage of
our economic development in 1961 and of
course societies keep growing and the
difficulties becomes different and so we
have we we sort of modifies or adjust
with our system to the new issues and so
59:03
at this stage we are facing super aging
society so now we are modifying the our
system to fit the super gene society and
this year that we are going to host the
g20 and 7th Tokyo International
Conference on the African Development
and of course we continue to foster USC
there and also we are working on
supporting the preparation of un
high-level meeting through un friends in
59:33
New York and so momentum is there and we
believe that it should be now translated
to the impacts on the ground and what
the other panelists mentions about it
should be bottom-up way and we are
trying to find how we can make it and in
this regard we tank
EU for initiating this USC partnership
it is highly valuable because it's
strengthened abrazos countries about
01:00:05
capacity and Japan joined the USC
partnership last year and we see it as a
platform to streamline different
resources in the and then strengthen the
richest country support capacity and as
you said that USA is very flexible and
but we all understand that policies can
01:00:36
be changed based on the political
situation and this kind of flexible
flexible partnership may be one of the
best way to respond to that change so I
I hope that other countries and donors
will join up this partnership and also
that I would like to ask the ratio to to
support country through this partnership
01:01:07
so that we can all enjoy the USC by 2030
thank you
well Pisa in order for that to happen
the Global Fund is going to be a key
component Peter sands who of course is
the head of the Global Fund we keep on
hearing about how primary health care is
the essential stop on that road to
realizing to achieving universal health
coverage and when we look at the origins
of the Global Health Fund it was always
about innovative ways to deliver for
01:01:44
people when you look at this plan when
you hear your fellow panelists speaking
today do you think that there is a cost
effective and sustainable plan in place
to achieving HIV TB and malaria
objectives is that going to be good
enough first of all maybe it's because I
haven't been in the global health
environment long enough but I don't find
the well-established dichotomy between
01:02:17
vertical and horizontal interventions a
very helpful form of language but it is
one that still has quite a lot of
currency and I think in this discussion
sort of blowing that away is really
important the only way we are going to
defeat the three biggest infectious
diseases afflicting humanity is by
building resilient effective primary
healthcare systems and looked at from
01:02:47
the other perspective a primary health
care system that doesn't effectively
diagnose treat and ultimately defeat
AIDS TB and malaria isn't a very
effective primary health care system so
we need to do both and that's why at the
Global Fund we are investing
significantly more than a billion
dollars a year in investments in
strengthening health systems and as we
01:03:22
look forward we are going to be putting
even more emphasis on
integrated packages of care so
patient-centered packages of care so
when we're providing seasonal malarek
humor prevention to children in Asia
also assessing them for nutritional
needs or when we're supporting
prevention of mother-to-child
transmission in a pre and antenatal care
setting doing it within the context of a
01:03:54
broader pre pre and postnatal care
delivery and likewise when we are
supporting the development of functional
capacities be they human resources for
health health management information
systems national health accounts supply
chains doing it with a view to the water
objectives of the primary healthcare
system but a couple of things we're not
01:04:25
going to lose sight of which I think
have been very important to the success
of the Global Fund thus far
first is the relentless focus on patient
outcomes on all the investments we're
making not just delivering more X or Y
or Z input metrics but are they actually
making a difference to people and second
the pervasive involvement of affected
01:04:57
communities in the design the delivery
the governance of what is being built
because ultimately if we lose either
those things if we end up investing in
systems that don't deliver outcomes that
don't deliver involve communities we
won't achieve what we want to achieve we
absolutely recognize that the Global
Fund is only one actor in this in this
01:05:31
journey the most important actors are
the countries and communities themselves
they need to lead they need to determine
the priority
but we among the international agencies
among bilateral partners we absolutely
need to get our act together better in
the way we work together and that's why
we at the Global Fund are completely
committed to the global action plan and
the underlying accelerators and we're
01:06:03
also taking the initiative to deepen our
relationship with the individual other
actors so we've recently signed new
framework agreements with both w-h-o
afro and whu-oh here in Geneva we've got
a we've built a very deep partnership
with Gavi the head of unit Aid and I
were just presenting to the Global Fund
board last week on how we're deepening
that partnership so we are we are
absolutely committed to the view that
01:06:34
all the partners need to be working
together very closely playing to their
strengths I would caution also the the
only thing I have a slight reservation
about the global action plan is all too
easily it can come across as if in a
sense the multilaterals are going to do
it that we're going to deliver actually
it's all about how we work together
better to be enablers because ultimately
it's the countries and the communities
that are going to make things happen
01:07:07
just coming back to the point about the
interrelationship between and the
interdependence between the fight
against individual diseases and building
a primary health care system and thus
the platform for UHC I actually think
Japan is a fantastic real world example
of that story Japan after the Second
World War had a huge problem with TB
which was the biggest killer in 1951 I
01:07:39
think a massive TB program was launched
and as part of that a whole system was
built to tackle TB and that became then
the platform for in 1961
the launch of the UHC so it's a it's a
really interesting story of how you can
use the fight against the disease to
actually build the infrastructure the
capacities to deliver a PhD system and
01:08:12
above that a UFC system I just want to
close with coming back to a point that
Ted was made right at the beginning
about he used the language about UHC
being a political choice and I'm
consciously this is framed it's a
technical briefing but actually however
challenging the technical problems are
around UHC I think they are less
challenging than the fundamental
political problems if political
01:08:43
leadership in a country will confront
the political problems the technical
problems can be wrestled with and dealt
with and and to just underscore why I
think the political challenges are
significant the first of all financing
UHC requires significant redistribution
you can dress that up in health
insurance actuarial tables so you can
disguise it in the way you weigh raise
taxes but ultimately there is
01:09:13
significant financial redistribution
second point is is that in the delivery
and the design and delivery of the
package there are inherently big
trade-offs whether you're spending per
capita is $50 $500 or $5,000 you will
still be having to make very difficult
trade-offs and those are inherently
political and then the third point which
is probably the point I care about most
of all is the universal bit of universal
01:09:45
health coverage doesn't happen by
accident
it requires tackling gender inequities
it requires tackling human rights
related barriers to health which both of
which prevail actually in most countries
however rich and unless those are
tackled then
you don't really have universal health
coverage so I just wanted to finish with
point is the the the most challenging
01:10:17
thing is about UHD and the fact that
it's a deeply political choice there are
lots of technical issues about
delivering it but we can work on that
if the political leadership is there
thank you or to Anna tars Graham who's
here to represent not only herself not
only the civil society organizations but
01:10:47
more fundamentally people and we
sometimes hear and we heard it yesterday
that civil society is rarely given a
seat at the table well you have a seat
at the podium and we strategically put
you towards the end because we want you
to reflect on what's come before and
call out if you don't agree two weeks
ago you were in New York at the
interactive hearing as we come up to
September's high-level meeting at the
General Assembly there were a number of
asks that came out of that designed by
01:11:20
civil society essentially what was the
big ask and do you feel that it's
accurate to say that civil society are
being included as a core part of this
whole process and I would just like to
clarify despite the fact that it says
doctor I'm not a doctor and you should
not take medical advice from me but I
can talk to you a little bit about civil
society partnerships advocacy policy
01:11:50
strategy and financing and I've been
reflecting on many of the interventions
and contributions of the other panelists
and think that we have a lot of the the
building blocks here I lead the primary
health care initiative with Pai which is
an organization that over the last 50
plus years has dedicated to advancing
sexual reproductive health and rights
and improving the lives of women and
girls and one of the things that we know
is that the silos now won't hold us and
before you jump on me Peter about the
vertical and horizontal
01:12:22
kind of dichotomy all that means is that
within the specific health issue areas
that we know the most about the
constituencies that we care the most
about we have to take that and work
together with other folks that know more
about other communities and
constituencies and throughout this
entire panel I've been staring at this
picture that's at the back of the room
and I feel like it's a really apt sort
of metaphor for what we're trying to do
here there is a plan or UHC roadmap if
you will there are people working
together to build something and there's
01:12:54
a sort of schematic in the background
line drawings of what we're trying to
build we're not there yet that doesn't
mean we just stop building I'd also like
to see maybe in this picture a few more
women perhaps some young people a few
more older folks folks with disabilities
LGBT folks folks have been displaced and
I want to echo the point that we have a
lot of the building blocks things like
financing and I'll get to that and I did
hear your question about talking about
01:13:24
the hearing will be challenges but one
of the things that is most easily is
most easy to accept at the highest level
but the I think will be the hardest to
implement is leaving no one behind and
what that actually means and really
confronting those who are sort of de
facto left behind and those who are
systematically left behind the the
high-level meeting on on UHC presents a
really important opportunity not only to
01:13:54
shape the political declaration and have
this kind of mandate this global
agreement but also to really reinforce
the policies and processes and
structures that are in formation
underway or in place at the country
level as well and there are a number of
country level advocacy meetings and
policy dialogues that the UHC 2030 civil
society engagement mechanism UN aids I
FRC and others are supporting to promote
dialogue among civil society and
communities with governments to to come
01:14:25
up with identifying what those
priorities are and what the solutions
are back to your question about the
hearing we heard loud and clear
how important it is to to look at the
intersectionality of of identities of of
challenges that are keeping folks behind
gender equality and gender inequality
and addressing that came out loud and
clear during the hearing again this need
to break out of our silos and find ways
of working together even if we don't
know how to do that we shouldn't be
afraid of figuring out how to form
01:14:57
unconventional partnerships take what we
know and work together to come up with a
solution that promotes health systems
and access to essential health services
that are comprehensive integrated
rights-based and people centered the
addressing with structures that created
these inequalities that if we're not
doing that it's going to prevent us from
reaching the solutions that that we need
to reach and the importance of
mobilizing public financing a call to
01:15:28
increase public domestic spending
towards a minimum of five percent GDP as
government health spending or country
and regional targets as appropriate
using that as a as a real sort of
driving force accountability
accountability accountability that it's
so important to have this high-level
meeting on UHC to identify the the
action agenda and we need to understand
how we're looking at identifying what
progress is being made and where we need
to make improvements and I'd like to
01:16:00
echo what was shared the Honorable
Minister woody they are talking about
quality that coverage does not mean
access and understanding what it means
when someone is afraid of the service or
the provider who is available to them
and ensuring that that someone who may
have access to or the service is
available that it's not causing harm or
inducing fear so really looking at that
01:16:30
quality and underpinning as well I I
really could go on there's it was nine
hours of interventions thankfully all of
the statements that were contributed are
available on the UHC 2030 microsite on
the high level
and highly encourage you to take a look
at that
and would just like to conclude by
referencing actually a sermon I was
reading the other day and even advocates
need a day of rest and reflection this
01:17:04
passage really spoke to me about this
question of universalism and what does
that mean and how do we get there if
there's a man or a woman or a child
anywhere in the world who needs your
understanding your compassion your mercy
your support your love you give it give
it unstintingly and selflessly this is
the demanding call of universalism this
is not a casual Sunday walk in the park
it's a tough and foolish doctrine of
inclusion and care that constantly
challenges us beyond the narrow confines
01:17:34
of our natural selfishness and fear to
ever wider circles of caring and
compassion it is not enough simply to
speak up about universalism with our
lips we must further speak it with our
lives with the deeds and doings of our
hands in our hearts so I ask us now to
lift up our hands and our hearts to work
to make universal health coverage and
health for all a reality thank you thank
you very much to Arianna Charles Grimm
01:18:05
because you've condensed those nine
hours of hearing so that we don't need
to watch the nine hours of playback
online I also countered that painting I
know the livestream audience can't see
it but it's a picture painting of
essentially 35 men lifting up a few
pieces of wood if there was some women
involved in that it wouldn't take 35 men
to do this so let's jump into the floor
we've got about 10 minutes together so
anybody who wants to contribute an idea
01:18:36
a question or a comment we ask to keep
it to 60 seconds or less and so we're
going to whip around the room randomly
let's start off with a gentleman in blue
then we'll go to the delegate right
behind you this is a quick comment I
thank you thank you very much my name is
Steven watt ET I am a medical doctor
from Uganda but I'm also part of living
with HIV
and in 1999-2000 had TB meningitis had
cancer but thanks to palliative care
01:19:08
that I accessed so I'm here today my
question though goes to but all of them
really panelists universe so sorry
universal health care is from birth to
end of life
how are you sure another package
operative care as part of you involved
there is a package of per elf can
universal health care so that poor who
need it like me can access it because
all of us eventually my well we need it
01:19:43
thank you
but take a couple of questions in a go
we can see how the parents will feel and
how our time works our I think we saw
question from the front here is one
we'll work our way back a familiar face
the Assistant Secretary General GERD of
their book who I think is also the
coordinator of the scaling up nutrition
movement yes indeed thank you very much
thank you for the excellent contribution
and the scaling of nutrition movement
has 61 member countries and is working
01:20:13
with for Indian states where the
government takes the responsibility the
lead the ownership to invest in
nutrition and ends or better prevent all
forms of malnutrition why do I want to
take the floor because I think universal
health coverage is a brilliant idea
but my question is why is such an
important building block and such a
strong foundation like nutrition missing
in the universal health coverage why is
01:20:43
the coverage in the in the primary
health care system on counseling
pregnant women and adolescent girls and
supporting breastfeeding why isn't it's
there it's so easy to put it in the in
the toolkit and it can prevent 800
million child child lives and it can
prevent 20 thousand 20 million mothers
dying every year it can prevent the
01:21:15
so my question is please edit it is low
cost high impact measurement but it's
also emphasizing the multi-sectoral
approach that is needed especially if
you want to go far leave no one behind
then you need the community approach the
Sun movement has experience in
communities is able to bring people
together and is ready to work together
with whu-oh with us
01:21:48
partnership and with all countries so my
request to dr. Salim our dr. Peter
Solomon is pleased at this as an 11th
key point to your list and nutrition
work together with multi stakeholders
because then you also include water and
sanitation early childhood development
and a little bit more of equity thank
you let's go then to the delicate in the
middle and the black jacket and we'll
move forward to the gray thank you I
01:22:21
have to tell you I'm not a delegate I'm
speaking on behalf of women in global
health and I'd like to echo the comments
of Peter sands and Arianda
Charles Graham and that we will not
reach UHC without addressing gender
equality and women's rights women in
global health women deliver and the
International Women's Health coalition
have formed a new alliance on gender
equality and UHC and we now have 35 NGOs
from 24 countries with us and the number
is growing we're calling on all Member
01:22:52
States and everybody in this room from
whichever sector you come from to
include gender equality and women's
rights including sexual and reproductive
rights and health and UHC and including
gender equity for the 70% of the health
workforce who are women women will
deliver UHC if we enable them thank you
let's go to the front here you know
thank you very much Andreas both
01:23:21
speaking with medical in medic made it
cause one day international they're not
sort of the
Niva global health hub and also thank
you very much for this panel and also
the renewed there is a very strong call
for renewed focus on health system
strengthening under the concept of
universal health coverage I'm I want to
put a bit of a challenging question into
it because what I understood mostly also
that universal health coverage in its
01:23:52
background also tries to deal with the
big challenge of not having only a
public health system in in face but also
trying to integrate private health
services and public health services into
something under an umbrella and I hope
following the South African example of
national health insurance saga you might
can tell now over the last more than 10
years and it is extremely difficult
particularly if you speak about resource
01:24:23
allocations and who really has access to
good quality health care to really try
to make this work when you have so many
different actors involved in this so I
wonder if this might not also be good
not to show the the good access the this
success stories on such a panel but also
look into more deeply also the the
really challenging ideas about behind
universal health coverage thank you you
have to remind everybody to keep your
01:24:54
comments very very brief because we are
running out of time we are going to go
to the front
after noise pace you'll go first sorry
I'm just forgetting a bit of the order
voices from civil society and we'll go
to you
thank you very much James and my
appreciation to the panelists for this
great briefing today I'm Louise peace
with the global health Council just was
thinking I wasn't hearing much about
prevention or social determinants and
wanted to ask with regards to some of
01:25:25
the country examples to what extent
those examples are covering the full
spectrum of health so not just health
care or services but also general public
health health promotion and obviously a
lot of the other socio-cultural issues
that leads to a lot of these poor health
outcomes
thank you thank you
I'm a Celica and from I'm working in
Mozambique in public health for many
years supporting Ministry of Health for
many years my comment is around actually
just following heroes
01:25:56
it's about health promotion and health
prevention because we know that we are
we have a like a gap of 80 million human
resource for health and we know we won't
really fill that gap so the idea is to
promote health not necessarily the
health care the health that people are
empowered and know their body and how to
take care of their body and their mental
health so why not investing in in health
workforce that is looking to prevention
01:26:27
and also look at the traditional
medicine and traditional wisdom thank
you thanks very much
lots of great ideas coming up here and
I'm not trying to discriminate go to the
center of the room but I think over here
we certainly have one question good
morning or good afternoon my name is
Victoria Shoei I'm from Los Angeles
California I'm off I'm also a youth
member a part of the young leaders
network with WHL so I do have a question
regarding or comment regarding the
investment of youth and youth leaders
01:26:57
within your respective countries and if
you are including youth and youth
officials at the city and having them
have a seat at the table with regards to
these issues regarding universal health
care and universal health coverage I if
not I will encourage you all to please
join us we are having the WHL Wyoming
Network ours are having a session on
tomorrow morning at 10:00 a.m. to have
conversations regarding how we can
resolve all of these issues thank you
thank you it's great that we've got some
01:27:29
youth voices out here as well all the
way to that side please hello I'm
Camille Williamson representing help aid
international and I wanted to raise the
issue of aging and older people and to
ask how countries who have spoken
excellently and very helpfully today on
their progress towards UHC and how have
they gone about understanding measuring
and addressing older people's access to
health and care
services and a group of people who are
making up a rapidly increasing
percentage of the population and it
01:28:01
links to a broader point on the UHC
index which is missing all to people
okay I think we've got one last comment
from this side of the room dr. Matthias
bonk from the Berlin Institute of Global
Health what did you want to contribute
to this thanks James
and thanks to the panel and a really
interesting session which I really
appreciate and as James mentioned and as
01:28:32
the last commentator mention else as
well
I think the whole spectrum of the life
course as Peter sarama has in his
department has to be included in this
universal health coverage from the very
beginning from bachelor students into
the palliative care and it's it's a
great challenge of course but I think to
really have the whole spectrum covered
is is the big goal and listening to all
01:29:03
those examples here I'm very confident
that you guys will make it thank you
very much the big vision ending goes to
dr. Chris Ahn who is the regional
director for the Amaral region of the
World Health Organization and dr.
Etienne I know that you've been
listening intently to the diverse range
of opinions comments and ideas even
people asking for another part to be
added to UHC we're a couple of months
off only a couple of months off perhaps
01:29:33
you can we together connect the dots for
us and to close today thank you and let
me thank all of the presenters and
certainly those who made interventions I
have a few ideas that I want I want and
to live what's your as I listen to you
many of you the tendency is when we hear
universal health coverage to move
immediately to financing and essential
01:30:06
packages and social protection
but I think the importance is also we
need also to think about access and we
we need also to think about confronting
the barriers to access because you can
have all the financing that covers
everybody and still not achieve what
must be our common vision and a common
goal that all peoples have access to the
conditions that would allow them to live
healthy productive dignified lives and
01:30:35
that has to be the ultimate goal of all
of us now it is important yes to realize
that it is not one size fits all and and
what we heard here is how the different
countries moved along the implementing
towards this universality and I think
that is another concept that is very
very important it has to be the living
no one behind
also speaks about universality that's
why we had help for all that's why we
have universal health etc because that
01:31:08
basic principle of universality I think
as well and we heard it mentioned Peter
mentioned it the whole question of
equity there there there is no universal
T if we continue with with the inequity
that is very persistent in many of our
societies and without the recognition
that it is a right it is a right to
health and so there is responsibility of
the various governments and
responsibilities of all of society to
ensure this universality and that that
01:31:38
those rights are met it is important
from countries who are embarking on this
journey or who are at some point in this
journey to recognize you should not just
be content with your package of
essential services well you need to have
this long term vision towards the goal
that says that it has to be a
progressive realization so you need to
progress from one small package to an
entire package and I certainly I
01:32:09
certainly think that if you focus on the
needs of a specific population or
community that gives you what the
package should be and so it shouldn't be
an external entity that decides
what your package of essential services
is it should be a profound discussion
with your communities with what what are
the existing issues so the whole
question of whether we are going to
include nutrition or whether we are
going to include TB treatment or aging
01:32:39
would not come into question if we are
looking at a particular community with
its particular epidemiological and
demographic profile and III think it is
clear that we need a political
commitment and that was made but that
political commitment must be translated
into sustained action and I think that's
that's important we need the renewed
focus on reducing inequities we need to
reduce barriers to access be the
geographical cultural institutional
economic etc the discrimination that
01:33:12
that prevents people from accessing care
and what you said we need a new model of
care we need a new model of care that is
based on the primary health care
principles and I and I like to make that
distinction between the primary health
care approach and the first level of
care because it's not the same and I
think we need to see that we need to see
that that model of care needs to be
comprehensive and I like I like that
question that talked about promotion and
prevention because it needs to be
01:33:42
comprehensive care not just access to
curative care many times when we are
talking about universal health coverage
and the financing we are merely talking
about the financing of curative care an
individual curve diff key we need also
to be concerned about prevention and
promotion not only for the individual
but on a population and community basis
and there needs to be investment for
that as as well of course our model of
care needs to be people centered people
01:34:12
centered not just on the individual but
also centered with communities and
families we are moving further away from
addressing the essential Public Health
functions but those are also necessary
and and those need to be invested in you
can have the best clinic
with the best well trained and
sufficient numbers of of health care
workers and you never get to the point
where people can live healthy productive
01:34:45
lives so that that's going to be
important as well
I wanted to also look at the whole
question of community participation that
people need to be need to be engaged so
all of the work that you are doing with
planning etc with the MUHC partnership
that has to be rooted in community
participation and one of the things that
we've not addressed is what are the
mechanisms that we are going to use
institutional mechanism
institutionalized mechanisms that
01:35:17
guarantee community participation
because if you had community
participation for the various levels at
the local level at the the mid level at
national level people would have a say
in what they want to see and how they
want it and people need to be involved
in implementation monitoring and
evaluation and they're the important
role of civil society I think civil
society needs to get engaged in the
whole monitoring and evaluation and
being the watchdog for ensuring that we
01:35:47
are reaching the goal of healthy
productive dignified lives governments
need to invest in social participation
and capacity building of communities so
that they can better engage in those in
those processes and that's going to be
important we need a new governance
certainly and we talked about sustained
political will and commitment we spoke
about the broad engagement of all
sectors and communities including the
private sector we need a government
01:36:18
governance that is able to evaluate
analyze and use information for decision
making processes we need governance that
is inclusive that can bring into into
the governance civil society and various
persons and we definitely need greater
domestic investment for health that is
that is without question and I probably
want to end by talking a little about
this multi sectoral
01:36:48
dimension we just had a commission on
universal health coverage and 40 years
of my utter and and the fact that we
have this inequity that is persisting in
Latin America and what do we do what do
we do about it but the fact is this
inequity in health is not necessarily
only inequity in health it is based on
institutionalized systemic structural
inequity that leads to poverty and and
that leads to that drives illness and
01:37:21
and poor health so unless we begin to
look at the determinants of health be
there social or environmental or
economic we will never get to the point
where our people are healthy so this
can't be just a health sector approach
it has to be a holistic approach and we
are looking at a new developmental
paradigm one that has been described in
the the agenda 2030 where we bring all
of those sectors together to put people
at the very center of development and
01:37:53
don't take this really very funnelled
view of of what people need so let me
say that in the Americas we we had this
commission that I mentioned and and I
launched a compact on primary health
care I just want to tell you about it
PhD for uhd 30 30 30 that certainly by
the we need to improve increase to
ensure that 30 percent of the available
funding goes to the first level of care
01:38:27
and and that we reduced by 30 percent
all of the barriers to access and that
we ensure that we do have transformation
of health systems based on primary
health care by 2030 I am a firm believer
that we can get there but it will
require us all to work together let me
congratulate you don't know Peter how
this has been music to my ears you I
used to work in whu-oh I was a DG of
health systems and services our biggest
fight was with the the
01:38:59
these specific programs because we we
said no you can't just have these
specific programs and forget about
health systems they need to move in
tandem with and I can't agree with you
more we need to strengthen health
systems but we need to keep Kim look out
for some of the major epidemiological
challenges of our times so it is how we
bring those vertical vertical programs
I hate vertical and horizontal but how
we bring those two axes together so we
01:39:30
can ensure that people actually can
become healthy and leave those
productive and dignified lives so thank
you so much for this opportunity thank
you very much to dr. Etienne and as we
bring this to its final close just to
echo what dr. Ted Ross said at the very
start we know what works we know that we
have the political commitment and I
think we understand more and more that
this is our rights as humans join us
01:40:01
again at the same time tomorrow at 12:30
when we'll be here in the same room for
the technical briefing on mental health
but thank you to everyone here in the
room and everyone watching on the
livestream and we'll see you again this
time tomorrow