This transcript was automatically generated using speech recognition technology and may differ from the original audio. In citing or otherwise referring to the contents of this podcast, please ensure that you are quoting the recorded audio rather than this transcript.

Zoe: Hello and welcome to the third installment of our podcast on universal health coverage. UHC is a subject we're shining a spotlight on as part of the Lancet's 200th anniversary activities in 2023. I'm Zoe Mullen and I'm the Editor in Chief of the Lancet Global Health and I'm delighted to be joined today by two members of the Coalition Principal Group of UHC 2030, an international multi stakeholder partnership dedicated to universal health coverage.

Justin Koonin is co chair of UHC 2030. He's also a Distinguished Fellow and Honorary Professorial Pharaoh at the George Institute for Global Health. He's also an Adjunct Associate Professor at the Kirby Institute, University of New South Wales, both of those in Australia. And Helga Fogstad is the Executive Director of the Partnership for Paternal, Newborn and Child Health, or PMNCH.

Welcome, Justin. Welcome, Helga. 

Justin: Thanks for having us. 

Zoe: So, Justin, could you give us a short introduction to UHC 2030? Something about its history, its structure, and its mission. 

Justin: Sure. Our history, actually, you can trace back to about 2007 and the Millennium Development Goal, or MDG, era. There was a partnership called IHP plus the international health partnership, and really the focus of that partnership was around effective development cooperation and how to do development better and that operated quite effectively.

And then in 2015, as we know, there was a adoption of the sustainable development goals. And in particular, a CG 3. 8 around universal health coverage. And at that time, a decision was made to transition IHP plus into what we now know is you actually 2030 with a much broader agenda. Around universal health coverage around building stronger health systems around the need to prioritize primary health care and all that comes with all of that.

So that is the history and how it came into being. You actually 2030 as it stands today is a multi stakeholder partnership. We intentionally involve. We try and get everyone from all the different sectors around the table. So we have a steering committee that governs us. And that steering committee comprises member states, nine, three, high income, three, middle income, three, low income civil society organizations, the private sector, philanthropic foundations, multilaterals.

Including our hosts, WHO, the World Bank and OECD, but others as well. We've had GLABI, we've had the Global Fund, UNICEF and others involved. And the intention is really to make sure that all these different actors working towards universal health coverage around the same table on an equal footing. So that is the main governing body of UHG 2030.

We also have, and we're here today, To talk about the coalition of partnerships for UHC and global health, and we're thrilled to have Helga and PMNCH. With us, the point of that partnership is to bring together all of those partnerships and organizations which have stakes in UN processes. So PMNCH, we have UNH, we have Stop TV we have the NCD alliance.

And so that also it's not the governing body of UHC 2030, but it's one of our key initiatives. We have political advisory panel at the moment chaired by Maria Fernanda Espinosa. Who was president of the U. N. General Assembly at the time of the U. S. C. High level meeting in 2019. And the role of that advisory panel is to provide high level political advice to the move.

So it's this constellation of structures. We have our own civil society engagement mechanism with its own secretariat, which currently numbers about 1000 organization in 100 countries. But the constellation is united by the desire to see progress on strengthening health systems for universal health coverage, and it must be said for health security with a focus on primary health care.

Zoe: Great. So you queued up Helga nicely there. So Helga, PMNCH is working with UHC 2030 through this partnership for UHC, the Global Health Coalition. So what does that relationship actually look like in practice? 

Helga: Well, UHC has always been important for PMNCH. They can't we, we used to say before doing the MDGs, and we should continue saying it, that Maternal mortality is a litmus test for a functioning health system, and in fact, it needs to be focused in that way.

So, Zoe, you know, if you take the population of women, children, and adolescents, it is somewhere between 65 to 75 percent of the population, so it's not like, One niche of a very small population, we're really interested in strengthening health systems, but we're interested in strengthening health systems that deliver for women, children, and adults.

And if you do not make that explicit, that does not happen. I mean, today, 270 million women still lack access to, to modern family planning. 5. 6 million abortions each year happen among adolescent girls, and nearly 4 million of them are unfaithful. So, we are still talking a little bit about, you know, this being a critical issue, and we're sliding back.

We, again, made an MDG. They're not there in the right now and, and that's because of COVID, that's because of conflict, that's because of the climate change, you know, we have 10. 5 million children that lost a parent or caregiver to COVID. So, this is the time that we need to all come together and just in the city.

But pay attention to Women, Children and Adolescents because if you don't make it explicit, it doesn't, it doesn't become visible and it doesn't get prioritized at all. Thank you, 

Zoe: Helga. It is important this year and Justin, the UHC 2030 launched a UHC Action Agenda this year. So can you tell us something about that process and briefly take us through the, the eight action areas?

Justin: Sure. And to explain what the Action Agenda is and why it's important, let me backtrack a bit. Okay. And say that as, as your listeners probably know, there's a high level meeting on universal health coverage at the General Assembly this year, 2023 just as there was in 2019 and for these high level meetings the General Assembly produces what's called a modalities resolution, which explains how the meeting will be conducted and in 2023 for this year, just as it was in 2019, UHC 2030 was named as sort of the formal partnership to coordinate input towards the high level meeting.

And for that reason so, so you actually 20, 30 has this formal role. And in 2019, what we did is develop through an extensive series of consultations, what we call the key asked for the, the, the UHC movement. And they were submitted to the president of the general assembly and formed a sort of a key basis for what's known as a zero draft of the, of the political declaration that then gets negotiated by member states.

So we're doing the same thing again in 2023, and this comes. To the role on and the content of the UHC Action Agenda. We conducted in the first part of this year an inclusive multi stakeholder again consultation through all of our UHC 2030 constituencies, all of the ones that I mentioned previously as well as a public consultation, which gathered about 800 responses from over 100 countries.

And the idea was to update the key ask for the UHG movement in light of what we've learned given our extensive experience, good and bad, difficult and, and revelatory as a result of COVID 19. And what we've come up with eight, as you said, eight key action areas, and I won't go through them in great detail, but just to mention what the broad high level areas are, and then, of course, under these, there are specific milestones and much more detail.

But number one is around championing political leadership, universal health coverage, because what we realized if we didn't know it before COVID was that political leadership at the highest level is critical for progress. very much. The second action area is around leaving no one behind. So this is the equity dimension, making sure that the most vulnerable people are prioritized.

There's an action area. The third one on enabling laws and regulations because the legal environment is of course critical to progress in these issues. There's an action area on the health and care workforce. We've seen how critical having. Highly trained, well paid health care workers has been during COVID.

So there's an action area on strengthening the health and care workforce to deliver quality care. Number five, the fifth action area is around, we call it invest more, invest better, because of course you can't make progress in health unless governments invest money in health. And we know that domestic resource mobilization is the, the, the, the core of that progress.

And we have to do it better. We have to invest more efficiently. So that's number five around financing. Number six is around moving together towards universal health coverage. And this is really the multi stakeholder aspect. It's ensuring that efforts to achieve universal health coverage. Of course, the governments have a critical role.

But they have to be whole of society. They have to be multi stakeholder. They have to include civil society, the multilaterals we know and love so well, the private sector, foundations, philanthropy, all of this. So, so there's really an action area around multi stakeholder engagement. What we saw as critical in 2019, again, throughout the pandemic, and again to have Helder at PMNCH here, was the, the, the critical importance of ensuring gender equality in health.

We know, and Helga knows this better than anyone, but the, the 70 percent of the world's healthcare workforce is female, but something like 20%, maybe a quarter in leadership position. So we really need to, and not just in the workforce, but of course in service provision need to ensure gender equality.

That's the seventh action area. And then the eighth, the final one is making this critical link between universal health coverage and health security. We've had so much focus on pandemic preparedness and as appropriate over the last few years, but you can't be prepared for future health emergencies unless you have strong, well functioning health systems.

So it's about making those connections. So those are the eight action areas. And the idea is that we provide a coherent and consistent approach to your agency advocacy, which will inform negotiations and liberations at the high level meeting in, in September this year in New York, but also there are many other processes that are happening this year and beyond.

There's in fact not one but three high level meetings, also one on pandemic preparedness and one on TV. There's also the G7 in Japan. There's also the G20 in India. And there are pandemic accord negotiations and many others. So the idea is that the action agenda informs all of these. 

Zoe: Yeah, that's it. I mean, it's, it's so broad ranging.

It's it covers, it really covers everything. And I think your point about particularly pandemic preparedness and global health security is a key one because we've, we've tended to look at those things separately to, to UHC, but actually UHC is. is fundamental, really, to, to those, to those items. Helga, I was going to ask you a little bit more about those, some of those high level meetings, and, and why, you know, why this year is, is such an important year for UHC, and it, and in fact, for health in general, maybe, maybe for, for women and children, particularly.

Maybe could you could just speak a bit to What you, what you're seeing this year for UHC, what are your hopes? 

Helga: Justin has mentioned some of the you know, the three meetings here in Ungar which is very uplifting. But this year is important because it's the mid, mid March to 2030. And, you know, we're not doing, we're not doing better.

And we're not doing better because of COVID. We're a conflict climate change. But on the other hand, this, this needs more efforts and more concerted efforts. And, you know, to be honest, it was shocking that the SDG and the men paper the starting point for discussions of the SDG progress, for example, only mentioned to help one once.

And so this is why we, you know, have to advocate to put back hell on the highest political agenda. Because as we said in, in, in the last blog and for the health to be prioritized at the highest level, call for a biannual health progress review summit every second year is really critical. And if you don't focus on what they're delivering, what is UHC delivering?

Is it delivering for women? Is it delivering for children? Is it delivering for adolescents? You know, it won't happen. What you count, gets count, count. And so therefore, if it's really important, and an example where gender equality, one of the UHC action agenda areas Justin just mentioned, according to the latest estimate Zoe, gender equality will now take 300 years to achieve.

We're trying to rally the head of states of women. They are so few. So this is, and, and I've just been at the Inter Parliamentarian Assembly. A few women, even young people are like 97 percent of all problem that we need to get the attention. So we're almost 4. 3 billion people of reproductive age do not have access to even one essential reproductive health intervention over the course of their lives, yet it is fundamental.

Establish comprehensive SRHR, which is cross sectorial, meet education and all of the others as much as we need now, as an essential component of UHC, as without ensuring prioritization, accelerated financing, and implementation of comprehensive sexual and reproductive health and rights in a national UHC, UHC will not be achieved.

And I think what a critical you know element to repeat. Is that the coalition's work on advocacy and accountability is exactly focused on that to ensure truly universal health coverage of all essential services, in particular for the to ensure that we're a child adolescent and women. Is is boy or lives does not determine where she lives or died.

Really 

Zoe: powerful statements there. Thank you, Helga. And and, and you referred to a blog earlier, so for our listeners, you haven't spotted it yet. We published a comment a few weeks ago from, from our speakers today and some of the members of the UHC. Talking about the action agenda and the need to get health back on the highest political talking spots.

So thank you. And, and so back to the high level meetings and, and the, the General Assembly, I'm going to ask you both what a meaningful UHC political declaration would look like from your perspective. So Justin, if I can ask you first. 

Justin: Thanks. I would say three elements to a meaningful political declaration, but before I give those, One other thing I think we have to think about is who's actually giving the declaration.

And by that, I mean, we really need to be keeping health on the highest political agenda. So something that we'll be looking at closely is the extent to which heads of state engage in this health agenda in September. Because what we've seen, again, we knew it before, but especially during COVID, is you can't always solve health problems simply within the health ministry, critical as the health ministry is.

You need to look across government for that. You need head of state involvement. So, so that will be the first yardstick who who turns up and can we get the really highest level political engagement in the health agenda in terms of the declaration itself. I would say three things. First of all, as, as we've said before, there are not one, but three high level meetings on on UHC on pandemic PPR and on TV.

And it's critical that these are aligned and that we, we strengthen synergies between different health related SDGs. What we don't want through this high level meeting on UHC or all of the high level meetings happening in September this year is fragmentation of the health system. So as the Coalition of Partnerships for UHC and Global Health.

We really have an opportunity to demonstrate how we can can work together. So that will be my my first demonstration of a meaningful UHC political declaration, but also the other two declarations. How closely can we align ourselves and unite to a common agenda? And that may have varying on how closely we can engage head of state.

The second key element that we'd love to see, and Helga's already mentioned it, Is that the declaration should call for health progress review summits, ideally every two years that can be discussed at UN General Assemblies in 2025, 2027, 2029 and so on. Because again, it's critical that we reduce fragmentation in global health and we completely accept that there may be times where specific health issues need to be discussed.

I'm an HIV advocate and I, I know that too well. But it's critical that we see health in global as one agenda moving forward. So we, we want to see a specific call for these health progress reviews on it. And then the third critical element of a meaningful UHC political declaration, I think, is that we move from, I would call it aspiration to implementation or action.

The 2019 declaration on UHC Was a terrific achievement and the most comprehensive declaration in in our history, really on health at the global level. But what we need to do now is to move from the commitment that was espoused in that declaration to action. So we need the declaration to be sufficiently concrete, to be implementable.

and sufficiently concise to be implemented. There's a tendency when you talk about something as broad as UHC to try and cram everything in it, to have a sort of Christmas tree of hell. And that might look pretty, but it's not particularly useful. So we need something concrete, concise, and inactive. And so there are my three key elements of a, a really good political declaration.

Aligned with the other two political declarations calling for these Health Progress Review Summits and concise, concrete, and implement. 

Zoe: Brilliant. Thank you. Helga, what would your ideal political declaration look like? 

Helga: No, I think it would be, well, it gets there, the consensus achieved to it, but I do think it's one that addresses inequity then is explicit about focusing on women.

Children and adolescents because if you don't do that, then it does not get addressed. We have seen that far too often. So that would be really where he won. Priority two would be to look at financing. I think that there are too many competing financing priority within health and without.

And I do think one needs to rethink financing on, on, on global health and beyond. So that's an important thing. Could be one for a future podcast. The other thing is adolescence. Adolescence, we have not known enough and we have gathered evidence and that is showing. Remarkable need to to address that urgently.

So I do think that the 1. 8 campaign. And the addressing of adolescents and their needs, which are, you address them very differently than adults and children, and that needs special attention. And so I would really be very pleased if that received more focus, and we would be very pleased to really team up with you on on a future project.

Oh, a podcast on that because that we have now evidence there that we didn't have before and that needs to be made very visible. So those are really the three things from from our side. 

Zoe: Thank you. Thank you very much. So I like those two. And actually we do, we do have a podcast on, on UHC financing that, that we recorded already.

So if any listeners would like to go and go back and listen to that one I would encourage you to, to do so. But I think that's all we have time for today. I would like to thank both of our speakers today, Justin Koonin and Helga Fogstadt from UHC 2030 for explaining really what, what UHC 2030 is all about.

I think you did that very clearly. I think it's an amazingly powerful organization. And I really hope that we do see some heads of state showing up at the high level meeting and, and we get some joined up thinking and and we do include the most vulnerable the women, the children, the adolescents in these in these declarations.

Thanks, Ian. 

Justin: Thank you very much. 

Zoe: Thank you very much once again, and we'll say goodbye for now.

Gavin: Thanks so much for joining us for this episode of The Lancet Voice. This podcast will be marking The Lancet's 200th anniversary throughout 2023. by focusing on the spotlights with lots of different guest hosts from across the Lancet group. Remember to subscribe if you haven't already, and we'll see you back here soon.

Thanks so much for listening.