Address by the Regional Director at the regional consultation for strengthening frontline services for universal health coverage by 2030
23-25 July 2019, New Delhi, India
Your Excellency, Minister of State for Health, Maldives, Mr Mohamed Zuhair; Dr Vinod Paul, Dr David Evans, distinguished participants, experts, partners and colleagues,
Welcome to this important consultation, which comes at an equally important time.
Some of what I will say has been said by two stalwart speakers before me. Yet I need to say it, and have been saying it for some time – since 2014, in fact.
In that year, the Region committed to pursuing universal health coverage as a Flagship Priority.
The following year, in 2015, the world committed to pursuing Sustainable Development Goal 3, with UHC as its underlying theme.
In 2018, WHO Member States committed to ensuring that one billion more people globally benefit from UHC by 2024, as per WHO’s Thirteenth General Programme of Work.
We are now in 2019. Time is moving fast.
With great ambition comes great responsibility.
As you well know, UHC’s vision is bold but simple: for all people everywhere to get the health care they need, when and where they need, without financial hardship.
As a Region, we have made important gains.
Since 2010, all Member States have improved the coverage of essential services, providing much-needed access to more people than ever.
The availability of health workers has significantly improved, with their density increasing from 21.5 per 10 000 people in 2014 to 27.1 in 2017. Ten of the Region’s Member States increased their health workforce during the same period.
Moreover, unprecedented attention is now being paid to improving access to essential medicines, with growing collaboration between Member States to enhance quality.
Major inequities nevertheless remain.
Region-wide, some 800 million people still do not have full coverage of essential health services.
At least 65 million are pushed into poverty because of health spending, much of which goes on medicines.
Accelerated progress is needed.
The debate on how best to do that is where primary health care comes in.
Quality, accessible primary health care is the foundation for advancing UHC.
Well-functioning frontline services can meet the majority of a person’s health needs, whatever their age or health condition.
It was indeed heartening to see the world renew its commitment to PHC in Astana in October 2018, some forty years after the primary health care movement was launched.
It is also energizing to note that in three months’ time, at the High-Level Meeting on UHC at the UN General Assembly, primary health care will be a core part of the discussion.
Importantly, at the Assembly, the SDG GAP+ plan will be launched. As per the plan, 12 development agencies will outline how they will support countries accelerate progress on the health-related SDGs.
One of the seven ‘accelerators’ for reaching the SDGs is primary care. The political momentum for UHC – and with it PHC – is at a premium.
It is imperative we harness that momentum.
Indeed, let us be candid: Progress across Member States has been uneven. This has resulted in asymmetries in health indicators both between and within countries.
Moreover, new health problems are emerging, with the rise of noncommunicable diseases, ageing populations and urbanization.
Several Member States have meanwhile seen significant growth in the unregulated ‘commercialization’ of health.
Within this context, PHC must respond better to social change and rising expectations. It must also tackle fragmentation.
If PHC is going to be the cornerstone for advancing UHC in the Region, significant changes are needed. We cannot simply do more of the same.
That is, in large part, why this meeting is so crucial.
In coming discussions, I urge you to consider several key issues that, if effectively tackled, hold immense potential to accelerate progress, and to get us from where we are to where we need to be.
First, we must consider how frontline services can adapt to provide life-long care for the chronic and often multiple health conditions that come with ageing populations, as well as the rise in NCDs.
To accomplish that, we must think about how we can better organize, manage and pay for health services and frontline health workers.
We must also be unequivocal in asserting that increases in quality – including cleanliness and safety – coincide with increases in access.
Second, we must think about how we can address frontline and hospital services together. Achieving this outcome will increase the use of primary care and ensure people are referred to hospitals when needed, thereby decreasing overcrowding.
We must likewise get to grips with how best to engage the private sector. In some of the Region’s Member States over half of OPD consultations are with private providers. This presents the double challenge of protecting people against financial exploitation and poor-quality services, while harnessing the sector’s extensive assets.
Third, we must consider fresh approaches to community engagement. The rapid increase in access to information via digital technologies means individuals and communities are increasingly well-informed on the health issues that affect them and their communities. Wherever possible, these new technologies should be leveraged to maximum effect.
And fourth, we must always reflect on how best we can measure results and enhance accountability. This may involve making information on health care entitlements and health systems’ performance more public, including information about those being left behind.
As you engage in coming deliberations, I urge you to keep that point in mind.
No one – and I repeat no one – can be left behind if we are to keep to our commitments.
On that note, I am certain that together you will define the path forward and ensure that frontline services are better positioned to meet the health needs of all people everywhere in our Region – today, tomorrow, and well into the future.
I wish you a successful consultation and look forward to being apprised of its outcomes.