Best Investment for a Healthier World


At UNGA, Civil Society Must Mobilize Global Solidarity for Universal Health Coverage

Najore Ruth, a nursing assistant, attends to Angolere Lucy, who delivered her baby in the maternity ward of the Nadunget Health Center 3 in Karamoja, Uganda. Photo by Tommy Trenchard for IntraHealth International.

Najore Ruth, a nursing assistant, attends to Angolere Lucy, who delivered her baby in the maternity ward of the Nadunget Health Center 3 in Karamoja, Uganda. Photo by Tommy Trenchard for IntraHealth International.

Francis Omaswa

Let's press heads of state to invest in health systems and health workers.

As world leaders prepare for the United Nations General Assembly (UNGA) in New York, it’s important for those of us in civil society to prepare ourselves ideologically to engage, especially for pushing leaders to make commitments during the UN High-Level Meeting on Universal Health Coverage (UHC) on September 21. The theme for this important gathering is Universal health coverage: expanding our ambition for health and well-being in a post-COVID world.

We all have a right to life and to health. 

We need to remind ourselves of the basics, namely that health of the people is a precondition for productive lives. The right to life and to health, articles 3 and 5 of the Universal Declaration of Human Rights adopted by the UNGA in 1948, is also a right to responsive health systems. 

As we know, quality of life varies between regions and within countries. In some cases, there is unacceptable poverty and lack of social justice and equity—including in access to quality health care. In fact, at least half of people around the world still lack access to essential health services, including maternal care, HIV treatment, family planning, and vaccines. 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 Sustainable Development Goals (SDGs). 

Our response to the existential threat from climate change is also constrained by our inability to mobilise for collective action, hence the Climate Ambition Summit planned for September 20.

To reach UHC we need PHC.

There are admirable achievements we can build on, such as 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 the World Health Organization (WHO) and UNICEF. But the ability of these initiatives and agencies to achieve UHC that truly leaves no one behind cannot be realized until people are reached and engaged through primary health care (PHC) that is owned and driven by communities, and people participate as a duty and a right using the currently available resources. According to the WHO, scaling up PHC in low- and middle-income countries could save 60 million lives, and increase life expectancy by 3.7 years, by 2030. 

Achieving UHC is 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, such as promoting country leadership and capacity building, which are not generally followed. 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, including during negotiation of contracts and trade deals.

All countries need strong health systems.

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.

I recently attended the WHO African Regional Health Ministers conference in Gaborone, Botswana. What has struck me is 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.

We must address the global health workforce shortage and other challenges.

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 crisis that was recognized over 20 years ago and is characterized by widespread shortages, maldistribution of health workers, and poor working conditions. 

I served in the past as the executive director of the Global Health Workforce Alliance at the WHO and continue to follow this subject closely. I am disappointed to note that global health workforce strengthening is severely underfunded. 

We’re facing a shortage of at least 10 million health workers by 2030, with the global gap growing and Africa bearing nearly half of the shortage. Health worker migration from poor to 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 adopted by the World Health Assembly in 2010 is available to guide health worker migration. This Code provides for the training of a global pool of health workers to be shared, but this is not happening and poses a threat to our ability to achieve UHC and global health security.

Civil society must engage. 

It is my prayer that this UNGA 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. 

The role of civil society organizations and academic institutions in mobilizing for UHC is critical. We can hold governments and duty bearers to account and create a climate of opinion among communities, countries, regions, and globally, that enables the adoption and implementation of health promoting policies. 

During UNGA we can build expectations for heads of state to make strong commitments to strengthen the global health workforce at the High-Level Meetings on health and in the Political Declaration on UHC. After UNGA we can monitor their commitments and press our leaders to live up to them.  

Francis Omaswa is the founding executive director of the African Centre for Global Health and Social Transformation, an initiative incorporated in Uganda and promoted by a network of African and international leaders in health and development. Until May 2008, he was special adviser to the WHO director general and founding executive director of the Global Health Workforce Alliance. Before joining GHWA, he was the director general for health services in the Ministry of Health in Uganda, where he was responsible for coordinating and implementing major reforms in the health sector, including quality assurance and decentralization. Among Dr. Omaswa’s many accomplishments and leadership roles in the global health community, he was founding chair, and later served as vice chairman, of the global Stop TB partnership; was one of the architects of the Global Fund to Fight AIDS, TB and Malaria; and served as chair of the portfolio and procurement committee of the Global Fund board; was a member of the steering committee of the High Level Forum on health-related MDGs; and participated in the drafting the Paris Declaration on Aid Effectiveness.

Dr. Omaswa is a graduate of Makerere Medical School, Kampala, Uganda, a fellow of the Royal College of Surgeons of Edinburgh, founding president of the College of Surgeons of East, Central and Southern Africa, and is a senior associate at the Johns Hopkins Bloomberg School of Public Health and an overseas member of the National Academy of Medicine in the United States.