on Wednesday, 30 August 2023.

Dear Colleagues,

Here is a discussion for our consideration and action at this time.

As the world prepares for the United Nations General Assembly (UNGA) in New York in September 2023, it is important for us to prepare ourselves ideologically for this event. The theme for the UN High-Level Meeting on UHC is Universal Health Coverage: expanding our ambition for health and well-being in a post-COVID world.
We need to remind ourselves of the basics; namely, that health of the people is a precondition for productive lives. The right to life is also a right to health and a right to responsive health systems. The quality of life varies between regions and within countries; where in some cases there is unacceptable poverty, and a lack of social justice and equity. This is in a world that is connected, interdependent, and globalized with knowledge and resources to achieve UHC but sadly lacks the will and organizational capacity needed to expand and achieve our ambition enshrined in the SDGs. Our response to the existential threat of Climate change is also constrained by our inability to mobilize for collective action.

There are admirable achievements such as the negotiation of the SDGs, rolling out Global Health Initiatives such as GAVI and the Global Fund for AIDs, TB, and Malaria, and UN Agencies like WHO, and UNICEF. The ability of these agencies to achieve UHC that leaves no one behind cannot be realized until the people themselves are reached and engaged through PHC is owned and driven by the communities themselves and where the people participate as a duty and a right using the currently available resources.

Achieving UHC is also challenged by the quality of partnerships between countries in implementing PHC and reaching communities. Some countries and their institutions are donors while others are recipients of aid for health. Many conferences have been held on aid effectiveness and there are good practice guidelines that are not generally followed. However, in my experience, if aid-receiving countries take the leadership and are clear about what results they aim to achieve with the aid, donors are likely to follow. The implementing individuals from both sides need to be prepared for their roles and be personally committed to improving health.

There are also commercial determinants of health which are private sector activities and products that are detrimental or promotive of population health. Country health systems and corporate national and global institutions need to be awake to these and guide their populations accordingly as well during the negotiation of contracts and trade deals.

The role of civil society organizations and academic institutions in mobilizing for UHC is critical. The contribution of these institutions is through holding governments and duty bearers to account and creating a climate of opinion among communities, countries, regions, and globally that enables to adoption and implementation of health-promoting policies. The health of the people cannot be left to the market. The COVID-19 pandemic has demonstrated the centrality of strong and resilient health systems in all countries. The COVID-19 experience provides all countries with an opportunity to rethink the priority of health systems in their national plans. The pressures for resources in every economy are many but keeping the heath agenda visible and funded is popular with the people who value their health highly. Population health should be a visible issue over which elections are won and lost in all countries.

This week, I am attending the WHO African Regional Health Ministers conference in Gaborone, Botswana. What has struck me here is the observation that there are African countries that are high performers in achieving health goals and at the same time there are countries where health indices are depressing. The difference between the two appears to be the level of political commitment to population health and political and social stability.

This discussion cannot be complete without referring to Human Resources for Health who are responsible for implementing health plans and running health systems. There is a global health workforce (HWF) crisis that was recognized over twenty years ago and is characterized by widespread shortages, mal-distribution and poor working conditions. I served in the past as Executive Director of the Global HWF Alliance at WHO and continue to follow this subject closely. I am disappointed to note that global interest in this subject has declined and the agenda is underfunded. HWF migration from the poor to the rich countries is rampant and out of control partly fueled by push factors of poor working conditions, low pay, and unemployment in low-income countries. The WHO Code on the International Recruitment of Health Personnel which was adopted by the World Health Assembly in 2010 is available to guide HWF migration. This Code provides for the training of a global pool of HWF to be shared using the Code. However, this is not happening which poses a threat to our ability to achieve UHC and global health security.

It is my prayer that the UNGA in September 2023 will address the above issues and become an effective vehicle for mobilizing the right climate of opinion, global solidarity, and harmony for expanding our ambition for health and well-being in a post-COVID world.

What are going to do about all this?



Comments (3)

  • Prof. Miriam Khamadi Were

    Prof. Miriam Khamadi Were

    30 August 2023 at 13:00 |
    Dear Francis,

    Thank you very much for the clear presentation of challenges that need to be successfully
    addressed for the world to achieve UHC. I very much hope the world will rise and address
    these challenges.

    Maybe there is a need for you, Dr. Francis Omaswa, to be designated as
    the leader to work with existing organisations to actually achieve UHC globally but
    at least in Africa!!!!
  • Prof Lovemore Gwanzura

    Prof Lovemore Gwanzura

    01 September 2023 at 09:53 |
    Dear Prof Omaswa
    Brilliant as usual. I however note with interest that while you are advocating for Human Resources for Health in Africa who are responsible for implementing health plans and running health systems, The world. On the other hand end are busy undermining the human aspect with AI (artificial intelligence).

    Africa for that matter is busy coping just for the sake of being part of the fourth industrial revolution by cutting out training for that human sector in the medical field at many levels inclusive of tertiary training because very one thinks that is advancement as the MASTER dictates. For Africa to have 5 6 or 10 versions of internet levels and facilities to support to a village level or rural area where the populous is. It will take us a long time yet here we are already destroying what we have archived so far . This may be as long as it will be another 50 years.
    IT and its AI impact will take long for Africa let us not just copycat. Let us think first and save the current Human Resources for health that we have trained. So far and in fact continue doing the same. While slowly compassing the new technology

    Long Time stay blessed
  • Christopher Samkange

    Christopher Samkange

    05 September 2023 at 09:47 |
    Dear Francis

    I am always impressed with how clearly you articulate issues

    As UNGAss approaches, it is well for us to all recognize how dependent we are on the degree of understanding and commitment to the issues surrounding UHC by our political masters.

    Especially those of us who claim to be academics, we must rise above our natural tendencies to:
    think it is too difficult to explain to politicians what is, after all, a highly technical concept while we know very well they have >100% control over the national purse;
    continue, as trainers of bureaucrats, to minimize our responsibilities in not teaching enough social responsibility and accountability when we teach our undergraduates and postgraduates the concepts of social impacts of decision-making.

    It is important that health professionals are forever mindful of the finite nature of the national cake and we are responsible for how it is shared. How many of our practices indicate our consciousness of our contribution of maldistribution of resources and the need to have targeted deployment of resources in order to better achieve UHC?

    Those of us who manage Human Resources for Health how much care do we give towards the relevance of training programs and, especially the modules therein? How much attention do we pay to re-skilling and deployment as our HRH develop their career paths? How much do we respect personal development goals and align them with the national agenda? Or do we just use available resources and cry how ineffective they turn out to be?

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