Speech delivered at the Policy Roundtable, Kaiser Family Foundation and Center for Strategic and International Studies Global Health Policy Center
Thank you for having me. I’m really glad that you started with mentioning this tragic event over the weekend. It’s really sad. He was a young epidemiologist and he was only saving lives. It’s his commitment to people’s lives that made people so sad when he was killed. Thank you so much for your kind words.
That attack on him is affecting our programme now. Many of our colleagues are very shocked and our field operation has been significantly affected
I will be travelling to Butembo tomorrow to stabilize our staff, to show solidarity and to discuss with MUNUSCO on improving, beefing up the protection.
Still this attack should strengthen our resolve and should be a message for all of us to fight even harder. That’s how we can respect the friend and colleague, Richard, who we just lost, and we will remember him and strengthen our response to finish Ebola in DRC.
Dr Chris Murray, professor and director at the Institute for Health Metrics and Evaluation
Dr Joseph Dieleman, from the Institute for Health Metrics and Evaluation
Dr Loyce Pace, President and CEO of Global Health Council
Mr Chris Collins, President of Friends of the Global Fight
Dr Jennifer Kates, vice president and director at the Kaiser Family Foundation
Stephen Morrison, senior vice president and director of the CSIS Global Health Policy Center
Good morning.
It’s an honour to be invited to take part in this important event. I’m really sorry that I cannot be with you in person.
We are witnessing a profound and positive transformation in global health financing.
In February this year, WHO launched a report, “Public spending on health: a closer look at global trends,” that shows total health spending around the world is growing faster on average than the rest of the global economy, accounting for 10%
of global Gross Domestic Product.
In low- and middle-income countries, health spending is growing fastest, with average growth of 6% every year, compared with 4% in high-income countries.
Even more importantly, an increasing proportion of health spending – an average of 51% - is coming from domestic public resources, while a decreasing proportion is coming out of people’s own pockets.
That’s reason to celebrate, because it means fewer people are at risk of being pushed into poverty by out-of-pocket health spending.
As you probably know by now, Universal Health Coverage is one of my and WHO’s top priorities. At the heart of our strategic plan is for 1 billion more people to benefit from universal health coverage by 2023.
Ladies and gentlemen,
Universal health coverage is not a luxury that only rich countries can afford.
All countries can make progress with the resources they have.
WHO estimates that 85% of the costs of meeting the Sustainable Development Goal health targets in low- and middle-income countries can be met with domestic resources.
That means universal health coverage is not an economic choice. It’s a political choice.
And it’s a choice that many countries are making.
Just in the past year, Kenya, India, the Philippines, South Africa and other countries have made significant strides towards UHC.
In each case, political leadership at the highest levels was essential.
These examples prove that, with political commitment, all countries can make progress. And they can do so by committing their resources; progressively expanding access to services; and taking other steps to reduce out-of-pocket spending.
Primary health care services must play an essential role in ensuring everyone has access to the health services they need. Primary health care is a good value investment. When countries have quality primary health care available, they can save money and
improve efficiency by reducing expensive hospital admissions.
At the same time, however, WHO’s report on health spending shows that increased domestic health spending does not always translate into increased access to health services.
This is where countries need our support and guidance to make the best investments and get the biggest bang for their health bucks.
More money for health is good. But more health for the money spent is even better.
Sustainable financing for universal health coverage is not just about spending more; it’s about spending smarter, and using innovative ways to raise funds, for example by taxing tobacco, alcohol and other harmful products.
Progress towards UHC is a complex process. WHO does not endorse one specific approach to “health for all”.
We know that country ownership is essential to sustainable progress towards UHC. Every country has a different profile and there is no “one size fits all” approach.
We have a lot of evidence that shows that all countries can reach UHC.
While each country will take a slightly different path, there are clear principles that have emerged from our experience over the past 30 years working with countries at all income levels.
First, countries need to move towards reliance on public funding sources by strengthening domestic tax systems and ensuring health is a priority in resource allocation. This requires political will and insight into the steps that will make a country stronger
across-the-board, above and beyond specific health indicators.
Within a well-designed national health financing strategy, private health insurance can play an important complementary role. But domestic public financing is the bedrock of universal health coverage. No country has ever achieved UHC by relying mainly
on voluntary private funding.
Second, fiscal policy actions, such as increased taxes on tobacco, alcohol and sugar, as well as carbon emissions, are proven ways to raise funds and improve health at the same time. These also require political will along with an enlightened social consensus.
Third, funds should be pooled to reduce inefficiencies created by duplicative approaches, such as silos created by disease-specific programmes. To put it another way, pooling of funds empowers countries to take a holistic approach to providing access
to healthcare, an approach that is aligned with the course of each person’s life.
Fourth, countries need strong institutions – excellent people, information systems and decision-making processes –so that resources are allocated based on provider performance and the health needs of the people they serve. Weak institutions
breed weak access to healthcare.
External aid accounts for less than 1% of total health spending and recent numbers show it is declining overall However, it remains important for low-income countries where it represents about one-third of health expenditures on average. It is essential
that these countries receive more streamlined and comprehensive external support to strengthen their national health financing institutions.
At the same time, these countries need to develop their domestic financing systems to make more effective use of resources, both external and from within.
The Global Action Plan for Healthy Lives and Well-being is supporting country action on building sustainable financing. Partners -- including the World Bank, the Global Fund, Gavi, GFF and others -- are working with the WHO-hosted Health Financing Collaborative
to set harmonized approaches, instruments and methods of work across agencies. These global public goods are integral to the broad UHC2030 partnership.
Health spending is not a cost. It’s an investment.
Health is a driver of economic growth and a platform for sustainable development.
Health creates jobs. It drives productivity. It stimulates inclusive growth. And it protects economies from the impacts of outbreaks and other emergencies.
Investments in health in recent decades have already generated a huge payoff in terms of human capital. Between 2000 and 2016, global life expectancy increased by 5.5 years.
We have prevented millions of cases of -- and deaths from -- HIV, malaria and TB.
There are millions of women alive today who 20 years ago would not have survived childbirth.
There are millions of children alive today who 20 years ago would not have survived to their fifth birthday, thanks to improvements in access to health services -- particularly vaccinations against deadly diseases like measles and diphtheria.
Countries that invest in building resilient health systems, based on strong primary health care, are making investments that will pay rich dividends for decades to come.
Governments have a key role to play in ensuring everyone, no matter who they are or where they live, has access to health services. We must not leave anyone behind.
As we work together to support countries on their journey towards universal health coverage, we are not just working for a healthier world.
We are also working for a safer, fairer and more prosperous world for everyone, everywhere.
I thank specially Steve Morrison for inviting me and making my participation happen.
Thank you everyone.