UHC HERE THERE EVERYWHERE NATIONAL MULTILATERAL AND BILATERAL

UHC HERE, THERE, EVERYWHERE NATIONAL, MULTILATERAL AND BILATERAL RESPONSES TO A GLOBAL DEVELOPMENT CHALLENGE

UNIVERSAL HEALTH COVERAGE IS A KEY TO ATTAINING THE SUSTAINABLE DEVELOPMENT GOALS, UHC MEANS BREAKING DOWN SYSTEMIC BARRIERS WHETHER OF COST, ACCEPTABILITY, QUALITY OR SUFFICIENCY SO THAT EVERYONE, EVERYWHERE CAN ACCESS QUALITY HEALTH SERVICES WITHOUT SUFFERING FINANCIAL HARDSHIP ROLE OF FINANCING INSTITUTIONS IN CHANGING THE TRAJECTORY OF DISEASES AND EPIDEMICS, REDUCING POVERTY AND HEALTH RISKS IN LOW-INCOME COUNTRIES IDENTIFIED AT THE UN IN SEPTEMBER 2015

ROBERT THOMSON formerly of the Swiss Agency for Development and Cooperation now at the Global Fund to fight AIDS, Tuberculosis and Malaria Universal Health Coverage Conference Khartoum, Sudan Sunday 22 to Tuesday 24 January 2017

SWISS AGENCY FOR DEVELOPMENT AND COOPERATION (SDC) ENGAGEMENT IN HEALTH In its “Health Foreign Policy” (2012), Switzerland emphasizes the role of good governance in mobilizing, allocating and using resources for health while highlighting negative as well as positive impacts of globalization on health as a global public good SDC has three priority areas: https: //www. shareweb. ch/site/Health 1) Strengthening of health systems 2) Combating communicable and noncommunicable diseases 3) Improving sexual, reproductive, maternal, neonatal, child and youth health and safeguarding the associated universal human rights ▪ Contribution of public health innovation and research and development for NTDs ▪ Active in low and middle-income countries (in both stable and fragile contexts) and in transition countries

HUMAN RIGHTS THAT DEPEND ON ACCESS TO MATERIAL RESOURCES ARE DIFFICULT TO ACHIEVE IN THE FACE OF ECONOMIC DISPARITIES. FLAWED (FINANCIAL) SYSTEMS CONTRIBUTE TO THE FAILURE TO ACHIEVE HUMAN RIGHTS (TO HEALTH SERVICES) FOR WHOLE POPULATIONS POLITICS, POWER, POVERTY AND GLOBAL HEALTH: SYSTEMS AND FRAMES INTERNATIONAL JOURNAL OF HEALTH POLICY AND MANAGEMENT, 2016, 5(10), 599– 604 SOLOMON BENATAR

BASIS FOR SDC ENGAGEMENT ON SDGS ON HEALTH ▪ Health is a global public good, directly linked to socioeconomic status and quality of the environment ▪ The poorest people have least access to accurate information and adequate health care, their precarity often makes it hard to live healthily ▪ Underlying determinants of health such as access to water, education, and gender equality must be addressed ▪ For sustainable health development to become a reality, then social, cultural, economic, environmental and political factors, with the human rights associated with them, must be considered, including by health sector decision-makers ▪ The right to the highest attainable standard of health must be considered by the decision-makers in other sectors

P 4 H COLLABORATION TO ADVANCE UHC ▪ Global network (WHO, WB, ILO, African and Asian Development Banks, France, Germany, the USA, Spain, Switzerland) ▪ Collaborating for sustainability: to develop and implement strategies for equitable health financing and social health protection ▪ Coordinated technical assistance, strategic support to countries (reform options, facilitation, national dialogue, alignment of domestic and external financing), capacity building (e. g. leadership skills for UHC) and a wealth of knowledge resources http: //health. bmz. de/what_we_do/Universal-Health-Coverage/Towards_Universal_Coverage_in_the_majority_world/

FOCUS ON ALTERING STRUCTURES AND FUNCTIONS OF SYSTEMS IN ORDER TO OVERCOME STRUCTURAL ABUSES OF HUMAN RIGHTS … RECOGNIZING THE MORAL AND LEGAL IMPORTANCE OF INDIVIDUAL RESPONSIBILITY INT J HEALTH SERV. 2009; 39(1): 139 -59. HUMAN RIGHTS ABUSES: TOWARD BALANCING TWO PERSPECTIVES. BENATAR SR, DOYAL L

THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS AND MALARIA WORKS FOR UHC ▪ expanding access to essential health services, with a strong focus on and specific goals related to diseases (HIV, TB, and malaria) ▪ building resilient and sustainable systems for health ▪ promoting and protecting human rights and gender equality ▪ across sectors with a focus on the person, not just on the diseases ▪ through an e-Marketplace platform for ordering and procurement of health supplies in a reliable way at reduced cost ▪ with a new framework to better reflect a country’s capacity for domestic investment in health – beyond just Gross National Income per capita ▪ in partnership through the Equitable Access Initiative: WHO, the World Bank, Gavi, UNAIDS, UNICEF, UNDP, UNFPA, UNITAID

INCLUDE AIDS, TUBERCULOSIS AND MALARIA IN UHC STRATEGIES AND FINANCING ▪ Integrate AIDS, TB and Malaria in national health services and health insurance programmes ▪ Reinforce relationship between funding disease control and overall systems improvement ▪ Ensure national health insurance coverage is affordable to those affected by the diseases

OTHER ACTORS ENGAGED FOR UHC ▪ Private business sector through financial investment in the overall health system ▪ Religious institutions providing service delivery often to the very poor ▪ State and non-state (mixed) institutions using public /private models of governance ▪ Academic and professional bodies maintaining norms and standards ▪ World Health Organization through Executive Board Resolution EB/138 R 5 http: //apps. who. int/gb/ebwha/pdf_files/EB 138 -REC 1/B 138_REC 1 -en. pdf#page=17

GLOBAL HEALTH FEARLESSLY EXPLAINED (TO TAXPAYERS) ▪ The health gap between rich and poor continues to widen. This is not just unfair, but dangerous ▪ In many parts of the world, progress achieved in public health is being reversed. This is a waste of resources and of the potential created by MDGs ▪ Emerging diseases that are not prevented, contained or treated don’t stop at national borders ▪ Legal basis in place (International Health Regulations 2005) Step 1 See what’s happening Step 2 Assess the risks Step 3 Act on everyone’s behalf

IS ANYONE AGAINST UHC? ▪ Could anyone possibly be AGAINST health for all? ▪ Are there unintended consequences of good ideas… Global Health Security Agenda ▪ If protecting high-income countries against public health threats coming from elsewhere prioritizes global health according to the origin of infections, then resource allocation and health coverage may become less universal

SWITZERLAND SEEN BY WHO AND OECD ▪ A system more expensive / less accessible in some cantons than others ▪ People are generally satisfied (except with oral health care) though 3% deny themselves treatment because of cost ▪ High risks of noncommunicable disease (and from climate change) but nobody wants to be told what to do by the government ▪ Coordination (e. g. transmission of patient data, medical tests) within and between care levels could be much improved and shifted downwards https: //www. bag. admin. ch/bag/en/home/themen/internationalebeziehungen/internationale-gesundheitsthemen/comparaisonsanalyses-systemes-sante. html

SWITZERLAND SEEN BY WHO AND OECD (2) ▪ Needs a forward looking plan on training, recruitment and deployment of health professionals ▪ Little information available on health inequities ▪ Limited information on health service quality ▪ Health system is not well equipped for the challenges ahead (ageing of the population)

HEALTH PERCEPTIONS IN SUDAN ▪ Generally, a fragile health system though increasing prioritisation of public health and global health ▪ High risks of disease, floods and drought, low access to drinking water, and poor sanitation -> increase vulnerability ▪ Significant urban/rural, regional, gender and socioeconomic disparities alongside commitment to strengthen equity for universal health coverage ▪ Ongoing needs: protection of internally displaced persons, humanitarian aid in Darfur and South Kordofan https: //www. unicef. org/sudan/health. html

EVIDENCE: A COMMON NECESSITY FOR SDG & UHC* * UHC defined in terms of access to, receipt of essential interventions, and financial risk protection, measured using reliable, ethically gathered data from everywhere • What gets measured is (presumably) done. Learning from MDGs > focus on a small number of indicators for reporting trends in intervention coverage (Countdown) • UHC tracer coverage – promotion and prevention / treatment and care and SDG data missing at national level can sometimes be found in community-led and peer outreach programmes who have the trust of their communities and know who those populations are, where they are, and how best to reach them with services • Following slides from the WHO Bulletin (best accessed online) show at a glance that there is plenty of evidence to show that subnational geographical disparities in health care coverage exist, but that such inequality can be addressed http: //journals. plos. org/plosmedicine/article? id=10. 1371/journal. pmed. 1001728

NATIONAL COMPOSITE COVERAGE INDEX • • • Demand for family planning satisfied Antenatal care (1 + visit with skilled provider) Skilled birth attendance BCG vaccine DTP vaccine (3 doses) Measles vaccine Oral rehydration therapy Care-seeking for suspected pneumonia Composite coverage index (CCI) Co-coverage 6+ interventions ▪ High inequalities ▪ Intermediate ▪ Low ▪ Estimated percentage coverage ▪ Q 1 (poorest) Q 2 Q 3 Q 4 Q 5 (richest)

NATIONAL COMPOSITE COVERAGE INDEX ▪ High inequalities: Nigeria, Cameroon, Madagascar ▪ Intermediate inequalities: Haiti, Benin, Congo ▪ Low inequalities: Honduras, Jordan, Dominican Republic

PROGRESS CAN BE MADE IN THE HEALTH OF WHOLE POPULATIONS GLOBALLY BY MAKING SOME CHANGES TO HOW THE GLOBAL POLITICAL ECONOMY OPERATES, BY PROMOTION OF MORE SUSTAINABLE CONSUMPTION PATTERNS, MODIFYING RESOURCE DISTRIBUTIVE MECHANISMS AND WITH NEW CONCEPTIONS OF CO-OPERATIVE POWER POLITICS, POWER, POVERTY AND GLOBAL HEALTH: SYSTEMS AND FRAMES INTERNATIONAL JOURNAL OF HEALTH POLICY AND MANAGEMENT, 2016, 5(10), 599– 604 SOLOMON BENATAR

FROM EVIDENCE TO DECISION-MAKING • National programmes might invest more time and resources in community-based approaches to quality data collection, disaggregated to reveal age, socioeconomic status, geographical and sex differences • Analysis and aggregation nationally will help set meaningful targets — rather than having targets based on models devised in Geneva, London or Washington https: //megdavisconsulting. com/2017/01/04/in-2017 -set-global-health-targets-from-the-ground-up/

UNIVERSAL HEALTH COVERAGE CAN BE ATTAINED WITH A PLAN FOR > GLOBAL HEALTH SECURITY GLOBAL HEALTH SOLIDARITY GLOBAL HEALTH SUSTAINABILITY HTTP: //WWW. WHO. INT/BULLETIN/VOLUMES/94/12/16 -171488. PDF? UA=1

NATURE COVERS SUDAN WITH BEAUTY Let us work together to cover everyone, everywhere with good health Thank You v_20160120