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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.

Global Health Roundup ~ 06/11/2018

Heads Up! Upcoming Conferences in DC & Beyond
Summer is fast approaching and instead of taking a vacation, the global health and development communities are ramping up the heat as they host and participate in several landmark conferences. On the development front, this week the InterAction Forum (June 12-14) will host breakout sessions that address issues like strengthening local health centres while Devex World (June 12) will lead discussions on maternal and child health, HIV, and more. Speaking of honing in on specific global health topics, registration is open for the civil society hearing on the prevention and control of Noncommunicable Diseases (NCDs) as part of the preparatory process for the UN High-Level meeting on September 27. Moreover, the latest advances in HIV prevention science will be on display at the 22nd International AIDS Conference (July 23-27). Finally, network and develop solutions to the most pressing water-related challenges of today at the 2018 World Water Week (August 26-31). More details about these conferences and others can be found on GHC’s Upcoming Calendar of Events.

Governments Off Track to Meet Sustainable Development Goal 3.4 Targets
On World No Tobacco Day (May 31), WHO released its second edition of the Global Report on Trends in Prevalence of Tobacco Smoking 2000-2025. The report indicates that 27% of the population smoked tobacco in 2000, compared to 20% in 2016. While this may demonstrate progress, the report warns that global and national commitments toward tobacco reduction targets (22% reduction by 2025) are falling behind. Consecutively, on June 1, the WHO Independent High-Level Commission on NCDs published its “Time to Deliver” Report, highlighting the limited progress addressing NCDs. The report reveals that SDG target 3.4, which includes a one-third reduction of premature mortality from NCDs through prevention and treatment by 2030, may not be met due in part to the inaction from multiple national governments in following through with the commitments that they have made to tackle NCDs. In the midst of these reports, WHO shared its new goal to reduce physical inactivity in adults by 15% by 2030 through the Global Action Plan on Physical Activity 2018-2030. We encourage the advocacy community to use these WHO reports and recommendations to demonstrate the need for continued and additional support from governments and donors.

A New Global Gag Rule Report Points Toward a Significant Scale Down of Services
On June 5, the Center for Health and Gender Equity (CHANGE) released its “Prescribing Chaos in Global Health Report,” scanning the effects of the expanded Mexico City Policy, a U.S. government policy blocking funding to international NGOs providing services associated with family planning. The report demonstrates the reach of the policy among existing programs, which include, but are not limited to, sexual and reproductive health services. Other services affected include HIV and AIDS prevention and treatment programs, water, sanitation, and hygiene (WASH), and nutrition programs. While some programs have found flexibility to maintain funding levels, other programs have suffered in terms of potential future partnerships. CHANGE and others are continuing to collect impact stories from the community.

NEWS BITES

May 18: The Johns Hopkins Bloomberg School of Public Health is looking to recruit a diverse range of organizations and fellowship applicants for its Bloomberg Fellows Program. Potential fellows will have the opportunity to complete fully-funded Master of Public Health degrees.

June 1: The Centers for Disease Control and Prevention announced a call for abstracts for their International Conference on Emerging Infectious Diseases. Abstract submission is open until June 22.

June 4: The Medtronic Foundation is seeking innovators and advocates for the Bakken Invitation, which brings together patients who “Live On” through their advocacy contributions, “Give On” through their innovation, and “Dream On” through their vision of a better world. Applicants are encouraged to apply by July 18.

June 4: Civil society representatives identified multiple priorities in order to realize an impactful political declaration to end Tuberculosis at an Interactive Civil Society Hearing in NewYork City. This is one event, supported by the Stop TB Partnership and WHO, in the lead up to the UN High-Level Meeting on TB (September 26). Watch the recording of the hearing.

June 6: In recent news from the Ebola outbreak in the Democratic Republic of Congo, five investigational drugs have been approved for compassionate use in treating the disease. View more information on WHO’s response strategy. Also, see Gavi’s statement of support regarding the ongoing Ebola vaccine campaign.

Advocacy Update ~ June 11, 2018

This post was written by Danielle Heiberg, Senior Policy and Advocacy Manager, and Melissa Chacko, Policy Associate.

White House Withdraws Ebola Rescission

Early last week, the White House made a number of modifications to its proposed rescission package, including a removal of the rescission of $252 million in remaining unobligated Ebola response funding. The modifications to the package were expected after pushback from a number of Congressional Republicans on several of the proposed rescissions, including the Ebola response funding.  Late last week, the House voted on it modified bill, H.R. 3. The Senate has until June 22 to act on the rescission package, but it remains unclear if it will act on it. (Read more about the rescission process.)

The timing of the withdrawal also comes shortly after the administration committed an additional $7 million to respond to the current Ebola outbreak in the Democratic Republic of Congo. Health and Human Services Secretary Alex Azar announced the additional funding during the World Health Assembly in Geneva in late May. Read the Global Health Security Roundtable’s statement on the funding commitment.

The White House is reportedly working on another rescission package targeting unobligated funding from Fiscal Year (FY) 2018. The International Development Budget is expected to be a target and proposed rescissions will reflect the administration’s budget requests for FY2018 and FY2019.

FY19 Appropriations: Update on Bills and Pompeo Testifies on State Department Budget

Congress remains committed to completing the FY2019 appropriations process by the end of the fiscal year on September 30, with markups of the individual bills expected to begin this month. Last week, Senate Majority Leader Mitch McConnell (R-KY) canceled three weeks of the Senate August recess, in order to work on nominations and appropriations. The House is still expected to take all of August off. Despite all of this, many Beltway-insiders still expect that a Continuing Resolution (CR) will be needed to keep the government open after September.

In late May, Secretary of State Mike Pompeo testified in front of the House Foreign Affairs Committee and the Senate Foreign Relations Committee on the Fiscal Year (FY) 2019 State Department budget. Both hearings focused on a range of foreign policy issues including North Korea, Iran, and South Sudan, and on diplomatic security. There was little emphasis on global health issues. However, Representative Ami Bera (D-CA) and Representative Eliot Engel (D-NY) were concerned by the President’s rescission package which includes a $252 million cut to remaining unobligated Ebola response funding from the International Disaster Assistance (IDA) account at USAID (the White House has since withdrawn this rescission; see item above). In the Senate, Senator Jeff Merkley (D-OR) pushed on the administration invoking the Kemp-Kasten amendment and the withholding of funds from UNFPA without any evidence, to which Secretary Pompeo responded that he would follow up on the question.

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