Towards universal health coverage: leaving no one behind
Table of Contents
- Good afternoon from lockdown London and greetings from the Overseas Development...
- About setting priorities and it's about priority setting within the coffered...
- We were moving to really focus there this is where urban poor this is about...
- Us so that's the first thing that you clamp political leadership completely...
- Out I think that's a very big risk that that post corporate governance era may...
- Mean in terms of potential saving lives and of course what does it mean when...
00:04
good afternoon from lockdown London and
greetings from the Overseas Development
Institute and I'm sure I'm we're going
to be talking to be lots of people in
their homes today of release to requite
unusual setting for us to be having a
July this on universal health coverage -
my name is Robin
ensign the sense of universal health
that a Chatham House and I'll be
moderating days session and delight that
we think we have around 200 people who
have joined us from all the world to
00:36
this section to this vast universe for
bas that your novels have de that
nineteen crisis and universal health
coverage from your hundreds expensive so
they descend law questions and comments
through the chat room
they'll be then collated and that true
to me and hopefully we'll get
it's to start with auntie McDonald and
scraper and the research associated ODI
01:50
and he's going to be presenting early
I'd search for some health coverage and
some of the factors that have been
contributing to the spread of UHC around
the world and we're then going to have a
panel discussion the direct
hello and we seem to have had some
02:56
connection issues with Robbie eighths
there and so as the first person to
speak on the agenda I am I will take
over and outline some of the research
that ODI has been doing on universal
health coverage um though first of all I
want to say thank you all so much for
being here and for joining ODI today on
this description of UHC which is always
03:28
a very important topic but is obviously
particularly important right now um so I
want to outline some of the research we
did particularly looking at how
countries have achieved universality and
reached the left-behind I am pretty
presenting this research for there I was
also done in conjunction with Emma
salmon and Anna Eritrea though we wanted
to look at the motivations difficulties
and strategies for reaching the Left
Behind and we've done this true to
03:59
favorites the first is a historical
analysis of 49 countries and they're
moved into or towards universal health
coverage and the second page I say and
this aims to understand how why and the
benefits of universal health coverage
the second paper will be a literature
review on the costs and benefits of
reaching the Left Behind so with the
first paper we included all countries
with more than two million people who've
achieved universal health coverage so
04:31
all lower in middle-income countries and
I provided they were countries at the
point at which they achieved universal
health coverage and we looked at because
only one country low income country
Rwanda has achieved universal health
coverage we then also looked at the the
ten best low income countries on health
care and the outcome variable we used to
judge that which is obviously a very
subjective term was the Institute of
Health metrics and evaluation quality
05:02
access as I have acts
and quality index which looks at 35
they're treatable illnesses and how I
becomes very to them by country which
should show both the quality of care and
the access that people have to care in
those different countries and finally
most high-income countries have
universal health coverage and so instead
of including all of them we took the
first six countries to reach universal
05:34
health coverage and the six countries
that the best outcome outcomes again
using the health access and quality
index and that gives you this kind of
gives you a map of the countries in the
world that we love to understand health
outcomes for and for each country then
we we understood a very detailed
literature review looking at the
political motivations behind how the
country reached universal health
coverage the cost and the time it took
06:07
and the strategies that were used and
this work was led by Anna Hume it reacts
we also compared this to globally
available data because country
literature could vary and comparing them
was somewhat subjective in our part we
use global data to compare outcomes
using indices of democratisation indices
of health care outcomes to to test the
subjective decisions we've made in a
more objective way and then we coded the
06:37
results in two different categories
combining countries that were similar on
different variables and this data is now
publicly and freely available to
everybody and we would be very happy if
you were to use it and find it useful
just please do cite us um so our main
findings most countries who set out to
achieve universal health or say who
achieve universal health coverage don't
set out to achieve UHC in originally
they move into the healthcare space and
07:09
have been two spaces phases or multiple
little steps and in the multiple little
sets and two larger phases the first
step is to kind of look at
why fixing the worst excesses of kind of
a free market health care system
government and provide health coverage
for the very poorest the very oldest and
most commonly of all mandating insurance
for those informal employment um and
these kind of incrementally moves
07:39
forward and then in most countries you
looked at we see them a very big shift
towards universal health coverage
sometimes these two phrases are very
close together sometimes they're quite
far apart in the UK for example it was
in 1910 and that the government moved
into health care coverage and mandated
insurance for everybody formerly
employed and this continued to increase
throughout the 20s and then in the 1948
the whole health care system was
nationalized and there was a huge change
in strategy to achieve universal health
08:10
coverage and this is fairly common to
all the countries we love them and we
then coded 14 different approaches or
strategies to UHC and what we found is
that lots of countries achieve UIC in
very different ways lots of countries
use one set of strategies in their early
phase or employed workers in the very
poorest and then move to it as second
approach and and while comparing
approaches between countries is very
difficult and be because it's not clear
if some things are causal or they're
08:41
just correlation one notable thing we
did find is that countries that tend to
provide health care publicly either to
government-run insurance schemes or
through a centralized system or local
health care systems tend to have better
outcomes then companies in countries
that mandate private health care or use
the private sector to provide care now
it's not clear if that's causal or
simply a correlation but something I
think we'd be interested in more
research on the next one thing is
countries tend to not go backwards and
09:11
we see all across the countries in our
data set we see huge battles about
whether or not the country could afford
universal health coverage and whether or
not this was something that wanted to do
and very entrenched interests who are
against universal health coverage and
and these battles tend to subside very
quickly once universal health coverage
is reached and instead we see
so of arguments about iterative reform
about improving the package of health
care about improving the number of
hospitals but very few people arguing to
unpick the universal health coverage
09:43
that preceded it and we found that
wealth is not a major driver of UHC long
took about half the low and
middle-income countries in our data set
at the literature recited resource
constraints is a major barrier to
achieving universal health coverage but
these countries were only barely richer
13% wealthier than the other half of low
and middle-income countries in our data
set where resources were not considered
a major constraint and instead resources
seem to be constrained in countries
10:14
where government capacity tended to be
lower and what tends to be much more
important than wealth overall appears to
be growth rates and physical space and
this ties in with much of the other
literature on universal health coverage
where countries physical space or
economy is growing it's easier for
countries do to make the changes
necessary to - or the political
decisions to bring about universal
10:45
health coverage and the final big
takeaway and I think the biggest
takeaway from this paper for me was that
most countries don't just decide to move
towards universal health coverage 71% of
the countries in our data and our data
set made the decision to commit
universal health coverage in the wake of
some kind of crisis whether it was a war
in the case of someone like the UK or
Belgium whether it was in the wake of
genocide in Rwanda of civil unrest and
places like Mexico and U and Colombia in
11:16
into my like Thailand it was a mixture
of civil unrest and a major economic
crisis preceded it um and these crises
seem to break up the kind of the status
quo and are preceded by questions about
what a country wants to be and where it
wants to could move forward and in these
discussions countries tends to often
decide that they would like to create
universal health coverage and
and it's interesting I think from our
11:47
point of view at least that these are
often very difficult times for countries
and Britain created universal health
coverage right after the Second World
War as did Belgium um as did or Japan in
expanded its health care in this period
usually and while while money was very
tight and it emphasizes how much
universal health coverage is a political
decision much more than an economic or
resource decision a couple of final
thoughts obviously we were originally
12:18
supposed to have a meeting in London and
to discuss this and the world has
changed radically in the four months
that we were planning this event um Kove
and we are now facing what is probably
the biggest collective world crisis
since nineteen forties um Kovach 19
shows the need for universal health
coverage and the need to protect people
across the world and how we're all
vulnerable when one person somewhere
picks up an infection that goes
untreated it can spread rapidly and
12:48
impact us all but it also I think
hopefully will help change the narrative
around universal health coverage and
because this like other crises will pass
and hopefully in the reconstructive
phase we can have a.m. we can have a
broader conversation about the health
care needs that we want and as seems to
be happening already in in some
countries and finally I wanted to
quickly this flag that we have a
forthcoming literature review where we
have tried to understand how to reach
and the Left Behind briefs and and this
13:21
will be out at the end of the month we
looked at the social physical and
economic barriers and impacts different
people and their access to health care
and how these barriers can be overcome
and why they should be overcome and
that's kind of a that's kind of an
outline of the research that ODI has
been doing in universal health coverage
so thank you very much and I can't tell
from here but hopefully Rob is back on
the line yes I hope I am back with
13:54
Elijah how is that it's not a bit
drive I'm virtually sitting on top of
the server now yeah that is that is what
we're all dealing with these days with
this new technology and my children's
we're blind that was nothing to do with
them being on their neck or whatever
better that there you go well answer you
thank you very much indeed for stepping
in so quickly there and and I think it's
absolutely fascinating research that oh
yeah I've been doing particularly as
you're emphasizing the very important
14:26
politics behind this and that it's not
just a matter of wealth that determines
the degree to which countries are moving
towards UHC but is this this nebulous
thing about political commitment and the
extent to which politicians are running
with this agenda and of course in the
midst of this political you know heads
of state appearing on television night
after night talking about what they're
doing so obviously the the politicians
of the world are very much looking at
14:57
health and health reforms at the moment
and so I'd like to sort of throw this
over to our panelists now about you know
what's their perspective on on you know
what politicians should be doing at the
moment and if I could maybe start with
you kill it so what do you think sort of
policymakers should be doing in in terms
of allocating resources this is a big
area of interest of yours I know and
negotiating some of the difficult
trade-offs that need to be made on the
route to UHC thank you Robin thank you
15:29
Anthony and the ODI for for having me
and to all of you for being on line and
I think priority setting is obviously of
critical importance and when I was
preparing for this we hadn't realized
that least I hadn't realized the scale
of the coffee crisis or III have to talk
a little bit I think about priority
setting in the corvids
Eva because a lot of the way national
governments and indeed the whole the
globe is responding to the crisis is
16:01
about setting priorities and it's about
priority setting within the coffered
response for instance were seeing
massive mobilization do
or procurement of various commodities
from protective equipment masks oxygen
all the way to ventilators especially
for poor nations and again this priority
setting in action there how do we decide
and who decides what ought to be
purchased first then priority setting
beyond copied we've mentioned briefly
16:32
amongst ourselves before we went online
that decisions are being made implicitly
or explicitly to for example suspend
vaccination campaigns in the UK you've
stopped screening for breast and bowel
cancer we're seeing monumental
reductions in emergency admissions for
asthma for instance or heart attacks we
know that these things have not stopped
happening and and they will have a very
17:02
real toll on people's lives and then of
course priority setting beyond health
across other social sectors the human
capital impacts of the crisis you've
seen school closures around the world
including in developing condition for
some of the first to introduce school
closures and an unprecedented scale it's
never happened before the schools are
closed almost across the whole of the
globe and we don't really know what the
implications of that of this are and
whether and how we can restart schooling
17:33
especially some of the poor poorest
countries and then of course Trados a
cross flick and private sector
formalizing whole sectors of the economy
two attitudes on the part of debtors and
and also poorer countries towards debt
levels we're talking about direct cash
transfers and helicopter mine to keep
people at home and of course it depends
who you are as to whether you can afford
some of these measures so priority
setting all around and of course
18:03
probably sitting with in UHC Anthony
talked about the fact the finding that
most countries actually didn't set out
achieve u8z and that's really important
to note and also that most countries in
fact no country seems to have gone
backwards having achieved u8c and I know
Rob you're a great proponent of UHC and
the political capital that a campaign to
achieve UHC brings and I think that's a
really important and powerful deliver
however perhaps perhaps I'll sound and
18:34
I'll finished by perhaps sounding a bit
pessimistic and forgive me I wonder how
the BC before copied period compares to
what we're experiencing now and what we
will be experiencing in in the past we
saw despite commitments the UHC so
serious issues with mobilizing resources
domestically we've seen that majority of
health spending growth actually comes
from economic growth as opposed to
budget prioritization of the healthcare
19:04
budget we've seen fast growing economies
in Africa and particularly not
prioritizing or in fact even D
prioritizing health spending that's all
in the BC world we've seen fungibility
perhaps across sectors if you take
education and now I think we're entering
an era that's completely unchartered
with unprecedented levels of debt
unemployment social instability massive
financial shocks countries that rely on
tourism of remittances migration
19:35
movement women we're seeing a backlash
against globalization so the question is
I guess will countries continue to
invest in health will they see this as
an opportunity or perhaps is it a
massive detractor even a transition
happen going forward and and finally
will universal health care coverage be
attained by countries in sub-saharan
Africa and indeed sustained by Asian
countries could we be seeing
backtracking by countries that have done
20:06
well and have committed to UHC in the
context of the new post copied reality
so thank you for having me again and I
look forward to my fellow speakers
comments into the discussion thank you
thank you thank you very much indeed
calypso and you raised a very very
interesting points I mean it's it's
fascinating what one would like to
believe this is the great opportunity
for people investing in health and UHC
and you know this would be an obvious
thing to do
but we live in a in a strange world and
20:38
you can see their potential backlash is
against this and that some leaders might
not be so inclined to be true you truly
Universal and and sort of treat this in
it in a multilateral way as well so I'm
sure these will be things we're going to
come back to in the the discussion in a
moment but first of all I'd like to sort
of come to Katyn Geno continued you you
are heavily involved in the global UHC
movement so you have this helicopter
view as to what's happening earth sort
of across the world but I also know that
you're intrinsically involved in the
developments in in Kenya and sub-saharan
21:09
Africa so I was just wondering what
what's your perspective of how this
pandemic is playing out in Africa and
the implications for UHC maybe
particularly thinking of Kenya in South
Africa hmm think thanks Rob and yes it's
a very interesting change actually i'm
global level on UHC i because we've had
conversations around how this is the
moment to increase the political
21:39
pressure to accelerate UHC basically
expose our underbellies it has exposed
that most of the talk we've been having
has not translated into option and this
is the time that those would be not
compacted talking to the walk actually
being you know fairly exposed in terms
of the health system strength or the
else's ambassador an access capacity so
we we on one hand we have a situation
that is good to you know apply extreme
22:10
pressure on the health systems in
sub-saharan Africa Trisha on health
system that already have been
sub-optimal largely we know that even
across Africa if you look at South
Africa Kenya was just at in its plans in
versatile coverage we have actually been
working Peaceville introduced free
maternal health we started opening up
user fees from the health facilities
that was ongoing and we were about to
launch to go to scale after the plans
22:41
were that we go to scale by the me place
here including a full reform of the
National healthy you know how healthy
fund to be able to be at a key vehicle
for for in Sochi health insurance South
Africa had just started to dig through
their mention a really surance bill
through Parliament it was up for debate
it was an approval level and one of
those countries that is a tale of two
cities where you have reached community
23:11
that goes up for 7% of the total
healthcare expenditure and they are only
16% and you have the other edge for
struggling with balance of 30% and now
you have this that is happening you know
if what we've noticed if all to just
share my my learnings in this kovat
period is that obviously access even to
testing access to care as we know
obviously moco dream for those who can't
afford done for those who can afford we
23:42
have seen initially when testing started
people could go to private laboratories
and they could send their son poster of
Africa that was Kenya specifically and
they could get a case back but the poor
I had no way out and feel they waited
for the public health system to be able
to provide their testing to them so of
course we've seen the effect of the
inadequate health system on on the
response of OB but let me come more
specifically to how this is good for you
but you HC and is good to impact these
countries not only Kenya and South
24:13
Africa but gamma and others that I'm run
around this journey first is that we
know I have seen the presentation done
by Oda that says really you know the
economic affordability is not really a
big deal it's a political choice but at
the same time government friends use the
fiscal space as a key excuse to moving
forward or UHC
so reflecting on the fiscal space you
have several factors that are going to
upset and I'm kind of for reluctant
24:44
governments give them more reason why
they can actually give excuses as to why
they they can afford to move forward
don't you see one is that we expect
there would be massive job losses
there's good to be massive reductions in
GDP I saw a report by McKinsey that
estimating 10 percent GDP reduction this
year
from a projected growth of almost 3% to
a projected decline of about 4 or 5% and
this is going to of course put pressure
on revenues for government that's number
25:15
one number two is that we are getting
government also starting to look at the
economic protection of the people
therefore we have countries like a
they're reducing value-added tax from 16
14 percent we have a reduction of pay as
you on in no personal tax coming down
from 25 percent which means government
revenue is contained a more pressure you
know you have job losses your lower tax
collection so it is time for the
government's we bold and say then
25:45
actually help and lack of health access
is one of the biggest causes of poverty
and this is the time to actually start
to put social health insurance as a
social safety net for people in the area
would introduced at school then you
reduce tax you reduce tax on employed
you're reducing tax on corporations
you're basically giving tax breaks to
people who can afford health care but
you're not giving economic rescue to
people who don't have tax to pay enemy
so the only way to extend a hand with no
26:16
taxes to pay is to give them social
insurance so that you reduce their
expenditure on health on health needs so
that is one other thing that I like to
say the next thing is how this is going
to impact quality of care now we know of
course that we have seen that many
countries in fact are in Africa in spite
and sub optimal health system have
already started to put a you know
solutions to reducing transmission or
reducing trend by putting a few for
26:46
example you know you can move beyond 7
p.m. and you can that we have seen they
have reduced public transport use public
transit or private cars and no movement
at all or unless you own food in South
Africa we've seen a triple lock down
this is going to have a huge impact on
access to care because decision making
only went to go see care well you know
there is a curfew and you know you can't
find public transport is going to be
delayed to be able to start to see big
pressure on quality which is a big part
of universal coverage
27:17
Automation I know that soon I will talk
a little more about the effect on
maternal health child health we have
seen gender-based violence going up so
we have a media issue on quality so for
me in my you know as I close my back is
to say that even as Corbett 19 brings
distracted priorities for they for the
state so the state is now in response
mode emergency mode we must put back the
conversation of universal health
coverage on the table because you know
27:49
rescue an out of pocket not only for
coffee but also on everything else is
key providing people rescue or out of
pocket for vaccination for maternal
health for everything we're doing is key
to it is time to think and rethink and
to reimburse ice our plans on your
bustles coverage during covered and
postcode it and I would like to stop
there but I know that before I stop
remember the closure of schools is
something that we need to think about
very carefully because nutrition is one
28:22
of the biggest causes of poor health and
when schools close we know many
countries have school feeding programs
now keys at home so you're going to end
up with increased malnourishment of
children and the secondly household
incomes are coming down with a loss of
jobs top you know salary cuts and
therefore even when children at home the
families you know be able to adequately
feed them and therefore your so expect
to see a rising malnutrition which is
going to again have a boomerang effect
or know they have area so I stop there
and unless there any questions or
28:52
comment thank you both and fantastic
it's India and thank you so much for
broadening it out you know beyond the
health sector because we very much have
to take into account the impact on
education and a nutrition just like you
saying and I think this vital that you
know we get our act together in
articulating the case for increased
investments in health because you are
dead right there's going to be an
almighty battle over financial crash
which resulted in austerity you know
29:23
they're actually cut and health spending
in many circumstances so we better
one of those areas I'm sure we'd be
looking at and you've alluded to it is
his vaccination and if I can come to de
Souza now you know that everyone
recognizes the importance of
universality when it comes to vaccines
and Gabby's been very very strong with
that particularly around routine
immunizations how do you see this
Coby 19 you know the move to universal
29:56
vaccination and potentially also of
course you know that a coded 19 vaccine
and how important it would be to get
that out to the entire world
don't Susan over to you thanks very much
and thanks to the I mean for us we're
very worried we've just spent the last
20 years working with 73 countries to
get 760 million people some vaccinations
saved thirteen and a half million lives
30:27
and we were moving into the next gaby
strategy which is to just start to focus
on zero dose children and so that is the
ones that don't get DTP that don't get
the first immunization and that's an
absolute marker for poverty
two out of three children who don't get
any doses of immunization are also
suffering those families and those
communities are also suffering a lack of
health services and a lack of access so
30:58
we were moving to really focus there
this is where urban poor this is about
gender this is about conflict this is
about people on the move and with covert
coming in and the diversion of health
resources that's going to make it even
harder
and as Katyn ji says you're getting very
mixed messages stay home and isolate
that makes routine immunization very
difficult so not only do you have that
the impact or the threat of of the the
31:29
COBIT disease we also then have a delay
in retaining min per second or in
catch-up immunizations and that means
we're going to have more problems down
the track that means that
entire age cohorts would potentially
miss out on really important vaccines
and so then we're talking about measles
we're talking about polio and and if you
think about Ebola in in DRC the two to
three times as many people have had an
32:02
issue with measles as well so you have
these compounding threats that happen
and I think I think I'd like to take the
conversation into a dimension that I
think the earth injury was getting
towards that the haves and have-nots and
a universal health because there are
those who can get access and there are
those who have almost no access and so
listening to the ODI presentation when
you were talking about UHC I think the
notion of progressive universalism is
32:32
there to actually start to focus when we
get enough time for a breath to start
the folks in an area where there is the
most need and to build out the health
system from there then you have the
opportunity with immunization because
it's the one that gets to 90 percent of
people it is the widest health found
support an intervention that's offered
you have the opportunity then for other
touch points in health services so when
children are born you can talk about
33:04
deworming or malarial nets or post
maternal care and you can work through
the life course then as children come in
for immunization right up to the point
of young girls who who may need support
in terms of education or checking on
child marriage or menstrual advice or
things like that so you get you get many
opportunities for touch points with
immunization which allow you to apply
that to a universal health care
33:34
perspective because that's about access
and support and then as Gethins you
mentioned there's also the financial
dimension as well now I think with with
covert we really need to then think in
terms of policymakers there's the
immediate crisis and response but then
what does this actually mean
we organize our policy sectors and as I
was thinking back I was I went through
the SDGs and in the SDGs we were saying
34:05
well everything is linked to something
else and we got the heads of state there
and we got the ministers there and they
were kind of talking theoretically but I
think Ovid has shown like nothing else
how our fundamental health crisis like
this can have immediate economic impacts
in the short term and in the longer term
it can have immediate humanitarian
impacts immediate social impacts I think
if there are any opportunities out of
34:34
this one is I think that the minds of
the political decision makers are
absolutely seized on this issue and
while they are what is it that we can
get in terms of that change and and I'm
thinking again back to introduce
presentation it was after a crisis for
some countries but they made an active
decision to pursue the universal health
coverage path so what is it about this
crisis that can focus the minds of
policymakers on the very real and
35:06
tangible interactions here that between
health and the economy and and in
society and peace and and and also what
is it that we can do with this to really
show that some people the people who
have who have so little are the ones in
most need of support so that is the zero
dose if you like or that all the people
in the most vulnerable situations and
then you're starting to think about
gender and you're starting to think
35:39
about conflict and and fragility I think
I think thinking in terms of the short
and the long term response is is very
important here but it's also thinking
about well what are the costs of this in
the other areas so as has underfunded
low capacity health systems where there
isn't enough surveillance there aren't
enough tests there aren't enough
laboratories where health workers when
is not enough health workers
36:09
how can we how can we focus to support
those health systems and then how can we
start building out and really properly
strengthening the health systems and
properly strengthening budget
allocations in the future I think I'll
leave it there for the opening remarks
but but there were the dimensions I
wanted to come in on right thank you
thank you very much indeed Susan and I
think that you you've reflected a lots
of questions there that I very much like
us to discuss as a group now going
forward you know very much thinking
36:41
about now that we have the politicians
attention on health and you know health
coverage you know what how are we going
to use this what arguments are we going
to use before I sort of you know
specifically turn this to the panel very
much encourage you know those watching
to send in your questions and we got one
or two coming in already the time I'm
keeping an eye on but but we're very
keen to hear your perspectives from your
countries and I think you know a point
that Susan was making there you know
37:12
about the potential for using this
situation to catalyze UHC reforms in
countries and I'm sure that lots of us
are thinking you know we're are going to
be the countries that we could
potentially you know have this impact
that might have been on the verge of of
influencing UHC reforms that this is
perhaps galvanized mine encourage people
to think about these things so
particularly those of you you know
around the world who are joining who
think this might be the time now for you
37:43
actually in your country we'd love to
hear from you and you know sort of maybe
share thoughts with you about how we
could work with you um but first of all
I'd sort of like Susan put it to the
panel you know that we have been very
much promoting the idea of universal
health coverage and and we've seen every
country in the world
sign up to it at the United Nations on
numerous occasions in the last decade
but most recently last September when we
are perhaps soon of trying to get the
attention of a head of state or a
38:14
Ministry of Finance what do you think
are the key lessons that we've learnt
you know that that's
looking you know maybe reflecting on the
ODI research as well and maybe even come
to doe Anthony first on this what do we
think you know are the key lessons that
we say this generally is a strategy that
will seems to work better than others
and maybe as well what strategies don't
work when moving towards universe and in
38:46
terms of what strategies worked it it
seems to and the main I mean the main
thing is it seems to be about getting
them on sides we see a very large
portion of the countries in our data set
I think was about 45% had recently
changed governments or change leaders
and when in Prior to bring about
universal health coverage in in more
than in in a in a very large percentage
and we saw lights spread grassroots
39:18
levels you you trade unions people
marching on the streets camp people
writing to their MPs have all been shown
to be very experienced and then
unsightly laughs after pessimistic than
the other people on the on the panel the
world has lost a huge amount of money
right now economies are contracting and
that's a very difficult time to invest
in healthcare but there will be an
expansion presumably after this when the
crisis moves away and fiscal space will
39:50
open it again and not just in our
research but in the literature we've
looked at elsewhere it's that creation
of fiscal space that seems to be so
important and so to give the UK as an
example just because that's where we are
um Britain was incredibly poor in the
1940s but there was a lot of space
opening up as they were no longer
spending money on the second world war
and so in the seventies eighties
nineties countries might have been much
richer than they were in the forties but
in the forties they had all of this
money that they were spending on defense
and they could now spend it on something
40:20
else and hopefully soon but some point
in the near to medium term more likely
to have all of this money that opening
up as people go back to work as we no
longer have to pay the salaries of
people who are furloughed
as tax receipts come back in again then
and I'm hopeful absolutely just because
I'm an optimist that we can use some of
that physical spaces that is the point
at which we can channel that energy back
into healthcare alongside the arguments
that not investing in healthcare is
incredibly damaging to the medium and
40:53
the long term as we have seen in this
crisis what about other partners who
what what do you think in the in terms
of you know lessons that we've been
learning about what UHC strategies tend
to work on which which don't work I
think for us when when we're talking
with them
with finance ministers health ministers
and presidents and prime ministers I
mean you can get so different arguments
41:23
or different discussions to different
circumstances and I think that's another
another lesson here is it is so
contextual but generally the return on
investment just and we haven't talked
about primary health care here as well
but so primary health care is a very big
part of universal health coverage and it
is it is the cheapest thing that you can
do to protect the most people for a
dollar spent on vaccines you're saving
54 in terms of other health costs or
41:56
having healthy productive members of
society so it is an incredibly cheap
investment so you can talk about you can
I guess attract decision-makers to be
interested through the positive side of
this but also if we look at this I mean
the I saw some estimates about 2.7
trillion so far the costum estimate
around koban and no governments want to
be facing economic shutdown year after
42:27
year as something like this would
circulate governments do not want to be
facing this as an endemic issue in their
country so I think it is definitely in
the economic interest to be able to do
this and to be able to have decent
enough health care that you've got good
surveillance you've got good primary
health care you
got good immunization you have good
facilities you have well-funded health
workforce I think it's also in their
social interest as well and I think that
42:58
this crisis really is the most tangible
example I've seen an absolutely focusing
their attention on this Thanks the other
job there was one other point I was
going to make which is if there's
another bright light in this I'm not
completely pessimistic Anthony that one
of the things we've seen is the
extraordinary speed and goodwill at
which data is being shared across
countries to find out about this virus
to learn about it to talk about
43:31
potential treatments to talk about
getting vaccine candidates going I mean
we're working with all of manufacturers
and with w-h-o already on how can we
support vaccine development and vaccine
candidates and then what could we think
about in terms of the manufacturing side
and then for us because as Gabi we work
with low-income countries there's a big
part of the conversation on access to to
make sure that everyone gets their
access to a vaccine when it does become
44:02
available so I do think we've seen
phenomenal goodwill in data sharing so
far to face a global situation together
so I think we can build off of things
like this going forward and actually we
are learning and the discovery thing are
something that we planned
generally number one if you look at
Africa Union now they have been looking
44:32
at what they are continuing to response
to copa90 knees and have classified into
three billa's para one is preventing
transmission if you think about
preventing transmission it's a lot of
community engagement and proposed
engagement and 2% and component it's you
know you can't do it down in fact one of
the complaints that Hadi's government
attending to focus all their responses
on the Daily Brief and the government
policies rather than how to engage
communities and victim part of the day
to day hour
- our minute-to-minute response so
45:03
that's what that's one of them the next
one has been to present death which has
a lot to do with tensions and capacity
which we really haven't haven't invested
in a lot in terms of ensuring access for
everyone so that's a major brain sport
for the continent even within their
strategy and at that point the third
pillar of the strategy is preventing
harm which is more of a response and how
it affects people's livelihoods and
lifestyles so those are the three
pillars if you look at what we planned
and I will probably like to look at now
45:33
what you achieved when in fact the work
we've done or UHC we've said that
they're 16 they're six seven things that
we think are important for people to
look at and those things even more
important more relevant now one is
political leadership beyond health that
is really looking at health as a social
contract and government can now face in
that social contract now and saying we
wish we sign this contract and say what
are you doing for us we are about to die
this bridge is facing us so can you tell
46:04
us so that's the first thing that you
clamp political leadership completely
important I'm going back to under this
point it's not about the economic
abilities also political decision-making
so political leadership is critical the
second point is this is your ball no one
left behind which Anthony also reflected
on that actually and I think even
Suzanne talked about this then the issue
around ensuring they identify who are
the people left behind in a data visible
manner women and girls we already see
how they are facing the blunt of these
46:34
through gender violence we have people
who don't have access at all we should
have looked at them earlier and provided
them so she assistance including social
insurance for free that is publicly
funded so that bit about no one left
behind is also clearing in our face
right now the next thing is about
quality of care and culture cares about
if you have Germany with 40 as you bathe
a thousand heat element 7,000 ethically
wrong about one bed four thousand what
quality of care would be good to offer
47:05
if you actually had excessive capacity
requirements on the health system the
next issue is about like a regulation
and legislation we've seen price
movements in combat 19
there are beyond human comprehension on
supply chain government because we've
never really looked at the issue of
price regulation in the pharmaceutical
price regulation in commodities you know
Gandhi has worked a lot on try price
moderation and and ensuring that you
have a supply chain that's controlled we
have not been that civilian sector so
you are seeing for example basic
47:37
commodities being sold at a hundred or a
thousand times more than they were
before and this is affecting the health
system so this brings in polite they
need for legislation and the regulation
in the health sector the fifth point is
about more money we've talked about that
and also better use of the money where
do we put our money and finally how do
we move together for UHC for these
pandemic responses I am talking about
right now if you look at the impact on
education agriculture is going to be
disrupted through our food even from us
48:07
focusing on planting is gonna be
disrupted
you know transfer for commodities food
moving from one area to another code as
opposed to how to ensure food security
in country that's import from others and
how does that get disrupted so it shows
that actually help is not a health issue
it is a multi sector if you saw them as
reflected on talking about primary
health care because premier health care
is not about health care it's about what
is central it is about empowerment of
communities
48:37
so all these six points including gender
equality coming to life right now and
those are things you plant that mutual
flexed on juniper there is the pandemic
and post endemic to achieve you see as
all countries have signed up to the UN
declaration calypso as women
specifically and you know when sort of
talking to heads of states about lessons
learned on on UHC what messages might
you have for them you know around
resource allocations I mean you did you
49:08
think you know that we need to be
article PhD so as well because what are
the challenges we are having in South
Africa is ditch you know the country's
subside you dick
that even if they collect ninety percent
of their GDP they are give twenty two
percent of its debt payments this is the
time to think about as you think about
resource allocation and fiscal space how
are we going to if we are going to
49:39
another debt relief because I've
seen now the Prime Minister of Ethiopia
another rancifer that we need and we
make the debt relief conditional that we
will forgive this debt if it is going
specifically to universal coverage and
social health insurance for people
communicate coalition of over two
dollars off it that's a good question
trips are eating with our I'm usage I'm
sorry
well thank you for that oh not at all
50:10
challenging and a big disclaimer I'm not
an economist by background I'm a medic
but I think I think it's really
important to look at all these pressures
and as you've described look across not
just specifically health but look at the
other social policy sectors and also
look at the public private sector
balance and what this means for
countries as they move forward now I
think there's a natural huge need for
massive mobilization of resources well
beyond what has been talked about or
50:40
indeed committees so far we need to see
and and and some colleagues at the
Center for all of them have written
about this X IMF colleagues called for
the rule book to be effectively you know
throw it away now in terms of you know
good and bad debt in terms of credit
worthiness so that even groups such as
the IMF can come in with massive amounts
of funds even a non-concessional rates
51:13
which are still well below the high
street rates that countries could get in
order for them to be able to protect
some of these important social sectors
and that's again that forgiveness moving
moving on now is very important too and
all of these things need to pile up be
well articulated we need to find and
make up new rules for this big
bureaucratic financing institutions
there's an article by Jose the
it's today in The Guardian and he's
51:44
calling his his good taking us back to
Keynes and talks about the whole purpose
of this Bretton wood institutions why
were they said that they were set up to
help people around the world they were
not set up to help accumulate surpluses
in one part of the world and and
deficits in another this is the time to
revive that spirit to make among Griscom
commitments and yes can we make this
commitment conditional I think I think
conditionality is a difficult world word
especially in these circumstances but I
think being able to articulate the
52:17
vision or at least expect leaders
African leaders to articulate the vision
a new vision and you start this this
sort of dark times should be a
conditionality if nothing else so yes I
there I I agree with you
thank you very much Kenny sir and a
question that I'd really like to post
now you know is that what one can be
looking at things in generalities that
have globally sort of saying that we
need to move to do UHC and this is
potentially an opportunity but where the
52:47
rubber really hits the road on this will
be when specific countries nation states
make decisions good decisions to move in
this direction looking across the world
and in a way we're from different
continents and and you know with with
sort of different interests where where
does the panel see the opportunity the
real opportunities now because one fears
that there are some leaders who aren't
taking this seriously we know who they
are who are pretending it's not
happening and burying the heads in the
53:16
sand and and are very unlikely to grasp
this opportunity but there'll be those
that you think you know that maybe like
the UK and Japan and France coming out
of the second world war or prime
minister Thaksin after the Asian
financial crisis might use this moment
to really go for it so looking around
the world where do you think those
leaders might be at me looking at
specific countries because I think that
if we the UHC community can work with
stakeholders in those countries to have
53:47
those conversations with their heads of
state ministers of finance then you know
that you know that's maybe tens hundreds
of millions more people
might get access to health care coming
out of this crisis so do do we have any
top tips as to where we might be looking
and maybe to ask audience members as
well to give us your suggestions so any
thoughts on the panel well I mean death
in G and I were both involved in a
54:18
process for the last couple of years
which culminated in all of the heads of
states signing up to a document which
said we believe in universal health
coverage we think there's really good
reasons for it and we're going to move
towards it now I mean I talked about it
being contextual earlier in countries do
move towards it at a slower or faster
rate there are some bright lights out
there I think Germany Japan my country
Australia I mean there are Rwanda Ghana
54:50
there's a bunch of countries that are
really strong believers in this and
moving towards it and and not only
within their own health systems but
there's a bunch of countries that
support other countries to move towards
more primary health care or universal
health care whether it's issue specific
or more more general health system
strengthening as well so I think you
know getting he and I have sat in
meetings where we've said is this a
moment or a movement how do we create
55:21
this as part of the UHC 2030 movement
how do we create and energize this to go
forward so I mean I'll turn over to
Keith in G here had it how do you see it
because you've been at those discussions
as well I've been thinking about this so
there is an interesting exercise that
you and I should do we should actually
look at all the Canadian speeches made
55:53
by all heads of states and look for
community mentioned universal coverage
in it and I think we should start
tracking that and that would be I think
actually because I think that you know
we need to people need to see copa90
north
in isolation they need to see it as a
health system issue and we you know a
few your building it's a you know we are
not ready for the myth for the next
epidemic or the next pandemic I mean it
is true we were not ready but we didn't
take it seriously so the issue of
56:24
seriousness possibly to come down to
leadership to the g20 and need to be
talked to and I think that we have
discussed this issue we have actually
brought on board some political big big
heaters as a political adviser including
some of the elders from from your
institution and we are hoping that we
can take this message free g20 that here
it seems no longer contradiction of if
it's the commission of every country
56:56
must and there we are seeing that if you
are going to be ready for the next
pandemic that's the only way we must do
it in a while and as you say you HCM
double security as two sides of the same
coin so in this particular incident even
if the Europe and America and North
America fingers cross statute would
manage to bring down this epidemic
they will never open their boundaries
until Africa has managed it you know you
know so it's not about a country to
57:26
country issue now now it's time for
global solidarity and we need to take
that conversation to all the shining
stars but including you know the one
that Susanna talk about but more the
global active childlike g27 they need
accurate about the health issue as a
global issue and that's that and also
the UN Security they use the Security
Council needs to discuss global security
57:58
as well as long as a health issue oh
sure clip said he once came in um sorry
antony gonna go first though okay so two
quick points if I made so first of all I
was just thinking about looking at my
diary by accident looking in the past
rather than the future and I was looking
at all of the events I was involved
most of them in before Christmas had to
do with a transition and I think if
we're going to be specific as you say
58:29
Robin we ought to be beyond the sort of
the generalities and the rhetoric which
is also important I think we need to
start trying to imagine what practically
what the world will look like as you're
emerging or some countries are emerging
out of covet and I think the issue of
aid the issue of co-financing or
complete transition transitioning away
Tibbie products for instance TP drugs to
be paid for by countries or some of the
antivirals or certainly the GAVI
transition we need to rethink all of
59:01
that in the new environment first of all
looking at what the finances will look
like what the vulnerable populations
will be very different in terms of
quality and quantity and how the global
response can address that so it's not
gonna be business as usual and the
second point that blinks what you both
talked about just now is about
surveillance and governance in the post
profit world we're seeing Trump tweeting
against a Pho here in the UK the Foreign
Office or rather the foreign the Foreign
Committee which comprises
parliamentarians from different
59:32
different parties who care about foreign
affairs came out with a report calling
for a g20 group for public health and
again criticised China and to some
extent a breach or for not being
forthcoming with data still enough and I
think there is a big big risk here that
we revert back to nation-states or
blocks coming together and polarizing
the whole ecosystem global ecosystem
which is exactly the opposite of what we
need if you want to respond better to
01:00:04
see such crises in future and what comes
to mind a colleague from CJD Masuda made
raised that a few weeks ago when this
was starting that what he thought the
parallel should be drawn perhaps not
between covalent SARS
but perhaps within Corbett and 9/11 when
the most powerful countries in the world
came together and said okay aunt I'm an
auntie money laundry legislation
terrorist financing registration all
these major governance arrangements that
were introduced
which left people who wanted to send
01:00:36
money back to their families laborers
who wanted to send small amounts when
their families or indeed NGOs were
supporting very poor people across
Africa and Asia left them without bank
account's because these measures are
effectively targeting them so let's be
very careful so that we don't introduce
governance or agent surveillance
arrangements a data collection mechanism
that opportunity for for poorer
countries and then we end up building
walls and polarizing and keeping people
01:01:06
out I think that's a very big risk that
that post corporate governance era may
end up being very a very negative
development in terms of in terms of
global development if you like and you
need to caution against this all the
time because it's gonna be too late
these plans are being drafted as we
speak it's gonna be too late if you wait
until you're out of this yeah exactly
yeah I just had one small point so there
most of the countries that have this
very badly at the moment are very
high-income countries and we've already
01:01:41
seen in in Ireland where I'm from Spain
which you mentioned earlier are both
nationalized essentially the top tier of
their health care system Ireland for
years battling about it is essentially
at least in the short term created
universal health coverage in New York
they've changed the rules around cost
sharing in hospitals to make it easier
and more efficient to get care in
treating universal health coverage and I
think there's been a recognition from
governments across Europe and in some US
states that that we've got a link
healthcare system is much better to deal
with the shaft of universal health
01:02:14
coverage those arguments will be less
strong but still true in in the in in
the aftermath of kovat and I wonder to
what extent we might see in in low and
middle income countries if they are
unfortunate enough to see a spike in Co
big cases like you're up in North
America have seen to what extent they
will end up rapidly rolling out versions
of universal health coverage or linking
up health care systems to best treat the
virus and will those systems outlive the
virus or will they be temporary very
01:02:44
good question and then actually that
that takes us into I think some of the
question
we're being asked from our our audience
and so that Thank You audience for the
don't so patient with us and and I'd
like to some come to some of these
issues particularly as they relate to
low and middle income countries and we
have a number of questions around
fragile states as well sort of you know
recognizing some of these systems that
are are very weak systems and first of
all come to the a question very
patiently asked by going carlson who's a
01:03:16
master's students at Queen Margaret
University in Edinburgh and would like
to ask what point it out that yes sure
Cove in nineteen does present a window
of opportunity particularly in countries
you know coming out of conflict but how
does one deal with weak government
capacity and weak political will what's
going to be the the sort of solution I
guess and you know just to sort of pick
earth sort of a country random a big
like the Democratic Republic of Congo
01:03:49
you know very big important country in
Africa which has been hit with us of a
number of issues not least of course the
civil war
about ten years ago and coming out of
Ebola how's one really going to
capitalize on this crisis and encourage
governments like that to move much
faster to UHC any thoughts this is not
an easy question at all as I said
01:04:20
earlier fragile things a bit more
fragile and more vulnerable to covet
ninety and states that have been in war
and communities that have been in war or
in movement I didn't more vulnerable
because the it means that number one
they are more exposed because some of
the public health advice that we give
wash your hands with running water and
so social distance where mask that's not
even a possibility when you're talking
01:04:52
about some of these communities that are
will be disadvantaged by fragility so I
think that the first the first thing is
to say that it
be difficult and therefore there's no
straight answer but I think to motivate
these people is to take this opportunity
to STATS a People's Movement empowerment
of people for people to understand and
to all the response I think even when we
eat ball I was there and you talk to WH
one doctor Tedrow specifically you know
I remember a man telling me that when
01:05:23
when he went true they are Congo because
why are you here why were you not here
when time of measles and who are dying
of cholera
where have you come now you see but if
the people hold this particular response
the pandemic responder they can also own
the future investments in their in the
health sector that then protect the
McGinnis teacher pandemics and Fischer
dynamics I think that it's rod would be
enough for us from these political
leaders the people must then direct the
01:05:54
next step of accountability
holding their companies accountable that
actually are good to do this and I think
that the best way to hold accountable in
through the boots is through the
institution that it is in those
countries so this is the chance buckle
include parliamentarians in the
conversations you know that other arm of
government which is on legislation we
have had many countries you know there
were rumours in different countries that
multiple members of parliament have been
infected now this is the time to
actually make Parliament wake up and do
its work because if you just read on the
01:06:24
executive leadership it may feel us
power materials in whichever country to
take advantage of this to reform the
health legislation in each country to
direct resources into health and before
the executive to do the right thing I've
got a couple of thoughts to add in here
Gwen's question as well which is the
model for Gavi is that we don't pay we
don't work with donors to get a hundred
01:06:56
percent of the funds for the needs for
vaccines and and health system
strengthening in those countries every
country pays something towards their
vaccines so it's it's it's not right to
think that nothing is happening you find
political will in different
places you find weak capacity doesn't
necessarily equal weak political will if
I think of Central African Republic
that's weak capacity there's been
01:07:26
conflict but I can't think of a more
passionate person I've spoken to than
the Health Minister of that country when
he's talking about primary health care
issues so I think you need to look for
the opportunities that you can certainly
we work in a co-financing model with
those countries and we have pretty good
relationships
it's what kovat is going to do in terms
of the distraction capacitated all the
diversion I guess for under capacitated
01:07:58
governments is going to be really really
difficult so we're already working with
governments to say okay what
flexibilities do you need how can we
help with supply lines or how can we
help with different issues which we
think you're going to be facing in the
immediate crisis situation I think
there's a second dimension to this to
which we've hedged on in the
conversation a few times but haven't
really kind of named and that's an issue
around equity and not just equity inside
01:08:29
the country about who gets access to
what services and how frequently
services are and the quality of care but
also equity between countries as well
and if we're not careful with coffered
we're going to see some pretty we're
going to be working through some pretty
difficult times and we're already seeing
that with medical supplies and equipment
the things you talked about that earlier
but you know there's a real issue there
when a vaccine is available before it
rents up and there's a NASA who does get
access and under what sort of
01:09:01
circumstances is there access and I
think that brings me on to a third area
which is around budgets and until
government's put aside until governments
see that it is an investment not just in
health but it is a social investment it
is an investment in peace it is an
investment in the economy it is an
investment in education it is an
investment in the future and
put enough funding into budgets and
primary health care is a very small
01:09:33
proportion of budgets but until they put
a decent enough budget amount year after
year and and and build out their system
then we're going to see issues with
endemic diseases which cause the
backtracking that that Calypso was
mentioning earlier and maybe actually I
can go on to a question that's
specifically about this you know an
excellent question has been asked about
not only equitable allocation of
resources but an efficient out of
01:10:05
allocation of resources because of
obviously we've been seen through this
crisis that health systems across the
world have been tested right across the
spectrum you know from the public health
measures the preventive measures you
know that here in the UK we haven't
dealt with the testing well at all and
I'm sure you know there's going to be a
big post-mortem on that when this is
finished
but then as well get exposed lack of
capacity for inpatient services for icy
use for ventilators you know very
expensive what we might say top end
01:10:36
services now it's it's quite interesting
that's a lot of the debate and the media
fixation is on the big hospitals being
built you know the dramatic that the
ventilators you know Donald Trump was
going on about it last night do you
think there is a danger there even if we
might see big increases investment in
the health sectors that the hospital
sector and the tertiary sector are going
to capture a lot of those resources
because you know that is the type of
stuff that that sort of people in the
01:11:07
big cities look to when they're seeing
improvement to their health system so
how do we get a better more equitable
and efficient allocation of resources
going forward and and you know what's
the tactics we might employ let me give
it a go and actually I have looked at
this whole thing and I think the success
part of the success will be in tertiary
care but I think the bigger part of the
01:11:38
success is outside that I care I think I
would like to look at the
German kids for example Yemen has a very
low fatality rate I mean you look at
white people thing you have a local
territory having and the availability of
ice you bathe and we Irish you that in
the first Republic says so people CGR
Ali you probable to sit here I'll
because they don't fear about the cost
as number one that even then the testing
capacity that because there is a good
public health infrastructure be able to
test many people isolate as you wish so
01:12:09
there's a public health element there
which is significant even before you go
to because we know even for this thing
we are talking about maybe five percent
of people requiring tertiary care so if
you don't handle the eight-day 95
percent well then you end up with a five
percent of a whole linear system so we
need to look below the ice bag what we
are seeing now is there is the ice but
will it loop below the ice bag some of
the areas that I would like to think
about other than access Ali respond and
public health is lifestyle they this is
kind of a nature and I mentioned we
01:12:40
haven't looked at part of why you know
the kisses in each other we've said
majority of the minding up in moderate
and severe disease may because of of
cases of like for example smoking for
example people's you know n CDs people
how many people have non communicable
diseases you know lifestyle diseases
which goes back to be composition around
you know non communicable diseases as a
general interests as an important
element of the health system though I
01:13:12
Spock we lose the tip of the edge but
we'll find that it's actually public
health and primary care that is
significant
the other thing we must not forget is
they affect outside coverage that
actually the impact of they they they
entire population beyond the college
response itself is also going to expose
help system fragility vaccinations what
is going to happen for example to number
of kids who are vaccinated as they
should be between now and post copy and
01:13:43
we can see be crying because the health
system although the but respond to both
of it and the general needs and we will
to see increased teenage pregnancy for
example because the youth even in terms
of access to family planning
the planning was so shallow that the
coma dad gets tipped it over and now is
no longer being provided so we have a
pregnancy issue are we going to see
increasing maternal mortality because
the health system was so fragile that we
could not provide for maternal health
because we were responding for Kobe so
if we look people below the tip will
01:14:14
find it's actually a primary health
issue the parlor swats come in on that
yeah click say yeah sure yeah yes yes I
agree completely and just to reiterate
the importance of concentrating on also
clinical effectiveness as well I think
we're we're we're exporting measures
some of which will not show that working
01:14:44
well enough in high-income settings and
this emphasis on high-tech fixes I don't
think there's a high tech fix for this
the idea that we're going to build up
massively within the next few weeks I
see use across Africa and that this will
save lives the idea that we'll be able
to train people to intubate safely that
will have ECMO and dialysis is also
01:15:15
extremely problematic the idea that ICU
saves lives is also problematic in this
country it's specifically in London up
to 80% of people who go into ICU end up
dying unfortunately possess severely ill
so we do need to concentrate minds on on
where we can save the most lives and
protect the health service in every in
every system and protect nonprofit
services because people are also dying
from non-coffee things that death hasn't
stopped the death toll is continued and
so I think it's absolutely important not
01:15:48
to be driven by analysis designs in
developed nations this sort of idea
where we match ICU needs
against ICU capacity and this informs
massive procurement exercises that drive
ICU ventilators being purchased and
distributed without understanding or
even wanting
to understand how these things are going
to be deployed who is going to use them
and what does it mean in terms of
distorting other priorities locally and
he did this money that's been committed
to this kind of service what does it
01:16:21
mean in terms of potential saving lives
and of course what does it mean when
this thing ends what's the message
you're sending that we need to build
more hospitals we need to have had a lot
more ICU units around is this the
message we want people to come away with
that we're done because you haven't
built enough enough hospitals I think
that's a very problematic messaging
approach and needs to be tackled I think
both centrally in Geneva London see
Apple but also at national level
governments African leaders need to come
forward informed by evidence and say
look this is our plan that's how we're
01:16:53
going to save lives that's how we're
going to do it and tell people what
these they need in terms of commodities
rather than the other way around
I think I'm you know probably two points
just to add into these great comments
one is around making sure that we don't
have well making sure that we use this
situation in order to solidify some
issues which we know have been issues
for a while and one is around equity of
01:17:24
access what can we do in this to make
sure that everyone is as protected as
possible and and in it and Cove it is
not just a situation of or we just all
move on to covert because we don't want
to end up with these compounding
problems that can go on for years
afterwards if we completely divert
towards code and we get about the other
aspects of primary health care so it's a
matter of how do you deal with carbon
and how do you keep other services going
01:17:56
as far as possible and how do you plan
to catch up on those services how do you
plan to make sure that all of those
children in this year's cohort get their
first year vaccines and all of the
second year cohort children get their
second year vaccines how do you how do
you make sure that we we mitigate for
issues in the future that could come
from the diversion here
yeah yeah and oh here's a good question
that's just come in and honestly I
01:18:27
haven't asked this myself but it's bits
come up for one of our audience members
many countries have suspended user fees
what is the panel's view on whether
these should be reinstated post Kovich
and what can be done to influence
governments to permanently remove user
fees for the poorest thoughts on user
fees many of the kids that I've seen
have been very specific to the copied
response they have been user fees
01:19:00
removal for laboratory testing their
visa fees removal for copied the
maintained related admission grab and
remove of user fees or access to family
planning commodities more visa fees for
mothers or pregnant who need attention
for care for young children who need
pneumonia and the day before their fifth
paucity I think it needs to be looked at
as a more large-scale policy rather than
responsive to covet 19 alone and this is
the time to do it yeah so on on user
fees for COBIT and I think it's any
01:19:31
other infectious disease are incredibly
damaging because we don't have people
coming forward when they have a problem
until the problem becomes too bad and
then that infectious disease spreads and
you end up paying much greater costs
treating both the person when they're
sicker and that people they're likely to
pass it on for which is why it's really
important that we get rid of user fees
for COBIT but but also well I mean I'd
get rid of them for everything happen
happily but but also for other
infectious diseases things like
antibiotic resistance when you test
01:20:02
people to see if they have a bacterial
infection you are much more likely to
not give out an antibiotic that's not
used and I think the arguments are very
being used to reduce user fees and get
rid of them for Cova that is incredibly
applicable for all infectious disease as
and hopefully will lead to a broader
conversation about whether or not we
should be charging for health yeah yeah
and I think it's been very significant
isn't it you know that just last week
whao per tap is very strong statement
01:20:32
through the p4h initiative very much
recommend
that countries do get rid of use of fees
or basically all services and all people
as well I think sort of recognizing that
you know this idea of sort of trying to
means-test and say to some people you're
poor and you're not poor is totally
inappropriate at the moment and it does
need to be truly Universal and I think
there have been these very good examples
of countries that have come out of
crises caused by epidemics one thinks of
01:21:03
Sri Lanka in the 1930s that had a very
big malaria epidemic and that was
basically the birth of their Universal
free publicly financed health system
which i think is proving pretty robust
again to this this current epidemic so I
think just like you know you know the
panel saying really that to selectively
say that we will only make this for
kovat 19 cases is sort of illogical you
know sort of contingencies mentioned
plenty of other situations where it's
very important for people to access
01:21:34
services and of course if you suddenly
start feeling ill you don't know whether
it's coded 19 or not so you might go and
get a test you're told you know that
wasn't coded 19 and now here's a big
bill that we expect you to pay and then
there that's gonna very much discourage
people coming again perhaps one final
question from the questions that are
coming in here and I think it is one
that we need to a sort of address that's
we don't do enough in in health and I'm
sort of thinking Calypso you might have
01:22:04
sort of thoughts about this and that's
levels of waste in the health sector and
corruption as well that you know if
we're expecting government's to really
invest in health and health services you
know that is going to add for tangible
impact on people's lives it's vital and
that money's not wasted because we've
already identified public money is going
to be very scarce commodity but what are
we collectively going to do to improve
behavior and improve transparency when
01:22:35
it comes to public health spending thank
you I think I think this traditional
perhaps solution with
Thailand has done having an agency
dedicated to judging a value for money
from their local perspective of
alternative interventions this agencies
by the way also in for involved its
height up if they're also involved in
the commad response we're seeing other
countries to the Philippines India China
setting up similar institutions at
01:23:08
Africa Kenya considering it so we need
somebody who can safeguard and drive
investment decisions as this an influx
of new money so that at least there's a
defensible processes some evidence that
shows that those investments are indeed
the right ones I think that's really
terribly important and it needs to be
driven local it needs to be done locally
we have massive issues with
absorbability as you say it's not just
the rapture is a big issue at the
poorest the country the poor of the
01:23:38
country the the worse the rates of
absorbability of budget execution so
even countries like India budget
execution levels are very very low but
the DRC for instance up to 50% of the
very limited domestic resource allocated
to health doesn't get absorbed so I
don't think the answer is to say we want
more money but the answer is to have a
plan and make a case as to how the money
will actually bring about health gains
and then of course you can have
conversations also about other sectors
but right now I don't think that
01:24:09
ministers of finance trade rooms can see
that connection between spending and
then will they get from it in terms of
clear tangible outputs and we need to
make that case stronger and perhaps to
finish on a positive note call videos a
good way or an opportunity to do that
yeah I would like to add the value of
everything that it has said and add the
value of sociopaths efficient and switch
your accountability the role of people
because everyone has a boss you know I
have opposed all of you on this panel
01:24:47
have a boss and the boss of the
government is the people the people are
wanting for the demands seen and they
are the ones who can really hold them
accountable and therefore how do we
activate that force obsession and
ability by educating people on by the
advocacy by the replies
you know so that even when days and
increases you know they can go to their
local coven and say we know you had a
hundred but you only spend seventy wait
what what talked to you and this would
be important pressure on the executive
on the legislature to think about
01:25:18
reforms in the public financial
management act which is one of the
biggest you know problems position so
people power socio accountability and
social participation which is currently
being worked on would be an important
part of answering that question and I
think that they have to drop off because
I have a coil right in two minutes
thank you
early thanks good to get in G who's
fighting the u HC cause in Kenya and and
you know we we we wish you the best of
01:25:55
luck and thank you so much for for
joining is said today other panelists at
Susan did you have a point you'd like to
it to make that I mean I think calypso
and goth ng covered it well I think I'd
probably add two more pieces to it one
is accountability for governments a lot
of that rests with people with civil
society and I think that there are
plenty of civil society organizations
out there who do act as an
accountability mechanism and so I think
01:26:24
advocacy watching governments looking at
expenditure becoming well-versed in how
budgets are set what allocate of
efficiencies look like also making the
case for for more expenditure in primary
health care I think and just before we
end up there's another dimension I want
to bring in here that we haven't really
talked about and that's health workers
and I think one of the things we've seen
from Kovan is enormous support for
01:26:55
health workers my sister's a critical
care nurse so I mean I'm worried when
she goes to work I'm sure there are so
many families worried about those who
are getting exposed just because they
have a calling to do support and look
after in particular the needs of people
who are very vulnerable so I think in
this year of the health
worker it's really important to
acknowledge not only have we seen
support coming out from communities for
health workers but we've seen that there
01:27:25
are not enough and that there is an
exposure there is a danger to the work
and if we are talking about budgets it's
not just about treatments and it's not
just about high tech but it's also about
supporting health workers and community
centers and all of those places that
provide and support public health needs
yeah I can completely agree can I can I
finish with a final comment bring it
back to our research and say just
looking at the biggest here and 22 of
01:27:55
the 49 country we looked at had major
grassroots movements that proceeded and
moved to universal health care coverage
13 of them did it in the wave of
democratization and 10 of them there's
some overlap between these and 10 of
them had major pushes from trade unions
that preceded museum to universal health
coverage 'as we also find that much more
important than then the amount of money
estate has was the state's capacity and
obviously state has greater capacity
tend also to be wealthier but it was the
capacity and not the wealth the quality
01:28:26
of governments indices linked well with
governments who are able to move into
universal health coverage and so as well
as thinking just about healthcare
thinking about broader development goals
of strengthening democratization
strengthening freedom of speech
strengthening the quality of our
government and its ability to deliver
things we'll all in turn lightly greatly
improve the quality of health and
people's lives more generally at least
that's what I research suggests and
thank you very much for bringing it back
to that absolutely because I I think you
01:28:56
know you've encapsulated it very well
that when we started thinking about you
know this event and looking at the
research we hadn't anticipated we'd be
in the middle of a crisis like this you
know and now this has suddenly been
thrust upon us and I think that your
research is completely being sort of
indicated that you know that this great
crisis has flanked the the weaknesses in
the in health systems as we've
describing right across the board and
that so many of the issues are of this
universal health coverage nature and
01:29:28
and recognizes that to tackle code with
19 things have to be truly Universal
everyone has to get access to the
vaccines everyone must hear the
prevention messages and and everyone
must get an equitable access to hospital
services if they need them do I think
the UHC is absolutely essential now we
are very much coming towards the end now
and I'm not sure we going to get you
know literally timed out at half past
01:29:59
that I'd like to sort of bring our
discussions to do a conclusion who
thank the panelists but for joining in
as Susan Calypso Antonia Tingy who's had
to call off and the many helpers at ODI
to make this such a successful event
apologies for my technology problems at
the beginning that may be sound like a
Dalek
but let's I'd be delighted to be able to
to rejoin you through this process and
we look forward to fighting the calls
for UHC and just to say we at Chatham
01:30:31
House are very much interested in these
issues of the political economy of UHC
reform so any people watching and fellow
panelists if you feel that we could be
any help to you in fighting the cause
for UHC particularly promoting it to
your health ministers your ministers of
finance but also heads of state then do
please get in touch and we'll be
wielding the own ODI research as as you
know a very good example of why
countries to be moving to UHC so thank
you very much indeed all of you for
01:31:03
joining by now thank you Robert thank
you
it's