PMAC 2020

Parallel Session 3.4

Solidarity & UHC – Leadership for Change

Saturday, 1^st February 2020

Eamonn Murphy, Ann Keeling, Ana Santos, Sabrina Rasheed, Tracey Naledi,

Justin Koonin, Tomas Reinoso Medrano

Side Meeting
Opening Session
Plenary Session 0
Plenary Session 1

Parallel Session 1.2
Parallel Session 1.4
Plenary Session 2
Parallel Session 2.1

Parallel Session 2.2
Parallel Session 2.3
Parallel Session 2.5
Parallel Session 3.2

Parallel Session 3.4

Health is a political movement. This statement can be proven from the grassroot AIDS solidarity mass movement that occurred during the 80s and 90s in the past.  Universal health coverage is no exception.  For universal health coverage to work, it is necessary for multisectoral engagement with communities and civil society as the central of the movement. Active roles and leadership from civil society are needed to reach vulnerable and marginalized population such as people with HIV, drug users, sexual minority and many more.

Solidarity is an important aspect in mainstreaming the marginalized and vulnerable populations in the global UHC agenda. As mentioned in this session, lesson learned from Cuba is that no UHC can be achieved without health professionals trained on solidarity as a moral value and the role of state to provide quality services.  Coordination and support of all sectors and civil society are important to address health social determinants. 

PMAC 2020

Parallel Session 3.2

Artificial Intelligence and Digital Health Opportunities and Risks

Saturday, 1^st February 2020

Ashish Jha, John Wong, Pradeep Haldar, Parry Aftab

Side Meeting
Opening Session
Plenary Session 0
Plenary Session 1

Parallel Session 1.2
Parallel Session 1.4
Plenary Session 2
Parallel Session 2.1

Parallel Session 2.2
Parallel Session 2.3
Parallel Session 2.5
Parallel Session 3.2

Parallel Session 3.4

New technologies and digital innovation could revolutionize health care by becoming a tool that could overcome the challenges faced for the progress toward UHC. Various evidences have proven that usage of artificial intelligence will allow improvement of the wellbeing of an individual or a population, decreasing the cost of health services, increasing the patient awareness of their own welfare with the health system, and also improving the health provider experience which will lead to better service deliveries.

However, such innovations are not without any shortcomings. For instances, there may be bias in the algorithm system due to insufficient amount of data collected, risks of breakdown of an already fragile system, the concern on equitable access, cost of the technologies and obstacle on property rights, and importantly ethical concerns and risks regarding patients’ confidentiality. This session suggested solutions, including through implementing correct data set, innovate new approach for governance and regulations, new model for thinking about ethics, and lastly start a collaboration with NGOs, co-hosts of events, medical doctors, medical students, nurses, practitioners, and providers, but leave WHO as the last one.

Artificial intelligence (AI) may be able to help with misdiagnosis and can outperform human capabilities in terms of visual identification in 5-10 years to come. On the other hand, current AI have not reached the desired optimal performance and furthermore general public have the tendencies to resist change in how they usually do things so adapting the technology will be challenging. All things considered, the innovations and artificial intelligence have their own merits and shortcomings and need to be careful on utilizing it.

PMAC 2020

Parallel Session 2.5

Assessing Health Interventions for a Fair, Efficient and Sustainable UHC

Saturday, 1^st February 2020

Teo Yik Ying, Chhorvann Chhea, Kenji Shibuya, Walaiporn Patcharanarumol,

Erica Di Ruggiero, Stephanie Anne Lim Co

Side Meeting
Opening Session
Plenary Session 0
Plenary Session 1

Parallel Session 1.2
Parallel Session 1.4
Plenary Session 2
Parallel Session 2.1

Parallel Session 2.2
Parallel Session 2.3
Parallel Session 2.5
Parallel Session 3.2

Parallel Session 3.4

Universal Health Care (UHC) has two general dimensions namely multi-sectorial advocacy for health programs and efficient delivery of interventions. Assessment of health interventions for UHC quality in the context of the aforementioned dimensions is essential to ensure its sustained success. UHC assessment has to be a regular activity for governments and funding agencies to effectively design and extend dynamic health packages that are relevant to the people’s ever-changing needs.

Affordability, accessibility, quality and sustainability among key indicators in assessing UHC underscored the complexity of the decision-making processes in health assessment.  UHC assessment should not only about fiscal space but also on how resources are mobilized and how effective these are on a national and international level.

Funding agencies have to proactively identify indicators that reflect not just health output which are usually the emphasis of impact assessments, but the health delivery systems and processes as well.  There is a need to identify parameters that are sensitive and fair to the contexts of the local communities and using current systems and technology that measure UHC success indicators can be improved.  Collaboration and transparency among all stakeholders are keys to achieve UHC’s sustainability, adequacy, fairness and efficiency.

PMAC 2020

Parallel Session 2.3

Leveraging Strategic Purchasing for UHC through Strengthened Governance

Saturday, 1^st February 2020

Caryn Bredenkamp, Grace Kabaniha, Loraine Hawkins, Jack Langenbrunner, Lydia DsaneSelby,     Jadej Thammatch-aree, Jin Xu

Side Meeting
Opening Session
Plenary Session 0
Plenary Session 1

Parallel Session 1.2
Parallel Session 1.4
Plenary Session 2
Parallel Session 2.1

Parallel Session 2.2
Parallel Session 2.3
Parallel Session 2.5
Parallel Session 3.2

Parallel Session 3.4

This session draw attentions to strategic purchasing as an important health financing function. The objectives of the session are to understand the issues around strategic purchasing and learn from country experiences. Strategic purchasing means actively using the allocation of funds from purchasers to healthcare providers to achieve UHC objectives by using information on provider performance and/or the population’s health needs in how purchasers’ contract, pay and monitor providers. This session identifies two factors that significantly affect strategic purchasing: governance and institutional capacities.

Governance is an overarching health systems function and is about ensuring strategic policy frameworks exist and are combined with effective oversight, coalition-building, regulation, attention to system-design and accountability. In short, it has two main tasks, setting strategic direction and ensuring accountability for use of resources and performance. It operates at system level and agency level.  Countries are situated in the spectrum of health purchasing agencies as an arm of MOH and as an autonomous strategic purchaser. When health purchasing agencies are more autonomous and have higher capacity, they tend to have stronger decision authority over relevant policy levers and are able to generate better outcomes on efficiency, access, financial sustainability.

Strategic purchasing can be significantly influenced by political power. In many countries, politicians and local governments can influence what services to be purchased for whom.  Therefore, matching autonomy and institutional capacities of purchasing agencies are key to improve strategic purchasing.

PMAC 2020

Parallel Session 2.2

Smart Health Financing – Seizing Digital Opportunities

Saturday, 1^st February 2020

Aye Aye Thwin, Christoph Kurowski, Fahdi Dkhimi, Marvin Plotz, Alok Kumar,

Boonchai Kijsanayotin, Monique Dolfing-Vogelenzang, Oliver Groene, Sonia Ancellin Panzani

Side Meeting
Opening Session
Plenary Session 0
Plenary Session 1

Parallel Session 1.2
Parallel Session 1.4
Plenary Session 2
Parallel Session 2.1

Parallel Session 2.2
Parallel Session 2.3
Parallel Session 2.5
Parallel Session 3.2

Parallel Session 3.4

Digitization has opened various opportunities for the health sector to enhance its performance and accelerating growth towards UHC.  There are opportunities for digital financing in improving real time data, analytics (AI and big data), and balancing patient engagement (e.g. feedback, verification).  Some remarkable examples from each country such as in Thailand, standardize data collection to compare drug demand and pricing, in India, collect the biometrics data as part of patient’s profile and create a data network, enable a better referral system between hospitals, covering 500 million people, and in Burkina Faso, monitor drug cost and efficiency to reduce prescription, create e-platform for a better report system. 

Instead, constantly getting more connected, there are some challenges in addressing the technological gap (data infrastructure, inoperability, privacy) and managing the adaptive “human factor” (fragmented data architecture, weak regulation, risk related to data privacy, need for substantial change management).  It needs effort to regulate the digital opportunities in order to be more focus on data privacy, transparency, and how to collect and use the data more efficiently.  To increase cross-platform interoperability, a generalized standard should be developed to integrate data from various databases.  Leadership and vision of the government are also needed, as well as using data for decision-making and its role on issuing regulations.  Need to invest in enhancing human readiness for digital transformation, particularly on people’s digital literacy, skills, capacity building, and etc.

PMAC 2020

Parallel Session 2.1

Making and Using (Fiscal) Space for UHC

Saturday, 1^st February 2020

Sheena Chhabra, Ajay Tandon, Marielle Bemelmans, Thant Sin Htoo,

Joseph Kutzin, Nathaniel Otoo

Side Meeting
Opening Session
Plenary Session 0
Plenary Session 1

Parallel Session 1.2
Parallel Session 1.4
Plenary Session 2
Parallel Session 2.1

Parallel Session 2.2
Parallel Session 2.3
Parallel Session 2.5
Parallel Session 3.2

Parallel Session 3.4

Public financing is essential for universal health coverage. However, for LMICs, increasing public funding is difficult thing to do. There is also the issue of low budget execution, the existence of gap between allocation and expenditure, where some countries are unable to use all the budgeted resources for health.   This session suggested solutions to assist in solving problems related to financial aspect of UHC. To bring fiscal space in favor for health sector, some actions that could be taken are addressing the overall macro/fiscal issue such as through tax reform, re-prioritized which for instance by focusing on primary health care, reformation of public finance management which maybe done through output-based budget allocation.

Furthermore, civil society organizations also could contribute in fiscal space debate, including advocacy for expanding fiscal space for health, providing a platform for shared understanding of fiscal space for health, and facilitating government accountability. In addition, it is also suggested that in order to engage ministry of finance, ministry of health needs to present evidence on the impact of health investment, that is, how the investment in health improves not only health outcomes but also contributes to development of human capital and economy of the country.

PMAC 2020

Plenary Session 2

Making Health Financing for UHC SAFE

Saturday, 1^st February 2020

Kara Hanson, Lydia DsaneSelby, Holger Michiel Van Eden, Agnes Soucat,

Yasuhisa Shiozaki, K. Srinath Reddy 

Side Meeting
Opening Session
Plenary Session 0
Plenary Session 1

Parallel Session 1.2
Parallel Session 1.4
Plenary Session 2
Parallel Session 2.1

Parallel Session 2.2
Parallel Session 2.3
Parallel Session 2.5
Parallel Session 3.2

Parallel Session 3.4

Investment on health service is essential especially on primary health care.  If the countries have a right health financing, they will always ready for outbreak or pandemic situation.  Each country could choose their own mode of financing, either blended financing which will be very useful or very risky.  It still needs public private financing.  Since public spending is growing, in the other side, private spending is growing rapidly in 10%.  The combination of public and private financing should be agreeable.  On demand and supply side, it needs to be streamlined and minimal co-payment.

Spending better financing could be achieved by using data for cost efficiency, utilizing digital technology to increase access to health care  especially primary health care in remote area, changing the narrative in health seeking behavior, giving precise information and supported regulation, ensure that the poor could reach the effective cost and equity in health service.  Some strategies for those could be fully subsidized in chronic diseases, fully subsidized in preventive care, or co-payment.

PMAC 2020

Parallel Session 1.4

Addressing the Political Economy of UHC

Friday, 31^st January 2020

Gabriel Leung, Beverly Ho, Jacqueline Kitulu, Chalermsak Kittitrakul, Jesse Bump

Side Meeting
Opening Session
Plenary Session 0
Plenary Session 1

Parallel Session 1.2
Parallel Session 1.4
Plenary Session 2
Parallel Session 2.1

Parallel Session 2.2
Parallel Session 2.3
Parallel Session 2.5
Parallel Session 3.2

Parallel Session 3.4

Political economy is inevitably involved in the system of universal health coverage. Problems could come from the government of a nation, for instance, power game which influence the allocation of resources, subsidizing informal non-poor citizens, and challenge to maintain UHC momentum with changing governments. Issues also can arise from global level, where there could be misalignment of goals between donors and recipient countries, and also from pharmaceutical sector where they impose unaffordable highly prices that make domestic financing of UHC challenging.

Overcoming those challenges require the cooperation and communication between and also within multinational to multisectoral approach. International agreements can be conducted to bring down drug prices. However, the solutions should not be only limited from international partners, but also from the support of multiple local stakeholders either from the government or private sectors. Responsibilities should be divided among the stakeholders to ensure accountability; laws could be implemented to define the structures and to delineate the roles of different stakeholders. In parallel, it is also crucial to increase the people’s sense of ownership, which will subsequently protect the system.

Universal health coverage was formulated at the end of one era (the latest cycle of globalization and the end of industrial revolution 3.0); it is now being implemented and monitored at the start of a new and very different era (age of uncertainty, nationalism, reduced solidarity, start of industrial revolution 4.0). Effort are needed to sustain work around UHC and to translate rhetoric into concrete actions.

PMAC 2020

Parallel Session 1.2

Investing in the Health Workforce for the 21st Century

Friday, 31^st January 2020

Kumanan Rasanathan, Tomas Zapata, Ann Keeling, Donela Besada, Sunil De Alwis, Ayat Abuagla, James Buchan

Side Meeting
Opening Session
Plenary Session 0
Plenary Session 1

Parallel Session 1.2
Parallel Session 1.4
Plenary Session 2
Parallel Session 2.1

Parallel Session 2.2
Parallel Session 2.3
Parallel Session 2.5
Parallel Session 3.2

Parallel Session 3.4

Health workforces have major role to play for smooth execution of health care system. They act as the frontline of health services that often come in contact directly to the patients or located close with the people. Thus, it is expected that the quality of health workforce services will mirror the satisfaction and overall result of wellbeing of a patient or a community.  Producing quality health workforce will require to pay attention to their welfare as an individual along with providing environment where they could thrive to their full potential.

Sometimes, problems may arise where there are gender segregation, gender inequity, and sexual harassment occurring in the workforce environment. For such situation, laws to prevent sexual harassment could be implemented, where the solution can be further supported by having quotas in health workforce to ensure adequate representation of women including women in leadership. There may also be situation where there are unpaid and unrecognized community health workers as well as inadequate number of workforces, high turnover rates and migrations. The government could tackle those problems by creating evidence-based policy to support priority area and aligned national priorities through decentralized approach.  Molding an already established system, or introducing a new one will entail to substantial amount of resources. However, it is crucial to regard health workforce as an investment, rather than cost.

PMAC 2020

Plenary Session 1

Implementation Challenges and Innovative Solutions for UHC 2030

Friday, 31^st January 2020

Naoko Yamamoto, Beverly Ho, Erica Di Ruggiero, Justin Koonin, Takao Toda, Koku Awanoor 

Side Meeting
Opening Session
Plenary Session 0
Plenary Session 1

Parallel Session 1.2
Parallel Session 1.4
Plenary Session 2
Parallel Session 2.1

Parallel Session 2.2
Parallel Session 2.3
Parallel Session 2.5
Parallel Session 3.2

Parallel Session 3.4

Achieving effective universal health coverage undoubted will confront many challenges which can come from various area of systems. Some of the current system had shown the inadequate attention given to health promotion and prevention sector, which can be seen by the insufficient investment in their evidence-based policies, resources  prioritize on secondary health care, shortage of workforce in term of number or skill and in general lack of government support whether in funding or decisions in that particular field. In addition, problems may also arise from operational aspect of the UHC itself, as well as complications that may arise from multisectoral engagement in separated fields relating to health. Not only from the technical aspect, the bias patients may receive have to be taken into account as well, whether it’s the inaccessibility of the marginalized groups on health care, stigma surround LGBTQ community or some races, and other similar discrimination acts that may hinder effective UHC. 

It is essential for those challenges to be addressed for the progress of UHC. The solutions can be acted upon multiple level of scale. Globally, countries that relatively have success in their hometown could share their knowledge to others, that subsequently tailored to country’s context. On a national level, the government could promote social participation to ensure trust and accountability between them and their people, as well as investing in health promotion and evidence-based research to ensure long term sustainability. When we go down to the operational level, the focus can be given to the health workforce, where capacity training such as collaboration across multisector can be given to all without leaving anyone behind. 

Innovative solutions are needed to overcome challenges for the progression of the system. Through multisectoral approach, that is collaboration among various stakeholder groups and private sectors, as well as multinational cooperation, UHC 2030 can be jointly attained.