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The Blended Financing Road to UHC Must Go Through the Community

This blog post was written by Katey Linskey of Last Mile Health, co-written by Living Goods. Living Goods empower people to improve the health of their families, friends and communities. They are a 2018 Global Health Council member.

The 71st World Health Assembly (WHA) was Dr. Tedros Ghebreyesus’ first as the Director General of the World Health Organization. As expected, expectations were high, and the conversation around the World Health Organization’s (WHO) main theme—Universal Health Coverage (UHC)—was serious and solution-driven. Though there were meaningful discussions on achieving, financing, and optimizing UHC, questions on how to effectively finance UHC lingered. The discussion of financing UHC is a difficult one—it requires diverse thinking, nuanced planning, and blended visions. In an attempt to tackle this, the Center for Global Health and Diplomacy, Johnson and Johnson, Last Mile Health, and Living Goods joined forces to bring a group of amazing leaders who are tackling the difficult discussion around getting to UHC with a particular focus on community health.

The event opened with remarks from the Honorable Wilhelmina Jallah, the Liberian Minister of Health, who acknowledged the importance of national community health worker systems, a sentiment echoed by others including the Honorable Minister of Rwanda Dr. Diane Gashumba and Honorable Minister Dr. Jane Ruth Aceng of Uganda. In Liberia, the National Community Health Assistant Program has now scaled to over 70 percent of the country. Minister Jallah made it clear that this progress was made possible by partnerships, including hard work from the Ministry of Health; donor alignment among the US Agency for International Development (USAID), UNICEF, and the World Bank; and concentrated technical assistance by nongovernmental organizations, such as Last Mile Health, the Clinton Health Access Initiative, and the International Rescue Committee. Building off strong partnership with governments across the continent, Dr. Angela Gichaga, CEO of the Financing Alliance for Health, highlighted her organization’s success in supporting countries to build costed investment plans for their national community health workers programs. Dr. Gichaga also stressed that using this costing method to build financial roadmaps could lead to increased investment and aligned funding to the programs.

Innovative programs like the Financing Alliance for Health do not operate in a silo, but rather leverage the major donors in the space. As Deputy Assistant Administrator for USAID Bureau of Global Health Dr. Alma Crumm-Golden noted, USAID has worked with community health workers (CHWs) for 45 years and the agency remains committed to supporting governments in growing national community health programs. As a paediatrician, Dr. Crumm-Golden has seen the difference CHWs can make in ensuring access to Integrated Community Case Management services, a strategy utilizing community health workers to identify and treat common childhood illnesses, and extending primary healthcare services to children in remote “last mile” areas.

We know the national community health plans will not work without a financing plan. Mariam Claeson of the Global Financing Facility at the World Bank shared how they are supporting countries in developing investment cases that prioritize reproductive, maternal, child, and adolescent health services. These investment cases help the private sector support the government plans by providing clear investment priorities that are aligned to national strategies.  Joanne Manrique, President of the Center for Global Health and Diplomacy (GHD) who has been leading the efforts to work with investment firms over the past six years to address health and development challenges across the globe introduced Mr. Gerhard Pries, CEO and Managing Partner, Sarona Asset Management who spoke about the role blended financing can play in developing sustainable interventions. In addition, he addressed the lingering misconceptions and prejudices between the different sectors. He also spoke of the eagerness of the private equity firms to work with governments in providing financing solutions to address global health challenges. The evening closed with Dr. John Nkengasong of the African Centers for Disease and Control (CDC), who had just returned from the DRC where he was working on containing the current Ebola outbreak. He acknowledged the various CHW programs across the continent that have not only been utilized to respond to crises like Ebola in West and Central Africa but also in providing day-to-day primary healthcare services that build and strengthen resilient health systems at the community level.

If we are to truly “make the last mile the first mile”, the global community needs to leverage the momentum from events like these at the World Health Assembly and drive true partnership for change. We recommend the following:

1) Governments must be empowered and supported by donors and NGO partners with donor funding cycles aligned to national strategies and timelines and tailored technical assistance to develop, implement, and manage national community health programs.
2) National community health programs must have cost investment cases and financing roadmaps to ensure sustainability.
3) The private sector and major donors must have access to data to strengthen government relationships necessary to prioritize community health programs.

The Center for Global Health and Diplomacy, Johnson and Johnson, Last Mile Health, and Living Goods extend their thanks to all the speakers and attendees of “The Role of Blended Financing in Providing Sustainable Solutions for Community Health Programs” and look forward to moving from conversation to action in order to ensure that every community has access to the quality care they deserve.

5 Reminders for the G7 Towards a Secure and Sustainable World

This blog was originally posted on Global Health NOW. This guest post is written by Sulzhan Bali (@sulzhan), an independent international development consultant specializing in global health, Roopa Dhatt (@RoopaDhatt), the co-founder of Women in Global Health, and Ann Keeling (@annvkeeling), a Senior Fellow at Women in Global Health, and the founder of NCD Alliance. The views in this article are the authors’ alone and do not represent the views of the organizations with whom they work.

Fairmont Le Manoir Richelieu in La Malbaie, Quebec, Canada, where world leaders gathering for this weekend’s G7 summit will stay. Daniel Slim/AFP/Getty Images

When the G7 and heads of intergovernmental organizations come together today in the beautiful Charlevoix region of Quebec, there will be one goal in everyone’s mind: Build a more sustainable, equitable and secure world.

Canada’s Prime Minister, Justin Trudeau, has outlined the priorities of the G7 (including Canada, France, Germany, Italy, Japan, UK, USA) meeting: investing in growth that works for everyone, preparing for jobs of the future, advancing gender equality and women’s empowerment, working together on climate change, oceans and clean energy, and building a more peaceful world. Advancing women’s empowerment and gender equality in itself has a domino effect on enhancing global prosperity and security.

Here are our 5 key areas that we hope the G7 leaders will keep in mind as they deliberate:

1) Investing in women entrepreneurs is essential to boost global economic growth: As the G7 heads of state discuss ways to boost economic growth, we hope that they remember why investing in women is “smart investment.” Multiple reports have demonstrated that gender equality pays major dividends when it comes to economic development. Furthermore, women are known to invest twice as much into their communities and families. Apart from representing 50% of world’s consumers, women entrepreneurs are growing at a remarkable pace—out of necessity, in some countries, due to the lack of opportunities in the formal sector. In Nigeria, for example, 41% of entrepreneurs are women, most of them in the informal sector. While women entrepreneurs are rising at a remarkable pace, their growing participation brings with it an opportunity to scale-up wealth creation, job creation, private sector development, and a reduction in gender inequality. However, gendered barriers such as access to funding and uneven distribution of family work remain major obstacles preventing women from achieving their true potential in boosting economic growth.

2) When the gender pay gap closes, the world benefits; it is smart economics: We are excited to see the advent of Gender Equality Advisory Council for Canada’s G7 Presidency. We hope the G7 will take endorse and work to implement the Council’s recommendations to “Make gender inequality history.” Particularly, as the G7 discuss gender aspects of building a secure and sustainable world, we hope they discuss the issue of gender pay gaps and gender parity in senior leadership across sectors. As per a recent World Bank report, gender inequality in earnings per capita could lead to a loss of $23,620 per person globally. According to the report, gender equality in earnings and closing of the gender pay gap could add $160 trillion to the global economy.

3) The rationale for gender parity when preparing for jobs for the future is strong:  The future of human capital has strong gender dimensions, and tapping into the female talent pool is a promising area as we prepare for the future. In fact, women’s rising labor force and economic power as consumers will be key drivers of change across sectors. There is both a moral imperative and an economic case to engage more women in formal workforce at all levels. Even as the number of women in health and the STEM (Sciences, Engineering, Technology, and Management) fields is increasing, we are not seeing the same growth reflected in senior positions. In fact, women are among the most under-utilized human capital resources, untapped or wasted due to lack of career advancement. Reports suggest that while women are more educated than men on average, their chance of acquiring leadership positions is 28% to that of men. As the G7 countries discuss preparing human capital for the future, we hope the discussions will yield solutions on how the world can better leverage female human capital.

4) Leveraging women as drivers of change for inclusive disaster risk reduction and climate change adaptation:  When it comes to inequality, climate change and disasters are gendered vulnerabilities. While women constitute a majority of the world’s poor, they are also more reliant on informal trade, and natural resources for their livelihoods—hence, they are at a greater risk to the effects of both climate change and disasters. Further, more traditional roles as caregivers and socio-political-gender norms can often increase their vulnerability and coping capacity to health emergencies and disasters respectively. Internal displacement and external migration due to conflict, climate change, or disasters also renders women vulnerable to gender-based violence. However, as 50% of the global population, women can also serve as change-makers and leaders in climate change adaptation and resilience to health emergencies. In 2018, we hope G7 countries will take into account not just women’s needs and priorities in the anthropogenic era; but also, how to leverage the human capital, knowledge, and resources of women to enhance climate change adaptation.  While there is a need for gender-sensitive indicators, sex-disaggregated data, and policies that reduce inequality in access to resources in response to disasters and emergencies; there is also a need to implement capacity-building measures for women to enhance climate change adaptation.

5) The SDG road for health leads to universal health coverage, and women will deliver it:  Any talk on health for all needs to take into account the key role of women health workers in providing care to over 5 billion people. To achieve the Sustainable Development Goal for health, over 40 million new health care jobs will be needed by 2030. Investment in SDGs, especially with respect to universal health coverage, will require attention to women in the health workforce. We hope the G7 countries will take into account the crucial role women play at the frontline of healthcare, and work to ensure gender parity in compensation and leadership at all levels.

Needless to say, our success in building a prosperous, secure, sustainable, and equitable world will depend a lot on our investments in women and by women through promoting gender equality.

 

 

#CivilSocietySpeaks Up at WHA71
This blog post was written by Elizabeth Kohlway, Senior Manager, External Affairs & Operations, Global Health Council

CALL TO ACTION
“I urge you to go with a renewed determination to work every day for the health of your people. Don’t accept the status quo. Don’t believe that some problems can never be resolved. Choose to believe instead that it’s within your power to make real, lasting change”

—Dr. Tedros Adhanom, Director general of the World Health Organization, in his closing speech to the Seventy-first World Health Assembly (WHA71)

And That’s a Wrap! 

Diversity in DelegationGlobal Health Council (GHC) made a splash at WHA71 this year (May 21 – 26) with a robust delegation of nearly 100 members. Our delegates came from more than 18 countries and represented female and youth leaders in the field. Throughout the week, they shared their collective work with WHO and national governments from around the world. <Check out this infographic>
Civil Society Speaks UpThe GHC delegation submitted 15 statements to the WHA, most of which were read on the committee room floors. Agenda items addressed by our delegation include: WHO’s 13th General Programme of Work, access to medicines, comprehensive mental health, polio transition, and more. <Read the statements>
High-profile Speakers & ParticipantsOur 4 public partner events(shout-out to all of our wonderful co-hosts!) welcomed Dr. Tedros Adhanom, U.S. Health and Human Services (HHS) Secretary Alex Azar, HHS Assistant Secretary Brett Giroir, Uganda’s Minister of Health Jane Aceng, Patient Advocate Kwanele Asante, and South African Singer and Songwriter Yvonne Chaka Chaka, among other esteemed guests.<Read/view a recap of our events below>

On Twitter: Thank you for amplifying our collective voice during WHA71! GHC earned on average 21.2 K impressions per day during the week (more than 2.5X our normal daily average!). Moreover, our delegation hashtag, #CivilSocietySpeaks, generated approximately 1.9 million impressions. <Share our Twitter moment #CivilSocietySpeaks Up at #WHA71>

Our Partner Side-Events

Getting Local with Global Health Security: A Pathway Towards Sustainable Action

Watch the event recording: www.tinyurl.com/GettingLocalGHSLive
Post-event Blogs/Articles:
1) “Local Participation is the Key to Success in Global Health Security” by Ashley Arabasadi, Policy Advisor at Management Sciences for Health
2)“‘Two Sides of the Same Coin’: Can a Health Systems Lens Inform Health Security Efforts?” by Taylor Williamson, Manager, Health Systems at RTI International
3) “Global Health Security: Take Action to ‘Close the Gaps‘” by Jo Anne Bennett, GHC WHA Delegate
4) “The Local Path to Global Health Security” by Brian Simpson, Editor-in-Chief at Global Health NOW.

Taking Civil Society Engagement to New Heights to Advance WHO’s 13thGeneral Programme of Work and Achieve the Triple Billion Targets
1) The emerging recommendations of the WHO-CSO Task Team have been published online and are open for feedback. We encourage you to share this link with your networks and to submit your own feedback by Friday, June 8.
2) Post-event Blogs/Articles: A New Era of Partnership at WHO” by Kate Dodson, Vice President, Global Health Strategy at the United Nations Foundation and Loyce Pace, President and Executive Director at Global Health Council 

From the Ground Up: NCDs, TB, and Resilient Health Systems
Post-event Blogs/Articles: Tuberculosis and NCDs Jostle for Space in the Global Health Agenda” by Vince Chadwick, Correspondent at Devex

 Diverse Pathways and Partnerships to Universal Health Coverage
Watch the event recording: www.tinyurl.com/DiversePathwaystoUHCLive
Post-event Blogs/Articles:
1) “You Can’t Have Universal Health Coverage Without the Community” by Rita Bulusu, Deputy Director, Community Health Strengthening Team at Living Goods
2) “Universal Health Coverage: ‘More Than Just An Aspiration’ by Jo Anne Bennett, GHC WHA Delegate
3) “Alex Azars’ Excellent UHC Adventure” by Brian Simpson, Editor-in-Chief at Global Health NOW

And More!

1) “The GPW: Making the Impossible Work of the World Health Organization Possible“: GHC WHA delegate Elizabeth Montgomery Collins elaborates on how the 13th General Programme of Work (GPW 13) for 2019–2023 was received and promoted during WHA71.

2) “The 71st World Health Assembly: A New Vibe in Global Health“: Ambassador John E. Lange, Senior Fellow for Global Health Diplomacy at the United Nations Foundation suggests there was a new vibe to WHA this year.

3) “Long Story Short #16: Inside the World Health Assembly“: GHC President and Executive Director Loyce Pace sits down with Devex reporters to discuss hot topics at WHA71, including civil society’s new role, the journey toward universal health coverage, and Ebola response.

4) “Kwanele Asante: ‘It’s Our Lives That Are At Stake’“: Patient advocate and GHC delegate Kwanele Asante shares how to be an NCD champion at WHA71 with Global Health Now. Watch the interview.

5) Women in Global Health’s Blog shares takeaways from their WHA71 activities, which aimed to advance the dialogue on gender equality and women’s leadership in global health.

THANK YOU!
We could not have had such a robust presence at WHA71 without your support.
Help us amplify the voice of the global health community today:
www.globalhealth.org/amplify

 

Global Health Security: Take Action to ‘Close the Gaps’

This event summary on GHC’s WHA71 side event, Getting Local with Global Health Security: A Path Toward Sustainable Action, was written by GHC member and WHA delegate Jo Anne Bennett. 

Speakers at this opening-day session characterized the key to health security in terms of addressing health systems’ endemic problems: absent or insufficient frontline health workers, inefficient supply chains, and poor data systems. In other words, the foundation for preventing epidemics is a well-functioning health system ‘on the ground’ in communities.

A point repeatedly made was the need to get past identifying system weaknesses and take action to ‘close the gaps.’ A common theme was prioritization, specifically the challenge of prioritizing in the context of competing priorities and prioritizing according to available means. Rwanda’s health minister framed this challenge as stepwise moving toward Universal Health Coverage: focusing in communities ‘because that’s where problems are and that’s where solutions must be.’ Community action plans start with a large list of priorities that becomes shorter as actions are taken.

Former CDC Director Tom Frieden addresses a packed room for a WHA71 side event on global health security.

Tom Frieden, President and Chief Executive Officer of Resolve to Save Lives and former Director of the Centers for Disease Control and Prevention (CDC), explained how countries participating in the Global Health Security Agenda can use Joint External Evaluations (JEEs) to help clarify priorities related to core capacities. The few JEEs conducted thus far provide a good news/bad news story: The good news is that progress is possible: countries have improved along some criteria that have not been fully achieved. The bad news is that for some criteria no countries have progressed and some countries show no progress on any criteria. Frieden said the disappointing results called for analysis and action.

Keynote speaker Peter Sands, Executive Director of The Global Fund, took up the call for analysis of the underlying weaknesses. Smart investing, he said, rests on the “right analysis,” i.e., analysis that turns knowledge about gaps to costed action plans.  He provided the business case for investing in prevention rather than preparing for response. Using MERS and Zika as examples, he described how the staggering local and worldwide economic impacts of even relatively small epidemics reach far beyond the affected region(s).  Smart investing looks at activities that can achieve dual outcomes, not just emergency preparedness.  He pointed to the Global Fund as an example of recognizing the links across programmatic silos. Similarly, basic public health activities can be leveraged to strengthen core health security capacity.

Chief Executive Officer at Foundation for Innovative New Diagnostics (FIND) Catharina Boehme’s remarks lent further support to prioritizing prevention over response: the reality is that there is no quick scale-up for diagnostics and no diagnostics are available for six of the nine diseases prioritized by WHO.

Dr. Rüdiger Krech, Director of the Department of Ethics and Social Determinants of Health at the World Health Organization (WHO), reflected on the importance of country ownership and political will.  National leadership provides the system-wide view to ensure that all parts of the whole are being addressed. The JEEs simply expose weaknesses.  Everyone needs to understand the implications of just one case.

Universal Health Coverage: ‘More Than Just An Aspiration’

This event summary on GHC’s WHA71 side event, Diverse Pathways and Partnerships to Universal Health Coverage, was written by GHC member and WHA delegate Jo Anne Bennett. 

GHC delegate and NCD patient advocate Kwanele Asante shares her unique perspective on pathways to UHC.

“More than just an aspiration” was the opening and consistent theme of this session. Global Health Council (GHC) President and Executive Director Loyce Pace invited discussion on ‘really finding how to chart pathways to achieving universal health’ and speakers all emphasized the axiom that ‘one size does not fit all’ and success would be achieved, could only be achieved, through multiple approaches –i.e.,” country-driven pathways.” The commonality underscored by all speakers was that efforts needed to be patient-centered/patient-driven, with concrete, system-focused capacity building at the community level. Such effort depends on political commitment, but patient advocate Kwanele Asante Shongwe from South Africa pointedly emphasized that political commitment is not sufficient: “Patients aren’t looking for political commitment,” she said, ”they need real change.” She noted that commitments needed concrete timeframes that address both global and within-country disparities and service quality as well as access. Subsequent speakers echoed her points.  Dr. Mariam Claeson , Director of the Global Financing Facility reminded us that universal health care is not the goal, but rather the means to the goal of health and well-being.

There was little agreement with the view presented by U.S. Secretary for Health & Human Services Alex Azar that a system based on market forces most effectively allows patient choice. Acknowledging that each country should choose its own approach, he maintained that the market approach, accompanied by price transparency, allows patient-choice to reflect assessment of service value. He pointed to effective U.S. global initiatives that helped strengthen system capacity, such as PEPFAR and PMI. Unfortunately, he had to rush to another engagement and did not have the opportunity to hear the panel’s diverse insights.

Uganda’s Minister of Health Dr. Jane Aceng, in her keynote, described user fees as a barrier to accessing available services and thus a hindrance to equitable access. Uganda eliminated user fees in 2001, replaced by diverse insurance schemes: social, commercial and community. Its current 10-year financing strategy (2016-2025) addresses quality as well as access by “steering resources in the right direction” through results-based financing. Health extensions workers are paid and work in village-based teams.

Barbara Stilwell, Senior Director of Health Workforce Solutions at IntraHealth, agreed with panel moderator Harvard University professor Ashish Jha’s statement that the two overarching challenges for an effective model are financing and delivery and pointed out that human resources for health is the second biggest bill for any minister. She described three ways IntraHealth has tried to innovate: Electronic systems allow better resource management by tracking location, age/seniority, and skill-level of workers throughout the sector. Locally-driven public-private partnerships can facilitate funding that incentivizes a worker pipeline to specific areas of need by offering decent working conditions, pay, and retirement benefits. 

Kenneth Mugumya, Director Government Relations and Advocacy at Living Goods also emphasized the importance of data to track financing, human resources, and quality of care.  He described how “mini-doc” in smartphones facilitated the latter by providing technology-driven supportive supervision, continuing education and guidance to standardize daily routines, and a dashboard of managerial data.

Dr. Angela Gichage, the CEO of Financing Alliance for Health, pointed out the dual interest of both the Minister of Health and Minister of Finance in avoiding fragmented financing: integrating services adds value. She spoke to the importance of accessing concession funds for community health. The issue of fragmentation was echoed by other panelists who emphasized the need for system solutions. Stillwell, for example, pointed to barriers that kept frontline workers from using all their skills or working ‘at the top of their license.’

Dr. Claeson underscored that bringing initiatives to scale required realistic timeframes for reaching outcomes and thus “process-for-impact” metrics that allow practical year-by-year tracking of progress.  While Dr. Jha noted an underlying theme regarding digital solutions, Dr. Claeson also pointed out the need to distinguish the simple and complicated processes where digital support is useful from the more complex issues requiring judgment and ‘just-in-time’ decision making.

The consensus among panelists and in attendees’ comments was that Universal Health Coverage will be a journey, more than a destination, and that while there is no unique solution, public financing is needed along the way.