Keynote address of Dr Shin Young-Soo, WHO Regional Director for the Western Pacific, to the Universal Health Coverage Forum

13 December 2017 — Tokyo

Honourable Minister Kato; Esteemed senior leaders from the World Bank, UNICEF, JICA, WFP and the ADB; Newly appointed WHO Assistant Director-General Dr Yamamoto; Distinguished guests

Good Morning. It is my honour to be invited to speak in this prestigious forum.

I would like to begin by summarising why this Forum is so important.

Right now, at best, only half the world’s population has coverage for essential health services. Hundreds of millions of people cannot access the health services they need to stay healthy, manage a chronic condition, or recover from illness. This is because services are not available, or because for many people, using them causes serious financial hardship.

Simply, we cannot create a more equitable world unless we deliver strong progress towards Universal Health Coverage.

We are not here today because UHC is a new idea. Its roots can be found in the WHO Constitution, which says that ‘the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being’.

UHC was also central to the Declaration of Alma-Ata’s rallying call of ‘health for all’, nearly 40 years ago.

We gather here in Tokyo – to be joined by Prime Minister Abe later in the week, along with the WHO Director-General, the World Bank President, and other global leaders – because UHC has captured attention at the highest political levels.

UHC is now at the centre of the global development agenda. Our task is to ensure this political momentum is turned into real changes to people’s lives.

Today I want to reflect on where we currently stand, and how we can get closer to the goal of ‘health for all’.

My starting point – always – is how can we best support countries in their efforts and aspirations? What do countries most need from us? Shared aspiration is crucial, clearly, but so too is a country-specific approach to delivering. To achieve UHC, different strategies are needed in different countries – based on what is already in place, available resources and capacity, and political commitment.

We must also monitor and learn from different experiences, and build on them – nationally, regionally, and globally.

Across the six WHO regions, all Regional Committees have adopted resolutions which outline pathways or strategies for achieving UHC.

In the Western Pacific Region, our approach is guided by our Member States – and in particular, the regional action framework on UHC they adopted in 2015.

This framework acknowledges that UHC is more than just service coverage and financial protection – as important as these are. By definition, UHC is also about equity, quality, as well as efficiency, accountability, and resilience and sustainability.

These are the hallmarks of high-performing health systems – the foundation for UHC. Our framework also identifies a series of areas where action is needed to deliver on these health system attributes.

For example, to assure quality of health services, a country must have appropriate regulatory standards, and a competent health workforce.

To achieve equity, financial protection and access are critical, but so too are strategies to reach those likely to be left behind.

A resilient health system is not only about investing in essential public health functions to ensure preparedness, but also about supporting community capacity to address health hazards and risks.

Different countries will prioritise these actions in different ways – depending on their own circumstances and state of development.

For instance, high income countries are focusing on service delivery transformation to address demographic and epidemiological transitions. They are also grappling with cost containment, and health equity. No single country has all of it right.

Countries in economic transition – such as China and Viet Nam – are strengthening regulatory systems, modernising health workforce education, and reducing out-of-pocket payments. They are also increasingly focused on service quality, and the impacts of rapid urbanization and industrialization.

Small island states in the Pacific have hospitals full of patients with advanced stages of non-communicable diseases. Without the capacity to treat in-country (for instance, to perform heart surgery), this puts huge pressure on overseas treatment costs.

These countries are looking anew at how primary health care services can be strengthened, to better manage NCDs and reduce the need for expensive hospital care.

Finally, in highly decentralised countries such as the Philippines, the major task is to improve the connectivity across different levels of the health system, through tools such as service delivery networks.

In all of this, there are some key lessons – in particular for development partners.

First, there is no one-size-fits-all approach to UHC which will work for every country. There are no clinical trials – from which the results can be copied from one setting to another.

Second, development partners must base their support on countries – not their own – priorities. We must offer advice and options based on each country’s situation, bringing together the best international experience and knowledge – grounded in a clear sense of what is feasible.

Finally, the long history of UHC shows us that progress is not always linear. The path ahead will not always be easy – but the goal is clear.

We are at a unique moment in history. We owe it to the billions of people who can’t access the health services they need right now, to get on with the job.

Thank you.

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