Taking action for universal health coverage: How do we ensure that our health systems protect everyone?

The COVID-19 pandemic is pushing health systems around the world to the limit, having an immense impact on the way in which we all live. Local governments play a crucial role in health care planning and implementation and need to be part of global health conversations

A webinar, co-moderated by Githinji Gitahi, Co-chair UHC2030 and Emilia Saiz, Secretary General of UCLG took place on 14 July to initiate a dialogue process between representatives from local governments and UHC2030 partners who represent a range of stakeholders including national governments, international organizations, civil society, philanthropic foundations and private sector, focusing on how to envision the future of health services and the critical role that local governments can play to ensure that no-one is left behind.

The richness of the dialogue showed the importance of listening to the critical voice of local leaders, who are at the forefront of responding to the COVID-19 crisis and show how public service is critical for effective health emergency response.

Githinji Gitahi and Emilia Saiz introduced the event by welcoming such a dialogue given that the SDGs require local action under the direct responsibility from local authorities. Local governments have a crucial role in delivering a range of services that necessary to achieve UHC that is based on primary health care and includes primary care, multi-sector action and community empowerment. In fact, the local government constituency is responsible for delivering around 65% of the Sustainable Development Goal (SDG) targets.

“This pandemic shows that local service delivery is truly a backbone of the sanitary systems, that cannot solve crises like these by themselves. This dialogue is critical to bring the movement of universal healthcare and the local governments movement together, to ensure we can solve the health challenges of the urban era,” said Ms. Emilia Saiz, UCLG Secretary General and member of the UHC Movement Political Advisory Panel, UHC2030

“Even with political desire, and political will, it will be very difficult to achieve UHC without the local and regional governments that are in contact with citizens. The importance of local action cannot be understated when it comes to UHC or achieving the SDGs,” said Dr. Githinji Gitahi, Co-chair of the Steering Committee of UHC2030 and Group CEO, Amref Health Africa

The first panel looked at the experience of local governments in the COVID-19 response and what we need to learn from the reality of communities directly affected by the pandemic. Examples demonstrated the effectiveness of using technology to ensure greater access to health care during lockdowns or involving civil society and community organizations to reach out to the most vulnerable such as people with disability but also the additional challenges faced by local governments with inadequate support from central governments or areas affected by conflicts and security.

Dr. Mohamed Boudra, President of UCLG, Mayor of Al-Hoceima, Morocco, said that during the pandemic, local policies and basic services have underscored guidelines provided by scientific communities, and have tried to focus on the most vulnerable populations. These experiences led to the elaboration of the UCLG Decalogue, which aims to ensure a sustainable transition mindful of the sacrifices communities have made.

Ms. Patricia Monthe, Founder and CEO of MedXCare and PSC Core Action Group Member, UHC2030, argued that technology and telemedicine with a focus on patient-driven approaches had been key during the pandemic to improve access to healthcare and connect with people at home.

Dr. Githinji Gitahi, Co-chair of the Steering Committee of UHC2030 and Group CEO, Amref Health Africa called on “fiscal devolvement” as a critical aspect to ensure that local and regional governments have enough resources to carry out the local provision of health to their communities.

Mr. Musa Hadid, Mayor of Ramallah, Palestine said that while COVID-19 has brought further instabilities to local authorities they were the first to respond to the needs of citizens during the crisis.

Ms. Smitha Sadasivan, CSEM Advisory Group Member / Member of Working Committee, Multiple Sclerosis Society of India, Chennai noted the importance of communities and civil society organisations (CSOs) in the COVID-19 response to serve as a bridge between the government and communities. CSOs helped set up support systems such as help lines and information. She also reiterated the CSEM priority to call for increased public health financing and social protection as well as better date on vulnerability to ensure that on one is left behind.

Ms. Khadija Ahmadi, Mayor of Nili, Afghanistan argued that we need to look at ‪UHC from a global perspective. We are interconnected around the world and all countries need support for better health systems. We also need greater contributions from the national to the local governments who are at the frontline of the COVID-19 response.

The second panel focused on what we need to do differently to be better prepared for emergencies as well as make progress on UHC, making the case for: integration of public health into all levels of government; collaboration across all levels of government as well as decentralization which includes power and resources; and a whole of society approach and people’s empowerment, to ensure accountability and effective action.

Ms. Midori de Habich, Economist and former Minister of Health, Peru suggested that we build on the ‪UHC movement, and ensure key balances in the health system around continuity of care at all levels from primary upwards, pprovision of essential health services, avoiding vertical short-term responses and incorporating public health functions into health systems.

Mr. Jean Pierre Elong Mbassi, Secretary General of UCLG Africa argued that over 60% of diseases are caused by poor environmental situations and therefore we put too much attention on curative medicine. He advocates putting local people at the centre of health decisions and empowering them.

Dr. Vytenis Povilas Andriukaitis, UHC Movement Political Advisory Panel / Former European Commissioner for Health and Food Safety argued for more solidarity around the world, with good cooperation and collaboration.  Change needs to happen at all government levels with more emphasis on preparedness and equal access according to needs.

Mr. Carlos Martínez, Mayor of Soria, Spain, UCLG Envoy for the Urban Agenda said that public health should be part of all public policies and services and the only way to guarantee the health of the economy is to guarantee the health of the people.

Ms. Joy Phumaphi, Co-Chair, Independent Accountability Panel for Every Woman Every Child said that all decisions need to be made upon evidence and rule of law. A whole of government and a whole of community approach is crucial and the institutionalization of accountability should involves monitoring, review and recommendations paired with remedy and action.”

‪Ms. María Fernanda Espinosa Garcés, UHC Movement Political Advisory Panel and President of the 73rd Session of the UN General Assembly argued that inclusive and participatory decision making are needed for all health strategies. CSOs, women and indigenous people have not been included in ‪COVID-19 decision making and a multi stakeholder approach is needed for effective action for ‪UHC and COVID-19 responses. She also announced the process to compile a multi-stakeholder review “The State of UHC Commitment” and the launch of the UHC Survey to hear people’s voices about UHC commitments in action.

Ms. Carola Gunnarsson, Lord Mayor of Sala Municipality and First Vice President of the Swedish Association of Local Authorities and Regions said it is important to involve local and regional governments to find solutions for the future. When involving local and regional governments, it is also a way of protecting democracy. Political work must continue even during pandemics, especially in cities and municipalities and we need a stable democratic system. We must not exclude local and regional levels if we want to take care of democracy in the future.

Dr Githinji Gitahi emphasized in his concluding remarks the importance to institutionalise participation and to create the enabling environment for participation. Ms. Emilia Saiz, closed the meeting by saying, “We're delighted to join the UHC movement and look forward to sharing many of the tools being developed by UHC2030. It's the start of a long conversation and lots of action.”

Read the UCLG article about the event

Photo: © WHO / NOOR / Arko Datto