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In advancing global health advocacy, consistency and tangible messaging are at the core

This blog post was written by GHLS18 attendee Samya Stumo, who works as a (remote) research consultant for the Health Systems Research team at the Barcelona Institute for Global Health and is a recent MSc graduate from the University of Copenhagen School of Global Health. She is engaged in research and writing on topics of health systems, health equity, patient experience, and people-centered approaches to health. Twitter: @samyastumo

The Global Health Landscape Symposium: Revitalizing the Global Health Advocacy Agenda (#GHLS18) was a moment as well as a meeting: to gather leaders in global health policy, programming, education, implementation, and beyond. On November 30, nearly 200 attendees from 110 organizations came together in Washington, DC to engage with the state of global health from a distinctly intersectoral perspective. The 2018 Symposium is an annual year-end event, and is part of GHC’s global health leadership series.

Photo credit: Yasmin Cupala

After initial introductions from GHC Board Chair Kate Dodson (UN Foundation), the day was begun by opening the floor to jump-start the conversation with commentary by attendees. Despite panel moderator Raj Kumar of Devex launching into this discussion at 9:00 AM (on a Friday morning!), participants all over the room stood up to contribute ideas about the global health concerns, priorities, goals, achievements, positioning, and perspectives. I, meanwhile, was blearily scribbling their words down, while taking quick breaks to sip my heavily caffeinated black tea. Luckily, even as questions formed in my head, others in the room were expressing the same thoughts in focused statements.

Representatives from PATH, the American Heart Association, UN Foundation, Global Health Corps fellows, RESULTS, Last Child, the Global Health Technologies Coalition, Save the Children, and many more offered their perspectives on some necessary first steps for a discussion about global health, benchmarked at the end of the year 2018.

The audience began by bringing up needs for:

Phew. Did you get all that? Spoiler alert, the audience was incredibly prescient with their initial commentary. And, I repeat, at 9:00 AM in the morning. This boded well for the rest of the conference.

Indeed, in the first of what would prove to be a day of well-balanced panels, Jen Kates (Kaiser Family Foundation), Keifer Buckingham (Open Society Foundations), and Dr. Charles Holmes (Center for Global Health and Quality, Georgetown University Medical Center) discussed the above ideas, hearing opportunities and concerns and posing the question: what next? Financing and accountability were key topics of the day, as resource mobilization and the question of “who is responsible?” are organizationally important to consider for policy advocates and implementers alike. Panelists discussed the effects of positive versus negative messaging and what it means to keep up the pressure on certain diseases while also managing to draw attention and resources to more neglected areas of health.

Meanwhile, as resource mobilization efforts and needs vary between contexts, panelists called for each organization to make and share clear statements on the added value of their work. They recognized the importance of formal structures and high-level meetings but noted that action is what is ultimately required. The panel concluded that health advocacy requires making a solid case for why taxpayer dollars should be allocated in particular areas, as donors (public and private) demands increasingly rigorous attribution and results.

Universal Health Coverage as a Unifying Goal

In a brief recorded message, World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus welcomed GHLS18 attendees and reminded everyone that the basis of global health work is that health is a human right. Those who do not have access to health and healthcare are actively deprived of their foundational rights and that the pursuit of universal health coverage (UHC) aims to resolve this global disparity.

What a prestigious lead-in to the next panel on, “Achieving Universal Health Coverage and Primary Health Care for All,” moderated by Dr. Roopa Dhatt of Women in Global Health. Panelists nodded to Dr. Tedros’ reminder and wasted no time in jumping in to a discussion on access to health as the first priority. This in turn requires thinking about the distinct policy environments where implementation takes place. Elisha Dunn-Georgiou (PAI) repeatedly brought us back to practicality as she noted how we constantly see commitments, signatures, and action plans; but “whether these turn into implementation is a different story.” She noted that civil society must be included in all of these decisions because they are both the voice of the community and the ones who hold governments to account in reaching the most marginalized. Participatory design from the very beginning is the only way.

It’s unique to be at a conference where every panel is the rockstar panel. Discussants brought up the need to reach beyond health to advocacy and grassroots movements in other sectors. If we are truly intending to reach the most vulnerable this must be addressed. Dr. Dhatt summed up much of the conversation by remarking that the “usual people around the table means the usual solutions.” Dr. James Fitzgerald, Director of Health Systems and Services at the Pan-American Health Organization (PAHO), succinctly dismantled false dichotomies of organizational structure that distract from the point: a focus on priorities, health needs, how the systems can deliver them, and people. Mic drop.

Applied Advocacy – Learning from Experience & Strategizing for a Changing Political Environment

Eight breakout sessions, divided into four topic areas, gave space for attendees to participate in smaller group discussions that brought experiences, critiques, and suggestions for solutions to bear on the topics of the day – primarily how to effectively tailor global health advocacy for impact.

  • Session A: U.S. Perspective on Universal Health Coverage
  • Session B: Universal Health Coverage in a Multilateral Context
  • Session C: Transforming Advocacy through Messaging
  • Session D: Transforming Advocacy through Mobilizing

Photo credit: Yasmin Cupala

Some key takeaways are that advocates need to step outside their respective bubbles to translate global health priorities into language (and have I mentioned messaging?) that policymakers who have a constituency to report to would resonate with. UHC goals are more easily understand in their unpacked components and building blocks (e.g., strengthening community health systems, the journey to self-reliance, access to basic services) rather than represented as three simple letters we assume are clear to all.

 

In the second group of sessions, participants were invited to come up with transformational strategies based on past experience and future goals. Small groups brainstormed messaging strategies for engaging a wide coalition of partners, and their respective strengths and interests, in advocacy efforts. Ultimately mobilization was a key focus and the last session examined how advocacy could be ramped up, especially in the context of the UN high-level meeting on UHC and other global priority meetings.

Dialogue with U.S. Government Representatives

A lunchtime panel with members of the U.S. government Executive Branch was moderated by GHC’s own President and Executive Director, Loyce Pace. The session engaged administrators from the Bureau of Global Health at USAID, the Center for Global Health at the U.S. Centers for Disease Control and Prevention, and the Office of Global Affairs and the U.S. Department of Health and Human Services.

Photo credit: Yasmin Cupala

Soon after, California representative from Sacramento County, Rep. Ami Bera, MD (D-CA-07) took the stage to discuss government’s role in understanding global health and how to address these problems in the 21st century. Rep. Bera noted that the U.S. Congress has the opportunity to take a broader definition of “health” and consider poverty, displacement, hunger, and other underlying issues. He emphasized that many in Congress are new to health issues and so in conversations with them and their staff, it’s helpful to connect global health issues to issues that are important to constituents.

Transformation and Amplification: Propelling Global Health Advocacy Goals Forward into 2019

The late-afternoon panel, “Transforming Global Health Advocacy,” featured Carolyn Reynolds, (PATH), Dr. Grace Virtue (ACTION), Lisa Cohen (Global to Local), and Dr. Luc Kuykens (Sanofi). All mentioned the importance of working in advocacy on national and sub-national levels in each country. The sub-national arenas are where sustainable moves are made. Dr. Virtue emphasized the need for urgent action beyond talk, saying “as each decade goes by, we’re losing generations.” We can only strategize so long – if we are to make any difference at all we have to listen to those who are suffering and act.

Three health reporters participated in a concluding plenary on global health in media entitled, “Amplifying our Agenda.” Adva Saldinger (Devex) moderated a Q&A style forum with Washington Post reporter Lena Sun and Huffington Post reporter Lauren Weber. Both reporters were explicit in differentiating between issues that are news-worthy, and issues that are important for global health advocate agendas. One of Ms. Sun’s recommendations was to think about what and how you talk about issues around the dinner table; that is what they want to be covering – with depth and sources that create a story. Not necessarily each and every annual World Health Day, which, although they serve as opportunities to showcase achievements and goals, do not represent gripping news per se.

GHLS18 was the ideal setting to get an overview of who is doing what in global health in Washington, DC and to examine the challenge of how global health and universal health coverage advocacy can be aligned for greater impact. The Symposium showed that advocacy goals and strategies are comparable across all topics and disease areas. In order to move forward towards international aims of universal health coverage and health equity, we must continue to share best practices and operate with these overarching goals in mind rather than in such an individual organizational manner. Speakers and attendees alike called on attendees to operate at every level considering people and patients as the center of all equations rather than at some distance down the road.

Photo credit: Yasmin Cupala

Looking back at those 9:00 AM comments, it’s interesting that most ended up being predictors of the main themes of the rest of the day. There is a lot of work to be done yet but the ideas that were brought to the table were solutions focused and dismantled organizational distractions in favor of real, experience-based approaches. Those who attended GHLS18 can leverage the knowledge, inspiration, and renewed focus on UHC to continue to advocate in all spaces for the universal right to quality health for all on the upcoming “UHC Day” (December 12). But don’t be disappointed if reporters from mainstream outlets don’t pick up that particular story.

View GHC’s Twitter moment to get an overview of the #GHLS18 event and the vibrant conversations happening throughout.

Using HER Voice in the Fight Against AIDS

This blog post was written by Sarah Hollis, Senior Communications Manager, Friends of the Global Fight Against AIDS, Tuberculosis and Malaria (Friends).

On December 1, the global community will come together to mark the 30th anniversary of World AIDS Day. Organizations like the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) have helped cut the number of AIDS-related deaths in half since the peak in 2005. But in many countries, HIV infections remain extremely high.

Adolescent girls and young women face especially difficult odds. In some African countries, young women aged 15-24 are up to eight times more likely to be HIV positive than young men their age. Around the world, a young woman is infected with HIV every 90 seconds.

But with support from the Global Fund, young women are starting to fight back. A new HIV Epidemic Response (HER) initiative – HER Voice – is working to empower networks of adolescent girls and young women across Africa. The HER Voice mantra, “Nothing for us without us,” is based on the principle that adolescent girls and young women have a vital role to play in driving and shaping the HIV response. Their experiences and needs must be central for policy making, program design and implementation.

The innovation and creativity of the young women involved in this initiative breathe new life into HIV/AIDS activism in Africa. Beverly Mutindi (left), a HER Voice Ambassador from Kenya, is using artificial intelligence to reshape the conversation around sexual and reproductive health. She created Sophie Bot, an app that she calls, “Siri for sexual health,” to combat the spread of misinformation among young people. Users can ask Sophie Bot questions and she uses artificial intelligence to respond, either by voice or text, based on information from Kenya’s National AIDS Control Council and the United Nations Population Fund (UNFPA).

Across the continent, in Cameroon, HER Voice Ambassador Brenda Fuen Formin is also using technology to amplify the voices of young women and girls. Working with friends and colleagues across sub-Saharan Africa, Brenda is creating new safe spaces online for victims of sexual violence and HIV positive women. Using an anonymous blogging platform and bringing medical doctors and psychologists to provide online support, she is helping vulnerable women connect, share their stories and receive psychosocial support.

Programs like HER Voice are essential tools for engaging hard-to-reach and underserved communities in the fight against HIV/AIDS. But these programs are only available when the international community comes together to support the Global Fund. Every three years, donor governments, the private sector and private foundations make pledges to the Global Fund – called replenishment. The next replenishment, which takes place in October 2019, will require a strong commitment from the U.S. to leverage increased support from other donors and help end this epidemic for good.

The Global Fund has set a bold target to reduce the number of new HIV infections among adolescent girls and young women by 58 percent in 13 countries in sub-Saharan Africa over the next five years. By supporting the Global Fund’s next fundraising round, we can make that target a reality and ensure that young women and girls have access to the essential treatment and prevention programs they need to thrive.

***

Friends of the Global Fight Against AIDS, Tuberculosis and Malaria (Friends) advocates for U.S. support of the Global Fund, and the goal to end the epidemics of AIDS, tuberculosis and malaria. As an advocate, Friends engages U.S. policymakers and influencers in conversation about the Global Fund’s lifesaving work, and highlights the significant returns on health investment, both for global partners and for America. For more information about Friends of the Global Fight, visit www.theglobalfight.org.

Gender Transformative Leadership: A New Vision for Leadership in Global Health
This blog was originally published on Women in Global Health’s website. Authors include: Ann Keeling, Mehr Manzoor, Kelly Thompson, and Roopa Dhatt, Women in Global Health. Acknowledgments: Temi Ifafore-Calfee, Alanna Shaikh, and Caitlin Jackson.

Since its launch in 2015 the Women in Global Health (WGH) movement has campaigned for gender parity[1] in the leadership of global health organisations and for going beyond parity to gender equality, through operationalising Gender Transformative Leadership (GTL).

 The Sustainable Development Goals (SDGs), with Universal Health Coverage at the centre, set an ambitious agenda for global health[2] to reach by 2030. But progress continues to be held back by the narrow base from which global health leadership is drawn and specifically, widespread exclusion of women from decision making. Buse and Hawkes conclude: “For too many decades the issue of gender and gender inequality in global health has been swept under the carpet”[3] and that applies both to gendered determinants of health and to the health and social care workforce.

 In October 2017 400 leaders from 68 countries met at the inaugural Women Leaders in Global Health Conference and called for “a new vision for leadership in global health”[4] to address gender inequity and the gender gap in leadership. In this article we propose Gender Transformative Leadership (GTL) as that vision and outline why it is critical to #healthforall.

Global health: Delivered by Women, Led by Men

Often portrayed as victims in global health, women actually form 70% of the health and social care workforce[5] and are potentially powerful agents of change. But they hold only around 20% of senior posts[6] and are generally segregated into lower status and lower paid or unpaid sectors. Despite decades of global targets on gender equality, including SDG Goal 5 on gender equality and empowering all women and girls, the 2017 Global Health 5050 (GH5050) report[7] found that 45% of 140 global health organisations surveyed had no commitment to gender equality in their strategies or policies. Data from Women in Global Health (WGH) and GH5050 have also shone a light on the gender gap in health leadership.  Exclusion of women from the majority of health decision making roles is inequitable, but more than that, it weakens global health since the women workers who know most about health systems have the least say in their design and management. Women from low- and middle-income countries (LMICs) face the greatest barriers accessing senior posts in their home countries and globally.  Health policy decisions are not influenced equally by the priorities and experiences of men and women and global health is diminished by lost female ideas, innovation, expertise and talent.

The Roots of Gender Transformative Leadership (GTL)

GTL, used by WGH as the guiding principle for our work, is based on concepts of transformative leadership[8], feminist leadership[9] and gender transformative approaches[10]. The concept fills critical gaps in current definitions of leadership.

As the name suggests, there are two main constructs in the definition of GTL: ‘gender’ and ‘transformative leadership’:

(i)  Gender:

WGH draws upon WHO’s definition of gender: “ Gender refers to the socially constructed roles, behaviours, activities, attributes and opportunities that any society considers appropriate for men and women, boys and girls and people with non-binary identities. Gender is also formed through the relationships between people and can reflect the distribution of power within those relationships.”[11] 

WHO notes that gendered determinants of health are “among the most important social determinants of health inequities”[12]  ‘Gender’ refers equally to men and women and to non-binary people, despite it often being misused as a proxy for ‘women’. Gender driven inequities in health are significant both for the health outcomes of women and men and also for the composition and effectiveness of the health and social care workforce. Applying a gender lens to health systems’ policy and delivery is not optional, it is critical if #healthforall targets are to be met.

(ii) Transformative Leadership:

As Stogdill (1974) points out, there are as many definitions of leadership as there are people defining the concept.[13] WGH’s understanding of GTL builds on principles of Transformative Leadership initially described by James MacGregor Burns (1978) as a leadership approach which “raises the level of human conduct and ethical aspirations of both leader and led, and thus it has transforming effect on both.”  Transformative leaders inspire followers by setting out a vision for change and challenging power imbalances imbedded in systems, rather than working within an existing set of values and norms.

Gender Transformative Leadership in Global Health

GTL is Transformative Leadership with a gender inclusive lens.[14] In the global health context, GTL addresses the gender inequities in power that undermine health systems’ design and delivery.  GTL is driven by the vision of gender equality and women’s rights embodied in international conventions and agreements including SDG 5 and addresses social and cultural norms, conscious and unconscious bias and deep-rooted structures of inequality. Rather than expecting women to ‘lean in’ to professions and organisations that have largely excluded them from leadership and senior roles, GTL addresses discrimination, bias and inequities in the system so women are included on an equal basis to men. The term ‘gender transformative’ can be applied to decision-makers, the institutions they work in and to the health system itself.

GTL takes an intersectional approach, analysing how gender intersects with other facets of identity, such as race, disability, sexual orientation, caste and class, to multiply vulnerability and disadvantage for particular groups.  Additional action is needed to identify and address such multiple, intersectional forms of disadvantage that may affect any gender (black men, low caste women etc). In the context of global health, geography is a significant factor with professionals, especially women, from low income countries, facing structural barriers to participation in global health.

GTL applies to all leaders at every level of health system from community to global, regardless of their gender. WGH acknowledges that organisations operate in diverse settings and start from different points so approaches to address gender inequities must be customised to the context. WGH assumes that a gender transformative approach will include gender parity in leadership but will go beyond gender parity to advance gender equality within organisations and in the work of those organisations, resulting in better global health.

Gender Transformative Leadership in Global Health – Ten Headlines

1. It is grounded in a vision of gender equality and women’s rights.

2. It challenges privilege and imbalances in power to eliminate gendered inefficiencies an rights deficiencies that undermine global health.

3. It is intersectional, addressing social and personal characteristics that intersect with gender (race, ethnicity etc.) to create multiple disadvantage. In global health, GTL would drive equal participation of all genders from all geographies.

4. It applies to leaders from any gender, not exclusively to women leaders.

5. It covers leadership at all levels in global health from community to global.

6. It recognizes different forms of leadership, such as thought leadership, which are not based on simple hierarchy and people managed.

7. It can be used to describe individuals, institutions and health systems.

8. It follows the principle of ‘progressive realization’[1] allowing for different starting points and contexts but prioritizing inclusion of the most marginalized and excluded.

9. It is always ‘work in progress’ since power dynamics are constantly changing.

10. It assumes that gender equality = smarter global health and that GTL is therefore necessary for the achievement of #healthforall.

A final word….

Gender transformative leaders in global health aim to leave no-one behind in access to health and equally, aim to leave no-one behind in leadership and decision making.

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Link for blog 

 

[1] Women in Global Health define Gender Parity as 60/40.

[2] Jeffrey P Koplan, T Christopher Bond, Michael H Merson, K Srinath Reddy, Mario Henry Rodriguez, Nelson K Sewankambo, et al. Towards a common definition of global health. The Lancet. 2009;373:1993–95.

[3] Kent Buse, Hawkes S. Gender—global health’s dirty little secret. The BMJ. 2018.

[4] Michele Barry, Zohray Talib, Ashley Jowell, Kelly Thompson, Cheryl Moyer, Heidi Larson, et al. A new vision for global health leadership. The Lancet. 2017;390.

[5] ILO. Improving employment and working conditions in health services. 2017.

[6] Women in Global Health (data unpublished) 2018

[7] Global Health 50/50 ‘The Global Health 50/50 Report: How gender-responsive are the world’s most influential global health organisations?’, London, UK, 2018

[8] Burns JM. Leadership. New  York: Harper and Row; 1978.

[9] Batliwala S. Feminist Leadership for Social Transformation: Clearing the Conceptual Cloud. 2010.

[10] Emily Hillenbrand, Nidal Karim, Pranati Mohanraj, Wu D. Measuring gender-transformative change: A review of literature and promising practices. 2015.

[11] WHO. Factsheet on Gender and Health. 2018.

[12] WHO. Factsheet on Gender and Health. 2018.

[13] Stogdill RM. Handbook of Leadership – A survey of Theory and Research. New York: Free Press; 1974.

[14] WGH is thankful for the valuable insights provided by Rosemary Morgan at RinGs.

[15] OHCHR. Fact Sheet 33 – Frequently Asked Questions on Economic, Social and Cultural Rights

Can the Astana Declaration Be a Turning Point to Finally Ensuring Primary Health Care for All?

This guest post was originally posted on the Frontline Health Workers Coalition website. The post was written by Vince Blaser, Director, Frontline Health Workers Coalition and Senior Advocacy and Policy Advisor, IntraHealth International. The Frontline Health Workers Coalition is an alliance of United States-based organizations working together to urge greater and more strategic investments in frontline health workers in low- and middle-income countries as a cost-effective way to save lives and foster a healthier, safer, and more prosperous world.

Frontline Health Workers Coalition Director Vince Blaser asks a question of panelists at the ministerial session on health workforce at the Global Conference on Primary Health Care in Astana, Kazakhstan. Photo courtesy IntraHealth International. Image courtesy: Frontline Health Workers Coalition

Fellow delegates to last week’sGlobal Conference on Primary Health Care in Astana, Kazakhstan, have flown home to an awesome yet daunting challenge: 40 years after the landmark Alma-Ata Declaration of 1978 declaring health as a human right, how can we finally make the declaration’s vision of primary health care (PHC) for all a reality?

The monumental 1978 conference in Alma-Ata, USSR (now Almaty, Kazakhstan) pronounced for the first time global agreement that health is a “fundamental human right” and called for “urgent and effective national and international action to develop and implement primary health care throughout the world.”  Representatives from 134 countries broke across political and ideological differences, personally urged on by the likes of the late US Senator Ted Kennedy, and set a target to achieve PHC for all by 2000.

Forty years later we’ve come a long way, but are far from reaching the dream hatched in Alma-Ata.

Last Thursday, 1,200 delegates from more than 120 countries renewed the commitment to PHC for all with the Astana Declaration. More than 180 civil society organizations, including the Frontline Health Workers Coalition, through the UHC2030 Civil Society Engagement Mechanism signalled our intent to see PHC for all finally realized and what it will take to get us there.

Here are three factors I believe will be critical to achieving the Astana Declaration.

Learn from the past and build on progress made

The evidence and political will behind the Millennium Development Goals and major annual increases in development assistance for health in the 2000s gave rise to progress on many of the top issues in public health: annual deaths of children under 5 more than cut in half and maternal deaths nearly cut in half since 1990, almost a 50% decline in annual deaths from HIV since 2005, and deaths from malaria down 63% from 2000-2015.

But, as World Health Organization Director-General Tedros Adhanom Ghebreyesus noted in his opening remarks in Astana, progress has not been equitable. The people whose lives have been saved and made healthier have largely been the easiest to reach.

Following the Alma- Ata Declaration, many countries took action to increase access to PHC, including efforts to usher in CHW programs focused on the areas of least access. Unfortunately, large-scale CHW programs of the 1980s and 1990s largely failed due to a variety of factors, according to leading scholars like Henry Perry of Johns Hopkins University. But now, many countries, global initiatives, and donors are looking to scale up community health worker (CHW) programs to address the gaps in primary health care access.

Last Friday in Astana, the WHO released its first-ever guidelines to optimize the effectiveness of CHW programs. In the last two decades, CHW programs of all shapes and sizes have been tried and researched, many of which have been supported in some way by the US and other development assistance donors and implemented or supported members of the Frontline Health Workers Coalition. This evidence has been put to use in some countries’ development of CHW programs—but the release of these guidelines, backed by this evidence, will provide adaptable recommendations for all countries to utilize.

Central to the success of CHW programs, according to the guidelines, will be how well they are integrated into the health system, especially national health workforce plans. The message that permeated several panels in Astana, made clear by frontline health workers like Maria ValenzuelaMunashe Nyika, and Ruth Tarr, was that teams of well-supported frontline health workers with the education, training, equipment, information, and support they need, are required to deliver PHC for all.

Be unequivocal about the task ahead

A major factor in the progress made in global health was the solidarity, leadership, and leverage that came with the average annual increase of more than 10% in development assistance for health from 2000-2010. Unfortunately, that assistance has levelled off, averaging a 1% increase since 2010 and decreasing slightly from 2016 to 2017, according to the Institute for Health Metrics and Evaluation. At the same time, average domestic spending on health in low-income countries decreased from 1.69% of GDP in 2006 to 1.44% in 2015, according to Save the Children.

While overall global spending on health continues to grow, investment has not been focused on providing quality primary care to communities of least access and, as a result, health inequities are exacerbated. The new report of the Lancet Global Health Commission on High Quality Health Systems in the SDG Era found over 8 million people die annually in low- and middle-income countries (LMICs) because of “inadequate access to quality care,” resulting in $6 trillion in economic losses.

The laudable goal of quality PHC for all set forth in the Astana Declaration cannot be achieved without far greater global solidarity to focus and invest in communities of least access to quality health services in LMICs. This means greater investment in these communities by development assistance donors, greater investment by LMICs themselves in PHC, and greater investment from the philanthropic and private sector, especially in the areas where long-term investment is most needed, such as health workforce education and addressing gender inequities.

Be bold and concrete in political commitments

Although the Astana Declaration lays out the solidarity of commitment to the right of health for all enshrined in the Alma-Ata Declaration and the desire to achieve it, the specific commitments needed to make this vision a reality were as absent last week as they were in 1978.

Thankfully, the framework for what needs to be achieved is there on paper, waiting for bold, sustained action to be taken.

The goal of achieving universal health coverage or UHC, unanimously agreed to by United Nations member states in 2012, has itself become a driving force for achieving health for all. The opportunity is ripe for concrete commitments to realize the Astana Declaration at the UN High-Level Meeting on UHC in September 2019 in New York.

In the arena of health workforce, where FHWC focuses our advocacy, the blueprint of what must be committed to next year in New York needs better data to deliver better investment.

FHWC’s recommendations are clear: we will need a heavy dose of political will in the form of bold new financial and programmatic commitments, as will other core components of PHC and UHC.

Last week we celebrated the vision for PHC for all enshrined in the Alma-Ata Declaration 40 years ago but lamented our failure to reach its vision. Forty years from today, I hope we celebrate this week in Astana as the starting point for bold actions that made that vision a reality.

 

Delivering Quality Care to Patients Who Need it Most: Exploring Health Strategies at the Global Conference on Primary Health Care

This blog post was written by Maia Olsen, Program Manager, NCD Synergies at Partners In Health (PIH). PIH’s mission is to provide a preferential option for the poor in health care. By establishing long-term relationships with sister organizations based in settings of poverty, Partners In Health strives to achieve two overarching goals: to bring the benefits of modern medical science to those most in need of them and to serve as an antidote to despair. They are a 2018 Global Health Council member.

Maia Olsen (second from the left) joins PIH colleagues in Astana, Kazakhstan – including PIH Liberia’s Executive Director Patrick Ulysse, PIH Haiti’s Co-Executive Director Loune Viaud, and PIH’s Senior Director of Strategic Partnerships Leslie Flinn – in a surprise photo with WHO Director General Tedros Adhanom Ghebreyesus, who was between commitments amid a busy conference schedule. Photo Credit: Eric Hansen / Partners In Health

Last week, Partners In Health (PIH) came together in Astana, Kazakhstan with Ministries of Health and colleagues representing institutions throughout the world for a historic and inspiring week of meetings on primary health care and strategies to achieve Universal Health Coverage (UHC). The week was in honor of the 40th Anniversary of the Declaration of Alma-Ata, as well as in recognition of how much is still left to be achieved on the 1978 call to action so many years ago.

On Wednesday 24th October, PIH held a one day pre-meeting to the global conference entitled “Health Systems and Delivery Strategies to Achieve Universal Health Coverage” in collaboration with the Ministry of Health of Kazakhstan and the Global Financing Facility. At this meeting, PIH looked to generate energy and critical discussion around pathways to expand quality care delivery to patients who need it most, across all levels of the health system. A common theme throughout the day’s discussion was how imperative it is that we – as the implementing community in low- and middle-income countries – encourage donors and support governments to invest in comprehensive health systems strengthening that addresses what our patients need across the full disease spectrum, rather than centering prevention and care delivery solely around “low-hanging fruit”, vertical programs, or a more minimal and selective primary care package.

Over 150 participants attended PIH’s sessions, representing peer organizations such as PIVOT, Muso, Possible, Last Mile Health, Integrate Health, Amref, and many members of the Frontline Health Workers Coalition and Civil Society Engagement Mechanism for UHC2030, prominent stakeholders including the WHO, World Bank, Global Fund, USAID, GAVI, and Global Health Council, and more than ten Ministry of Health delegations across countries as diverse as Liberia, Madagascar, Kazakhstan, and Nepal. Throughout the day, discussions were forward-looking, social justice focused, and rooted in asking hard questions regarding how to provide increased access to quality care to the world’s most vulnerable populations.

As Dr. Joia Mukherjee, PIH’s Chief Medical Officer, stated in an opinion piece coinciding with last week’s conference:

“Provision of high quality care is attainable in some of the hardest to reach and least-resourced settings when patient-centered approaches are prioritized […] Universal health coverage is an ideal whose benefits are clear, whose time has come, and whose expense is nothing compared to the cost of continued delays.”

As someone representing the NCD community through my role with the NCD Synergies program at PIH and who has closely collaborated with partners like the Global Health Council, NCD Roundtable, and the Women and NCDs Taskforce in advocacy efforts leading up to the 2018 UN High-Level Meeting on NCDs, it was inspiring to be – just over a month later – in a room where NCDs, mental health, and injuries fit squarely in a broader conversation around how to achieve universal health coverage and health financing in the poorest settings where PIH works.

As we have demonstrated through PIH’s work and partnership across the Program in Global NCDs and Social Change at Harvard Medical School and the Lancet Commission on Reframing NCDs and Injuries among the Poorest Billion, there are proven strategies to address gaps in care for NCDs, mental health, and surgically-amenable conditions, which often extend beyond primary care, such as the PEN-Plus packagefor integrated management of severe, complex, and chronic NCDs such as rheumatic heart disease and type 1 diabetes at first-level hospitals.

For those that have seen or experienced the struggles of young patients like Babesh Tumang and Sheila Chipenge living with NCDs like neuroblastoma and type 1 diabetes, it is immediately clear why severe NCDs that impact the world’s youngest and poorest patients must be included as an essential part of the global UHC agenda. Their voices are why our NCD Synergies team made the call to action we did on behalf of PIH at the July 5th United Nations Interactive Hearing on NCDs alongside our colleagues at Global Health Council and other civil society institutions.

Their voices are also why we were so honored to be in Astana to come together around such an ambitious call to action to support governments to progressively achieve universal coverage to quality care spanning the health system and inclusive of all conditions – from cholera to multi-drug resistant tuberculosis to rheumatic heart disease.

We ask our colleagues throughout the world to join forces with us in advocating for increased funds for integrated health systems strengthening to achieve UHC. Let’s work together to realize the commitments in the Astana Declaration – and throughout the UHC agenda – in a way we didn’t following Alma Ata in 1978.