Achieving universal health coverage: from the past to the future Prince Mahidol Award Conference, Bangkok, Thailand
Dr Tedros Adhanom Ghebreyesus
Director-General of the World Health Organization
Your Excellency Dr Piyasakol Sakolsatayadorn, Minister of Public Health;
Your Excellency Mr Virasakdi, Deputy Foreign Minister;
Excellencies, ladies and gentlemen,
Thank you so much, it’s wonderful to be here in Thailand with you.
2018 as you know is a milestone year for WHO.
It’s our 70th birthday – a reminder that the reasons we were created are as relevant now as they were at our beginning.
WHO was founded on the principle that all people should be able to realize their right to the highest possible level of health.
"Health for all" has always been our guiding vision. It’s also the driving force behind our efforts to urge all countries to make progress towards universal health coverage.
But we must acknowledge that 70 years since WHO was created, and 40 years since the Alma Ata Declaration, the dream of health for all remains unfulfilled.
The Global Monitoring Report, launched at the Universal Health Coverage Forum in Tokyo in December, shows us how far we have to go.
At least half the world’s population still lacks access to essential health services – half of the world’s population is behind.
More than 1 billion people live with uncontrolled hypertension;
More than 200 million women lack adequate access to family planning;
Nearly 20 million infants do not receive the vaccinations they need;
And almost 100 million people are pushed into extreme poverty every year because of out-of-pocket health spending.
This is a global problem. In wealthy countries in Europe, Latin America and parts of Asia, which have high levels of access to health services, more and more people spend at least 10 percent of their household budgets on health.
We must face facts. We will not achieve the Sustainable Development Goals if this continues.
To achieve the SDG target on UHC, we need 1 billion more people to have coverage every 5 years between 2016 and 2030.
That is exactly the target we have set in WHO’s new 5-year strategic plan.
Now it’s time for all countries to take decisive action to make that plan a reality.
Last week, at the annual meeting of WHO’s Executive Board, I announced that we are issuing a global challenge to every country to take three concrete steps towards universal health coverage.
I have proposed that at the World Health Assembly in May 2018, as many countries as possible come ready to make commitments about the actions they will take in the next 12 months to increase access to services and reduce out-of-pocket spending.
We’re developing a menu of options from which countries can choose – a menu of best practices.
And we will engage in policy dialogue with all countries to identify gaps and solutions.
But I see plenty of encouraging signs.
A couple of weeks ago I was in Kenya, where the President has just announced that affordable health care will be one of the four pillars of the economy for his second term in office.
Madagascar is starting to roll out a National Health Solidarity Fund to protect people from catastrophic spending.
And just yesterday the Indian government announced a 12% increase in its health budget, which will benefit 500 million people and establish 150,000 health and wellness centres.
As more countries make progress on the journey towards universal health coverage, we will also be looking to those nations with a strong track record on UHC who can share their experience and lessons learned.
Thailand is one of those countries. You are living proof that UHC is achievable and affordable for all countries, at all income levels.
For that reason, it’s appropriate that we are meeting here at the Ministry of Foreign Affairs, instead of the Ministry of Public Health. Your experience is a valuable asset, and must become one of your most valuable exports. That’s why His Excellency the Health Minister said the whole government is needed to make a difference.
Yesterday I had the privilege of seeing your health system up close. I visited the Lumpini public health centre and met with health volunteers, community health workers, other primary care providers and a family.
Maybe I need to tell you about the family I visited. The father has kidney problems, and he was bedridden. Now he’s working. He’s on kidney dialysis.
We met him and his daughter, who takes care of him. I asked them one question: who is covering your expenses? They said, universal health coverage. If the government didn’t cover this, what would have happened? The daughter said, “I would have waited for the day of the death of my father. That’s it, nothing I could have done.”
That’s actually the best example of what UHC can do. The family we visited is a poor family. They can’t afford to cover the expenses for dialysis. But the bedridden father is working because of UHC. This is UHC in action.
I will quote again His Excellency the Minister of Health. The community is involved through its community volunteers, but the family itself, because the daughter actually is the caretaker for her father, meaning there is a community-based element of UHC. The community is owning it and contributing to it. This is a very important factor to sustain UHC.
So there is a strong level of commitment from the government side, and doing its share, which is very important, the political commitment that brings resources, but on the other hand, the community is also complementing it, for instance the daughter of this father, through in-kind contribution, which is labour. So there is community ownership and even responsibility. That is again, as I said earlier, the main element to sustain UHC.
I was so encouraged to see that: political commitment from government, and a community-based approach, community ownership and participation.
Your experience shows that achieving UHC is not quick or easy. It takes time, and it takes sustained political will, and community participation and ownership.
But UHC is not something you achieve once. It must be constantly sustained. You can never afford to rest. There is always room for improvement, there are always opportunities to expand services, and there are always some populations who are being left behind.
For instance, up to 3 million undocumented migrants still have no health insurance in Thailand. Leaving no one behind includes migrants, who are among the most vulnerable populations, and have unique health needs.
Even as you embark on a process of reform, it is vital that the principles of UHC – affordability, quality and equity – are preserved.
WHO stands ready to work with you to find ways of ensuring access to services for this group.
Ladies and gentlemen, Excellencies,
Everyone has a part to play in making UHC a reality.
Governments must bring about policy change to improve health and spur economic growth and social development, like what you’re doing.
Professional associations must work to protect the welfare of health workers.
Civil society organizations must advocate on the ground and represent the concerns of different population groups.
Individuals can use their own voices to demand good health services.
And the media can help to increase understanding of UHC as well as transparency and accountability in policy-making.
WHO’s role is to give countries the best evidence, backed up with world-class technical know-how and relentless political advocacy.
We know that we can count on Thailand for continued leadership and support.
Your own Dr Suwit famously said that in Thailand “we do not talk about UHC, we do it”. That’s what we have seen actually yesterday. That’s what you’re doing.
Congratulations. You’re showing the way. We look forward to working with you very closely in order to use your model to influence other countries, and to tell them that UHC is not just a dream that cannot be realized, it’s a dream, a vision that can be realized, like what’s happening in Thailand.
That motto – that we do not talk about UHC, we do it – that must become our motto in every country, because it’s possible.
Thank you very much. Khob khun krab.