High-Level Dialogue on Health in the Post-2015 Development Agenda concludes in Botswana

IFMSA Interventions at the Global Thematic Consultation on Health in the Post-2015 Development Agenda, delivered by IFMSA President Roopa Dhatt

March 3-5, 2013 in Botswana

Intervention #1—Importance of YP in the Development Agenda, Health in All Policies, and Getting to the Root Cause

Young people are a large population. Health issues (such as mental health, violence, injuries, child marriages, unprotected sex, early pregnancy and childbirth, sexual coercion, HIV) and social issues (such as employment, environment, education) continue to challenge their ability to meaningfully participate in achieving their future. We urge the post MDG framework to increase young people’s analysis, perspective and participation. We also urge the post MDG to consider forgotten voices of marginalized and vulnerable groups regardless of political, religion, social, racial, national, sexual, gender, national, sexual or any discrimination.   Not only are young people the future, but also they will be responsible for sustaining the efforts that are set now. We should engage with young people early on about healthy lifestyles, sexual reproductive health, and career planning and use them as a vehicle for social change, specifically in increasing the shortage in human resources for health.

We also feel that health should be placed in other policy agendas beyond the development agenda and the sustainable development. We urge the creation of more health indicators that are context specific, age-specific, and population specific in evaluating policies.

We encourage the global community to seek and address the root cause of inequity and the determinants that challenge health and well-being, especially in empowering young people early on.

Intervention #2—Political Language and Health in all Policies

1. We need a political language that is universal–understood and useful across sectors, so we can have more meaningful dialogue on setting the development agenda, especially if we are aiming for a more integrated approach.

We have heard a great deal about Human Security as potential framework that is emerging in some other non-health settings. It is a framework that focuses on development, human rights and state security. It is focused on the needs of people, multi-sectorial, integrated, and focused on both protections and empowerment.  It is a tool for both design and evaluation.  We need to consider such frameworks.

2. We need to keep our approach multi-sectorial, focused on sustainable efforts, addressing root determinants of health, bridging gaps, and integrating at the local level.

3. The how still needs to be answered, as we focus on these efforts.                                                       

Intervention #3—Human Resources for Health/Health Workers

 

When we talk about setting the health priorities for post-2015, we have to ask ourselves several questions.

• Who are the targets of these priorities?
• Who will be central to responding to the health priorities? Human resources for health or Human resources for development.
• If these are health workers or similar groups, how do we plan to engage with them and include them in setting in the post-2015 agenda?
• What will be their health literacy?
  • Will this include?
    • Multi-sectorial approach
    • Social Determinant of Health/ Determinants of Well-being
    • Sustainable development
    • Global heath
    • E-Health
    • Addressing the needs of target, marginalized and vulnerable groups
• How do we plan to build their capacities and make sure quality is

 

As a future health care provider, answering these questions are essential to setting the future development agenda and insuring that health priorities that are set are achieved.

 

Intervention #4—Specific Target Groups and An overarching goal on adolescents and young people

 

While we support universality of the goals that are set in the next development agenda, we want to highlight the importance of outreach to specific target group, like marginalized and vulnerable populations, especially adolescents.  While we do support the notion of age-specific, life cycle or other similar groupings for an over arching goal, we want to make sure that specific target groups are emphasized.

 Moreover, we would like to propose to the health community, about considering another additional overarching goal. We have heard in the room these past days a lot of mention of young people and their engagement, involvement, and access to health services, especially sexual reproductive health services. We also have been hearing at the UN level, at the WHO, the Rio+20 and other thematic consultations the importance of investing in young people as an emerging theme.

 

We have been discussing about the future…

The many health issues we discussed are most pertinent to young people, especially adolescents…(topics such as sexual reproductive health, mental health, violence, child brides, even health lifestyles and NCDs apply)

Young People are the future…

So why don’t we put adolescent health on the global development agenda, as an overarching goal?

Such a goal would be universal, sellable, and compelling.

Such a goal appeals to sustainable development (green economies, future generation)

Such a goal has the potential to be multi-sectorial (job employment, education, environment, nutrition)

Social determinants of health are a reality for young people, especially adolescents’ future.

Young people are innovators of social media, new technologies, tools and approaches.

Young people are already in some cases acting as human resources for health. 

Young people are engaging already on claiming their future and investing into it.

 

Discussion Points on Round Table during the meeting

 

GOAL: Universal Health Coverage

• The goal as is comprehendible, sellable, and universal.
•  The message should be more universal health access versus universal health coverage.
• We should make sure that such a goal, also has a specific mention for target groups, especially vulnerable and marginalized groups like migrant, rural, indigenous, young people.
• We should take the time to incorporate more sustainable development concepts in the goal, including sustainable practices.
• The goal should prepare health systems for a dynamic environment and not only the health issues of now, but for the future.
• Human resources for health (health workers) are an essential aspect of achieving this goal, so greater emphasis should be placed on targets for this workforce in the development agenda.
• When we talk about prevention, we should talk about health literacy and what competencies are we aiming for in UHC.
• There also needs to be emphasis on quality and therefore, quality indicators created, no only indicators on service coverage and protection.

 

 

 

GOAL: Maximizing Health Life Expectancy

• The goal is hard to understand and is not very sellable, but universal.
• We recommended changing the language to promoting a more understandable message and one beyond health, as a larger over arching goal (either well-being, healthy planet, maximizing human potential).

• We recommended age-specific targets, but making sure that there is a special mention of target groups, especially adolescents, marginalized and vulnerable populations.
• We should avoid in this setting creating silos and emphasize the multi-sectorial possibilities with other sectors such as education, green economies, environment, and nutrition.
• Additionally, there is potential to make this a larger goal.
• The possibility exists to keep the healthy life expectancy as an indicator.
• We should also integrate more sustainable development concepts and language into this goal—include education, green economies and the environment.

Written by Roopa Dhatt, IFMSA President 2012/13

WHO-EB132 Meeting Summary update

IFMSA was represented by Roopa Dhatt (IFMSA President), Usman Mustaq (IFMSA VPE) and Chantelle Willard (AMSA-Australia). We would like to share with you some updates about the meeting.

Chantelle Willard (LEFT), Dr. Chan (Middle), Roopa Dhatt (Right)

Day 1
Today was the first day of the WHO-EB 132. As an opening day, the discussions focused on key themes of the health agenda for the year–including special mention of the WHO reform, NCDs, and as well as the overall increased participation of member states on global health. A great deal of comments were made on the NCD resolution and indicators and the process that has been going on for sometime. The agenda for this WHO-EB is quite extensive thus they are being very selective about speaking rights.

Next Days..
The next days will be followed up with many more reports being presented and discussion of various resolutions. We have several follow up meetings scheduled with WHO representatives, WMA and other partners that are present.

Priorites selected by the delegation to focus on
IFMSA will be closely focusing on the agenda items below and consider delivering interventions on them based on the discussion and whether an intervention is appropriate. We passed several key policy statements in AM12 and MM12 that will be used as a foundation for our statements.

EB132/5
WHO reform

EB132/7
EB132/7 Corr.1
Draft action plan for the prevention and control of
noncommunicable diseases 2013–2020

EB132/8
Draft comprehensive mental health action plan 2013–2020

EB132/11
Monitoring the achievement of the health-related Millennium Development Goals

EB132/12
Monitoring the achievement of the health-related Millennium Development Goals
Health in the post-2015 development agenda

EB132/13
Follow-up actions to recommendations of the high-level commissions convened to advance women’s and children’s health

EB132/14
Social determinants of health
Report by the Secretariat

EB132/19
Neglected tropical diseases
Prevention, control, elimination and eradication

EB132/22
Universal health coverage

EB132/23
The health workforce: advances in responding to shortages and migration, and in preparing for emerging needs

Day 2

Mental Health

The morning has been spent discussing key health commitments in Mental Health. Member States across the board have supported the Mental Health Plan . This plan will potentially be used to impact the Mental Health Across the board.

Some key highlights:

Switzerland: protect mental health without sexual discrimination.

Australia: It is a very polished document. Mental health is a priority in Australia, there is a separate ministry.

Croatia: Mental health services should be paired with civil society organizations.

Lithuania: A call for universal call for mental health services coverage. By 2013, depression burden will be leading.

Thailand: The Mental Action plan requires health work force to implement.

Blindness & Visual Impairment 2014-2019 (Action Plan)

Member states discuss how this issue has been neglected, even though there are often preventable measures and treatments that are curable. Several express they hope this is on the agenda for the next WHA.

Some key highlights:

Saudi Arabia: We adopted the EMRO resolution on Universal Eye Care. We are delighted to co-sponsor this resolution on the Global Health Eye Action Plan.

Resolutions Submitted by IFMSA

Day 3: THEME DAY FOR REFORM

The day was used primarily for discussing WHO Reform. This is a process that WHO took upon itself in the past year to review how the entire organization works–from structure, to financing to engaging with civil organizations. It is a vast project and this could potentially impact our relations with them, as we are part of the Civil Society Organization (CSOs) group or NGOs. We will be delivering a statement on this WHO reform to areas that pertain to us. We want to focus on youth engagement, but also increasing transparency, inclusiveness, involvement and coordination to engage with CSOs more (all values we promote in IFMSA).

We networked on the Global Health Diplomacy Pre-WHA event. We had some successes, more to come. We also talked with the U.S. Mission, Norway Mission, and Australia Mission.

Health Promotion, (Health promotion is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions.)

The department has sent us an invitation to be involved in this conference–the specifics are to be further defined. They are also considering internship opportunities.

SDH (The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.)

The Rio Political Declaration of 2011 confirmed Member State commitment to take action to address the social determinants of health in five areas:

Adopt improved governance for health and development
Promote participation in policy-making and implementation
Further reorient the health sector towards promoting health and reducing health inequities
Strengthen global governance and collaboration
Monitor progress and increase accountability

The SDH momentum continues to grow. They have confirmed an internship opportunity in this area, more to follow. Furthermore, opportunities are being explored about pushing for an online module. The department expressed interest on documenting the value of sdh/global health curriculum–potentially meaningful measures for students.

Global Health Force Alliance

We received an invite to coordinate the youth component to this movement. We also received an opportunity to attend this meeting with a very large delegation of health students. The aim would be support this very key issue about health workers. We had the chance to meet with Robbert Duvvier an intern and LoME 2009/11. The department expresses continued interest on working with us. Very excited about IFMSA and the young voices being part of this.

THIRD GLOBAL FORUM ON HRH

(more news, very exciting new to be delivered on this) These maybe potential areas that medical student and health students could get involved in. As well, we met up with the fellow IPSF representatives.

Our statement is attached. Agenda Point 5.

Personal Comment–> The reform happening at WHO hasn’t happened at this level in almost 30 years. Things weren’t working well for them and they decided to do a major reform. TAKE HOME LESSON: REFORMs might be a huge investment of time and resources, but without them, organizations become ineffective. It might be time for us to consider in IFMSA to commit to a major reform process.

Day 4
Today was a day that IFMSA delivered its voice to the WHO-EB. It was a very tough day with only myself and Chantelle and many things to address.

Including, DG Maraget Chan jotted down notes. Day 4 was relevant to our key areas of focus Post-2015 and SDH.

Post-2015 was a very interesting discussion about how member states engage with either placing health into all MDG goals or making one goal. Another interesting point was universal health coverage (UHC) vs. vertical programs. The majority were supporting UHC. Interesting, it was noted that many do not know the definition of Universal Health Coverage and how it is easily confused with Universal Health Care (so what is UHC–> check out the link, I KNOW UHC. There was also concern about supporting the notion of UHC, especially in countries with weakened health systems. In other words, if the hospitals are bad, is UHC the answer. Our statement was well received. A few delegations in passing stated it was a good statement, including the representative from World Health Professions Alliance and UNFPA (United Nations Population Fund). Our statement focused on three key areas: considering health in all the 10 thematic discussions on Post-2015, using a human rights and human security (development and rights) approach, and a special attention to women & child related issues, especially reducing violence, ending child-brides and focusing on basic needs. PLEASE READ IT, AS IT WAS AWESOME. We also said a special thanks to Norway, as it was the only member state that mentioned youth.

We had the UK delegation approach and they spoke to us for an 1hr on our position. What we think. Of course.

SDH
The topic had more consensus in the room and is fully supported. Most states discussed how to implement and what are the next phases. They also discussed the range of SDH work in the regions with Africa being the weakest and PAHO doing great stuff. We delivered another great statement that focused on youth being a part of the innovative solutions.

We celebrated this awesome day with UN DRINKS–Bar De La Plage Geneva. Of course we were only there for professional networking–to hear how other young people are contributing to social change at the UN (loads of exciting thing…!)

Day 5, Key Discussions
Day 5 was an interesting day for the on-going discussions in WHO on a variety of topics. The key discussions were around the consultative Expert Working Group on Research and Development: Financing and Coordination (CEWG). There was a lack of commitment on part of the members states on CEWG report and the draft resolution was weak in many opinions. However, some member states, including China, fervently stated that they opposed the resolution, whereas, other member states felt this was a step forward, while still more needed to be done. There was a great deal of disagreement in the room, resulting in DG Chan singing at one point.

Some key comments:

Medicus mundi international network: “We firmly believe that the independent evaluation of WHO should produce a comprehensive and strategic situation analysis of WHO’s current positioning on the overcrowded stage of actors influencing global health.” (Democratising Global Health coalition and MMI statement on the independent evaluation of the WHO reform #EB132 http://bit.ly/V0bVLo)

Disabled

@WHO Executive Board: #Disabled ppl face barriers in accessing services such as health care, education, transport, employment #EB132

@WHO People with disabilities also face barriers in accessing justice. #EB132 #disability
RT @WHO: An estimated 1 billion people live with disabilities; this number is set to increase as populations age. #EB132 #disability

Vaccines

Doctors w/o Borders: Decade of #Vaccines” plan must do more to address high prices and lack of products for developing world. Vaccine costs rose 2700% over the last decade, so why doesn’t the blueprint for the next decade have a goal to bring prices down? We need products that make vaccinating kids easier. We need a clear signal that this is a critical objective for the next decade.

CEWG
#EB132-Director-General Chan throws down the gauntlet on the CEWG process: “Let’s fight this out at the Assembly”

MSF Intervention on CEWG: Financing & Coordination at WHO #EB132 http://www.msfaccess.org/content/msf-intervention-cewg-financing-coordination-132nd-who-executive-board …

Joint letter to WHO EB delegates on follow-up of CEWG report on R&D (HAI, KEI, MSF, Oxfam, PHM, Stop AIDS, TWN) http://lists.keionline.org/pipermail/ip-health_lists.keionline.org/2013-January/002758.html … #EB132

#eb132 Medico Mundis, TWN & PHM say CEWG report proposed a paradigm shift that draft resolution does not reflect

Day 6, Working on the Weekend, Reform
We came in today to follow up on the reform process and deliver our statement on WHO Reform. It was a low action day.

It was also Aussie Day, as Chantelle Willard is from Australia, we were very fortunate to have lunch with the Australian Mission and Dr. Halton. Including having very important diplomatic discussions on Vegemite.

The remaining part of the day was spent prepping for Monday and also meeting with our colleagues from IPSF ( International Pharmaceutical Students’ Federation). We discussed the follow-up on the World Health Student Alliance (WHSA), as well as representation to the high-level discussions on Health Promotion in June in Finland. We concluded by discussing a bit about on-going reform. President Radek Mitura will join us at the MM13.

Some Comments:

25% of the @WHO #budget comes from regular “dues”, the rest is money that countries, agencies, other partners give to WHO voluntarily #EB132

Day 7, Delivering a Message
Today IFMSA delivered a message on Universal Health Coverage. A special thanks to Schi from St. Kitts for the input. The statement was well received and we were approached by Save the Children, as we as positive feedback. We also received a request from the PHM to have our statement. Our statement is attached below.

Discussions also focused on health workforce. There were encouragement on reporting and migration studies. The ILO expressed there needs to be ethical guidelines on international recruitment. (PERSONAL COMMENT: THIS IS A HUGE TOPIC THAT IFMSA AT THE MOMENT HAS NOT LOOKED AT, IT COULD POTENTIALLY BE A PRIORITY AREA FOR US TO ADDRESS THE EQUITY ISSUES).

Some Key Comments:

UHC
China: #UHC not only responsibility of health sectors. Governments should have primary responsibility for implementing policies.

Universal health coverage. Report by WHO Secretariat. Discussion will continue today at 132nd Session of WHO EB http://apps.who.int/gb/ebwha/pdf_files/EB132/B132_22-en.pdf … #EB132

Italy: include human rights, equity and in particular gender equity. #post2015 #EB132 need to have simple subgoals under universal coverage

Argentina: free health care is best, but sustainability of these models is successful when implemented with health insurance #EB132 #UHC

Lebanon: involvement of NGOs and primary care important for #UHC (universal health coverage)#EB132 #WHO

Cuba: health is a human right and can’t be achieved without #UHC it fails when unequal distribution of wealth #EB132 #WHO

Lithuania: include #UHC in monitoring of healthcare systems, multi-sectorial approach required #EB132 #WHO

Yemen: quotes DG “#UHC is achieveable” #EB132 interplays of exisiting initiatives with #UHC and emergencies in our region #EB132

Health workforce

Brazil: analysis on migration patterns of health workforce must respect human rights #EB132 #WHO

Australia: self-sufficiency, spend 1.5 billion USD on this domestically to champion health workforce but still not there #EB132

USA: supports goals of global code, need health workforce training and health systems, increase medical, nursing school enrollment #EB132

Norway: Global code of practice-less than 1 in 4 member states submitted code report in 2012. Coordinate with GHWA #EB132 #WHO

Maldives: difficulty with their own eduction of health workers, trouble with forged medical degrees, massive expat health workforce #EB132

E-Health

@WHO Executive Board has adopted resolution on #eHealth incl. eLearning, capacity building and networks #EB132
Chad: protection measures need to prevent efraud, not enough resources currently in Africa for this IT health sector #EB132 #WHO

Day 8, the Conclusion
The last day was filled with many informal meetings among members states and discussions on WHO Reform. This was a quite day for IFMSA, but we followed up with some of the acquaintances we networked with and reminded them of the potential opportunities to engage with us for the pre-WHA, our GAs and additional chances. Ms. Chantelle Willard (AMSA-Australia) represented us to the last day.

Some Key Comments:
WHO’s Executive Board recommends adoption of a resolution on all 17 neglected tropical diseases.

E-Health

eHealth and health Internet domain names, Report by the Secretariat @WHO #EB132 http://apps.who.int/gb/ebwha/pdf_files/EB132/B132_24-en.pdf …

Global updates on eHealth, health Internet domain & the protection of domain names of intergovernmental orgs | http://apps.who.int/gb/ebwha/pdf_files/EB132/B132_24-en.pdf … #EB132

Finances

At @WHO Board meeting, Director Chan resorts to crying to persuade members not to micro-manage her on budget. Story to follow. #EB132

Brazil: Don’t cry for us Dr DG. The truth is we never left you. We reelected you – Tune of don’t cry for me argentina #EB132 #WHO

Related to WHO Reform:
- WHO Secretariat will continue developing policies for engagement with both civil society and the private sector, to be presented at the World Health Assembly in May 2013.
-The Secretariat agreed that there are some overarching principles that will guide all relationships such as transparency, accountability, and the criteria of making a contribution to health.
-However, WHO must ensure that it properly and appropriately safeguards against vested interests.

Thank-you for following IFMSA at the WHOEB132. If you have any questions, please email me at president@ifmsa.org or Renzo at lwho@ifmsa.org.

PreRM: Global Health Equity and Health Systems in America and the Caribbean

“Action on social determinants of health and health equity means putting social justice at the heart of social action…You are the future and the future in your hands is one that has the potential to improve lives for everybody” Professor Sir Michael Marmot, chairman of the WHO Commission on Social Determinants of Health.

A few weeks ago marked the last day of the 2013 pre-Regional Meeting of the Americas IFMSA region on “Global Health Equity and Health Systems”; and we can only say that everything went beyond our personal expectations.

On the menu of the workshop, we had trainings, dynamics, interactive lectures, videos, group presentations and small working groups on social determinants of health systems, health systems from America, advocacy, global health challenges and new approaches. We also had the opportunity to visit the National Public Hospital “San Rafael” in Santa Tecla, El Salvador. Health systems as identified by the WHO Commission on Social Determinants of Health are one of the crucial determinants of health within countries. The visit to Hospital “San Rafael” was an eye-opening experience, most of us were shocked and impressed at once: shocked because it was far from the reality we are used to; and impressed because Salvadorian health professionals were doing so much with so little. Just as one example, the lack of material is a constant burden on the health professionals, especially interns, as they must, in their daily practice, ventilate manually their patients because they don’t have enough machines to do it.
The reality is straightforward. The world as we know it has never possessed such a sophisticated arsenal of interventions and technologies for curing disease and prolonging life. Yet the gaps in health outcomes continue to widen. Much of the ill health, disease, premature death, and suffering we see on such a large scale are needless, as effective and affordable interventions are available for prevention and treatment. The power of existing interventions is not matched by the power of health systems to deliver them to those in greatest need, in a comprehensive way, and on an adequate scale. Making even harder the achievement of national and international goals without greater and more effective investment in health systems and services.
Even though there is no single set of best practices that can be put forward as a model for improved performance, as health systems are highly context-specific. There are certain shared characteristics in health systems that function well. On day #2 of the workshop we studied the WHO Framework for action on Health Systems, followed by a Comparative Health Systems session. From north to south, Quebec, Mexico, El Salvador, Costa Rica, Colombia, Peru, Argentina and Chile even an adopted latino: Sweden. This might be one of our favorite activities of this preRM, as we saw young medical students sharing their passion and knowledge on their respective national health system. And as the purpose of the Framework for Action a common understanding of what a health system is, what are the fundamental “building blocks” of health systems and what constitutes health systems strengthening were promoted.

This interactive session helped us sharpen our vision on our healthcare systems, and we developed a critical eye on what is done already and what could be done better. One striking example of what we were lucky enough to learn about was the Costa Rican health care system which since its creation in the late 1940s, Costa Rica’s Social Security System, known as the Caja, has become the country’s most-respected public institution, providing universal health-care coverage and some of the best health-care services in Latin America. What’s more the World Health Organization frequently place Costa Rica in the top country rankings in the world for long life expectancy. Add that Costa Rica tops the 2012 Happy Planet index and has embraced sustainability in its national policies: it produces 99% of its energy from renewable sources, has reversed deforestation in the country, and has committed to becoming carbon neutral by 2021.

 

Over the course of those days, we shared knowledge, we shared inspiration, and we shared hope. Slowly, step by step, with trainings on advocacy and public speaking skills along the way, we were able to individually and with a collective approach turn our “wish list” of ideas and concerns about how we might do things differently, and better, on our wards, and in our hospitals and communities into potentially generalized realities whilst creating positive health and social change. A few more sessions on what can medical students do and how can we tackle the global health challenges of today were also on the menu to tool participants up with concrete ideas on what can be done locally, nationally and internationally and turn them into global health equity advocates.

We must say: Our stay in sunny Salvador was close to perfect. We met amazing and extremely generous people, who made us feel so welcome in this beautiful country of Central America. We feel extremely blessed for had been able to share those extraordinary preRM days with a group of dynamic, energetic and enthusiastic people convinced that we can close the gap in our generation, young physicians committed to work for “a world where social justice is taken seriously”. It is definitely more than encouraging to put IFMSA mission “to offer future physicians a comprehensive introduction to global health issues” in action. It is indeed through IFMSA meetings and other opportunities that medical students develop cultural understanding, and positively influence the transnational inequalities that shape the health of our planet.

Altagracia Mares de Leon, IFMSA Global Health Equity Initiative Coordinator
Claudel P-Desrosiers, President of IFMSA-Quebec

Coordinators of the Global Health Equity PreRegional Meeting of the Americas 2013