Reflections on the UHC Forum 2017 in Tokyo
The UHC Forum 2017 in Tokyo has been and gone. A week of global health officialdom in the spotlight; with global health dignitaries appearing in panels, breakout sessions and side events, issuing pledges and declarations of positive intent. A great occasion to parade ideas, plans, and initiatives, meet and greet, and make new connections.
An overview of the Tokyo deliberations with links to the many reports that were launched can be found in the latest IHP newsletter, to which we happily refer.
The UHC Forum took place in the week on which UHC day fell, on which the sobering World Health Organization and World Bank Tracking Universal Health Coverage monitoring report 2017 appeared.
This report forced everybody back to planet earth. At least half of the world’s population lives without proper access to essential health services. Each year, large numbers of households are being pushed into poverty because they must pay for health care out of their own pocket. 800 million people spend at least 10% of their household budget on health expenses.
The details of this report draw attention to the tough political-economic reasons why UHC will be hard to attain by 2030 and why massive efforts are still needed. The report painfully displays the global inequities that hamper progress: between countries and regions, but also inside countries. ‘No UHC without equity’, indeed.
Putting such harsh realities up-front, our Health Systems Governance Collaborative teamed up with the UHC-Partnership for a two-part Tokyo side event: Bold Moves: New Governance and Partnerships for UHC (Part One, Part Two), in which the spotlights were put on the pressing need to move beyond the rhetoric of change and take concrete steps.
The conversations between the participants in the sessions resulted in a ten-point Bold Moves Mini-Manifesto.
This Manifesto touched upon a number of deeper transformations which are urgently needed in our global health arena, and which pertain to the Tokyo Forum as well. Any programme of acceleration of UHC efforts would have to address the following.
1. Power inequities.
The week clearly demonstrated the current power inequities in the global health arena, and reflected the gaps in mutuality and global solidarity. This provoked much debate in the corridors of the Tokyo meeting, but less so on the main stages.
2. Turning the tables.
Despite considerable lip service to ‘local or country experiences’, the discussions were cast in familiar global narratives. ‘Bold local voices’ were limited on the main stages. In-depth dialogues on local diversity relocated to some side events. The gender and age balance in most panels left much to be desired. This is particularly disconcerting since awareness is growing that in the end, it has to be communities that should be the agents of change and put in the position to hold their leaders accountable. No UHC without true democracy!
3. Moving our scope of attention way beyond health.
Many speakers in Tokyo reminded participants that improving on health means dealing with much wider social developments. The details of these changes still require considerable hard talk as to ‘how’ to link health to other social spheres and how to discuss health impacts of political and economic developments.
4. Strategies proposed fit for purpose?
Speakers in Tokyo frequently touched upon the ‘rapidly changing world’ and questioned whether today’s strategies to deal with UHC were actually fit for purpose. Many panelists reiterated the political, economic and technological trends that influence our planet’s future. A deeper assessment would have been welcome. A market with 20 tech companies (‘drones, phones and digits’) was introduced to remind participants of the rapid technological changes happening under our eyes. But this part of the programme remained slightly disconnected from the rest. A critical debate about futures in the making and people’s faith in ‘technical fixes’ as a default strategy would have been very welcome.
5. Governance much more in the forefront.
It was heartening to note, that a growing number of participant seemed to agree that money and knowledge may be less the problem than governance. During the Bold Moves sessions, several speakers made a strong plea to move the debates squarely into the political economy of health and development, proposed to practice more what everybody is preaching and start introducing governance dimensions into every single strategic debate around UHC.