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#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.

The GPW: Making the Impossible Work of the World Health Organization Possible

This post was written by Elizabeth Montgomery Collins, MD, MPH, DTM, Global Health Council individual member and delegate to the 71st World Health Assembly in Geneva, Switzerland. 

In 2000 the United Nations (UN) marked a new era in global development policy by adopting eight highly ambitious Millennium Development Goals (MDGs) to be achieved by 2015 to address the world’s most basic development needs, ranging from fighting extreme poverty to fighting HIV/AIDS.  Building on the MDGs’ success, the UN subsequently extended its global development agenda by adopting the Sustainable Development Goals (SDGs), which represent an even broader and more audacious attempt to eliminate poverty, hunger, and disease from the world.  The SDGs are so ambitious, in fact, that many of the 17 goals appear to be virtually impossible to attain.

So, how will the world accomplish these very specific levels of achievement by 2030?

As with the MDGs, achieving the SDGs will require a combination of local, regional, and global action.  Member States are expected to continue the initiatives that enabled them to achieve many of the MDGs, and the UN, through its various subsidiary organizations, will no doubt continue to push for advancement on all fronts; but the question remains:  How, specifically, will the World Health Organization (WHO), as the official UN body charged with overseeing international health policy and progress, tackle those objectives relating to health on the SDG list—in particular, SDG 3, which seeks to “ensure healthy lives and promote well-being for all at all ages”?

WHO Director-General, Dr. Tedros Ghebreyesus (Dr. Tedros), proposes to make this seemingly impossible goal a reality by implementing the step-by-step plan set forth in the 13th General Programme of Work (GPW 13) for 2019–2023.  In GPW 13, Dr. Tedros seeks to transform the vague exhortations of SDG 3 into a concrete, measurable plan of action.

And, he fast-tracked the plan for approval.

In January 2018, after input from UN Member States, other UN bodies, WHO staff, non-State actors, and an Expert Reference Group, GPW 13 was presented as a draft to the WHO Executive Board (EB) at WHO headquarters in Geneva, Switzerland.  With some revisions, the EB adopted GPW 13 for consideration as resolution EB142.R2.  Following discussions of the 46-page draft document A71/4 as provisional agenda item 11.1 in May 2018, the Seventy-first World Health Assembly (WHA71) delegates formally approved GPW 13, one full year in advance of its proposed implementation date.

Many countries made strong statements in support of GPW 13 during the plenary session of WHA71, including Singapore, Jamaica, Poland, and the Republic of Korea, with Denmark stating that “we want these ambitions to be translated into implementable policies.”

In accepting GPW 13 as resolution WHA71.1, the Member States also requested that the Director-General use GPW 13 to form budgets, keep Member States informed of progress, provide contextual guidance and support regarding the plan to regional and country offices, and apprise WHA75 attendees in 2022 of any intention to extend the plan an additional two years, to 2025, in order to align with the UN’s larger strategic plan cycle.

GPW 13 is a plan of work not just for the Secretariat of the WHO, but also for each UN Member State, as well as the various other stakeholders that seek to achieve the SDGs’ objectives.  In fact, the document makes it clear that it is intentionally drafted in almost impossibly ambitious terms because, as Dr. Tedros declared, “it must be.”  And because no single entity can accomplish the goals on its own, GPW 13 by design invites assistance from the private sector and other strategic partners.

This roadmap, subtitled “Promote health, keep the world safe, serve the vulnerable” lays out three strategic priorities that will lead us to the overarching goal of healthy lives and well-being for all:  universal health coverage (UHC), health emergencies, and healthier populations.

Achieving Universal Health Coverage

The primary objective for this priority is to have 1 billion more people benefitting from universal health coverage.  This number was calculated to achieve SDG target 3.8 of UHC for all by 2030; to do that, at least 1 billion more people will need to have access to essential health services in each five-year period between 2015 and 2030.  The focus is on infectious diseases, noncommunicable diseases, and basic provision of reproductive, maternal, newborn and child healthcare.  Another central aim of the plan is to ensure that out-of-pocket healthcare expenses do not cause catastrophic financial hardship or increase poverty among families, households, and countries.  In order for coverage to be truly universal, WHO will particularly emphasize healthcare access for women and children, and people who have disabilities or difficulty accessing care due to poverty, stigmatization, location, or other challenges.  It is estimated that the investment necessary to create an educated workforce to achieve UHC will account for 50% of the WHO’s total budget for SDG 3.

Addressing Health Emergencies

The goal is to better protect 1 billion more people from health emergencies.  The WHO has committed to a new vector control strategy, cooperated with the Coalition for Epidemic Preparedness Innovations (CEPI), and begun work with Member States to form a Health Reserve Force prepared to immediately respond to health-related emergencies.  The architects of GPW 13 recognize that the methods ultimately adopted for measuring readiness and improvements in rapid response mechanisms will need to be developed in consultation with its myriad partners, and that people who are living in conflict zones or who have been displaced will be among the most challenging groups to protect.

Promoting Healthier Populations

To ensure that 1 billion more people enjoy better health and well-being, WHO is pursuing its agenda across 5 tracks:  increasing human capital throughout the entire lifespan, preventing and fighting non-communicable diseases (NCDs) including mental health conditions, accelerating elimination of the most impactful infectious diseases, knocking out antimicrobial resistance, and crushing climate change effects on health.  Perhaps the most difficult goal to measure, the assessment of this priority will be a composite estimate derived from adding multiple SDG life-improving targets, and scoring “life improving interventions” vs. “no intervention” scenarios, to see how much progress is made when improvements are attempted.  In particular, the WHO will seek to discourage unhealthy behaviors and marketing (particularly towards children) involving tobacco, harmful alcohol use, unhealthy diets, and inactivity.

Dr. Anders Nordström, Ambassador of Global Health for the Swedish Ministry of Foreign Affairs and former WHO Acting Director-General, pointed out at the Panel Discussion of the 13th General Programme of Work hosted by The Graduate Institute of International & Development Studies, that the factors which differentiate GPW 13 from the dozen that came before it, are that “now we have the SDGs” and “in this GPW…we have a goal, a number:  3 billion— and this pushes us to measure”.  In other words, GPW 13 establishes specific objectives that will make measurement and incremental progress achievable, and serve as stepping stones toward achieving the ultimate goal of SDG 3, one billion people at a time.

The WHO seeks to accomplish all this by making strategic shifts in leadership, driving public health impact in every country, and focusing “public health goods” (i.e. norms, standards, conventions, regulatory recommendations, assessment reports, open databases, etc.) on impact.

The WHO will also make organization shifts, reshaping its operating model to drive, measure, and manage impact at the country, regional, and global levels; transforming partnerships, communications, and financing; strengthening systems, health information systems, and processes; and changing the work culture.  Collectively these will entail incidental improvements such as paying interns a wage for the first time, paving the way for more representation by developing countries, increasing the number of women in leadership roles, and creating a more transparent, collaborative, and seamless WHO, unified and acting as one with the UN.

As Dr. Tedros stated in his speech at the Opening of the Seventy-first World Health Assembly “our new GPW or strategic plan is not about reinventing the wheel. It’s about making a bigger impact than we already make.”

Although the plan’s efficacy will be difficult to implement and measure, the WHO intends to focus on outcomes and impact.  One interesting way they might check progress towards their overall mission is to measure healthy life expectancy around the globe.

Because all components of the plan interact with and build upon each other, I believe the GPW has the potential to create exponential improvements in healthcare outcomes as each goal advances, culminating in healthier people living in a safer world, five to seven years from now.  That in fact may be the primary benefit of striving for the impossible:  even if we fall short of some of our marks, we can likely still make remarkable progress.

I commend Dr. Tedros’ leadership on establishing GPW 13 and encouraging states to “walk the talk” on these objectives.  The WHO must, through inspirational leadership, motivate individuals, families, communities, nations, and regions to address all of these items at the earliest junctures possible, for individuals at the earliest age possible, while aiming for the highest quality of healthcare and health possible.  One of the most important steps in making the SDGs a reality will be the creation of higher education centers to provide the necessary training of healthcare workers worldwide.  Partnering to build, distribute, and appropriately pay a capable health workforce will contribute substantially to the triple-billion goals.  If the WHO can enlist the help of academia for expertise, the private sector for resources, and civil society for input, including from children and adolescents, the world’s citizens may indeed enjoy healthier and happier lives, and reap the physical and emotional benefits of a health-focused world built from the GPW 13 blueprint.

When Dr. Ilona Kickbusch, Director of the Global Health Centre of The Graduate Institute-Geneva and moderator of the Introduction to the WHA: a briefing for delegates held just before the WHA 71 kicked off, asked about society’s current mindset in relation to the WHO’s master plan, Loyce Pace, President and Executive Director of the Global Health Council, answered emphatically that “[t]he shift from healthcare to health is something that the public can understand.  Civil society is ready for an emphasis on health…and the public wants to access more health.”

Adding, “We are ready.”

In his WHA71 Closing Speech, Dr. Tedros laid out the challenge that ultimately stands before us: “Now it’s time to implement it.  We have no time to lose.  Five years is no time.”

Kwanele Asante: “It’s Our Lives That Are At Stake”

This post is originally published on Johns Hopkins Bloomberg School of Public Health Global Health NOW and is written by Brian W. Simpson

South African lawyer and bioethicist Kwanele Asante is a non-communicable diseases advocate at #WHA71. (Image: Brian W. Simpson)

Kwanele Asante speaks her mind. And what’s on her mind at this year’s World Health Assembly is real action on noncommunicable diseases.

The South African lawyer and bioethicist lives with 3 NCDs and has participated in a half dozen panels. She wants the millions of other people worldwide with similar conditions to get the kind of quality care she receives. “I don’t want to feel this discomfort of knowing that I have access to privileged health care in a developing world context and the majority of my compatriots don’t have the same access,” she said in a Thursday interview following a side event on universal health care. “It’s immoral. Health is something that we need.”

Are you representing an organization here?

I actually came here on behalf of the NCD Alliance. I’ve recently been asked to join their 2018 Global Advisory Committee, but particularly to help them focus a rights-based appeal for the upcoming UN high-level …  meeting on NCDs.

If we’re going to be in a UN context where, from 1946, the preamble to the UN constitution gives this notion of the highest attainable standard as a fundamental human right of every person. That’s their language, and it’s just very ironic that now we’re sitting in 2018 and when population groups around the world are starting to say, “Hi, we’re going to hold you to your rights discourse,” there is a sense of high-level discomfort as though we’re being revolutionary or we’re being unreasonable.

If you had one major goal to achieve here at the World Health Assembly what would that be?

My one major goal is just to emphasize this message of we need to stop with the rhetoric. It’s nice to have a new [WHO Director-General] who says all the right things, but the proof is really going to be what we do when we go to the UN high-level meeting this time around on NCDs, and what amount of global real resources in terms of finance is going to be given to close the current global health disparities.

Do you feel a special responsibility here at WHA? You’re not only speaking for yourself, but for so many other people who suffer from NCDs?

I feel a particular, very personal responsibility actually. I was diagnosed at age 37. I was told that my prognosis was really bad. I wouldn’t see 38, but I’m here. Once I had recovered my health sufficiently I started working with people in informal settlements in South Africa, and I met 3 awesome women who were living with the complications of chemotherapy like I was. The only sad thing is they all didn’t make their 35th birthday. They died. These were mothers, these were hugely intelligent people, very dignified people, but what was different was they didn’t have access to the essential medicines that I have access to.

I feel a very strong sense of moral duty, and I’m really committed to use my legal training and my voice to just ask everybody to sit up and realize that we’re talking about lives here, you know?

You’re obviously impatient to get beyond the words here to action, to results. Will you leave here feeling optimistic at all or do you feel like it’s just a lot more talking?

I feel more optimistic. I’m exhausted. This was my sixth panel, but I saw especially in panels where I had more engagement, I saw a grappling, I saw a discomfort and a sitting up to say, “Wow, yeah. You’re right. Thanks for calling us out. Yes, we commit.” Even with the one panel I spoke on civil society engagement with DG [Tedros Adhanom Ghebreyesus], he said, “We need civil society to hold us accountable.” When I started my first panel I promised them that. I told them that I am going to be one of the people who are going to disrupt this opulence and rhetoric, and I’m gonna make them get real. In some platforms I’ll speak in beautiful English. In some platforms I’ll just be in your face because millions of patients’ lives are at stake.

Really, I’m going to borrow the script from the AIDS movement … this notion of nothing about us without us. Patients’ inclusion, substantive inclusion, that’s what we want. We don’t want this peripheral atonement. We want to be central to what’s happening, because ultimately it’s our bodies and it’s our lives that are at stake.