Is universal health coverage an opportunity to end AIDS and TB?

 Bobby Ramakant
 Contd from previous issue
There are heath emergencies happening all the time in most places. For example, I am speaking from Thailand where it is rainy season.
In rainy season vector-borne diseases such as dengue are at particular risk. We are also close to borders of Myanmar, Laos and Cambodia, precisely the hotspots where drug-resistant malaria is emerging right now. So, emergencies are not necessarily these large-scale public health emergencies of international concern but can be localized emergencies too” said Dr Tim France. Third part of the WHO ‘3 Billion’ model is related to general health and well-being as opposed to addressing ill-health, addressing some of the social, environmental and commercial determinants of health. Dr France shares an example to further underline its significance: “Few months ago, Chiang Mai in northern Thailand, where I am speaking to you from, was reported to having the most intense air pollution, as anywhere in the world at the time. What is the point of having the perfect health system when citizens are exposed to such a toxic environment? Similarly, one of the biggest causes of death and injury in Thailand is road traffic collision, largely caused by lack of enforcement of laws and drunk driving. Again, what is the point of perfecting a health system and universal health coverage when thousands of people die on the roads?”
After proposing the first global health shift on lines of ‘WHO 3 Billion’ model, Dr Tim France shares his insight on the second major global health shift: countries should be prioritising the health issue they will focus on. “This means prioritizing certain areas of research for example, so that we understand the given health issue or given health problem more, or developing specific capacities so that we know that the entire health system is working properly and delivers the services, vaccines and support that the people need” shares Dr Tim France.
“For too long, priorities have been set by combination of national health planning and international concerns, particularly in countries most dependent on international development assistance for health (which is decreasing as countries take more responsibility for domestic financing of health and taking more of a driving seat more than ever in setting priorities)” explained Dr France.
“With multiple organizations and interests vying for attention and financing, to make sure their issue or focus has prominence, we have inadvertently created an environment of competition among organizations. That means, we quite often do pit one disease against another: for example, AIDS against TB or cancer or diabetes or vaccine-preventable diseases in children” shared Dr Tim France.
After suggesting two major global health shifts to deliver on health for all (first shift of approaching health on lines of ‘WHO three billion’ and second shift of countries setting their health priorities), Dr France shared the third major change: international organizations must collaborate, partner and think together in close partnership.
Dr France hinted towards a new global initiative originally requested by the governments of Norway, Germany and Ghana, that will be revealed at the upcoming UNHLM on UHC in September 2019: “Global Action Plan for Healthy Lives and Well Being for All”, which seeks to improve the way and force these organizations to work more closely together.
Thailand’s progress on UHC as well as addressing HIV is seen as a model for other communicable and non-communicable diseases too, said Dr Nittaya Phanuphak, Governing Council member of International AIDS Society (IAS) and Chief of PREVENTION, Thai Red Cross AIDS Research Centre.
In 2000, Thailand piloted roll-out of antiretroviral therapy (ART) for people living with HIV and by 2006, ART was included in UHC for all people who need it. This year Pre-Exposure Prophylaxis (PrEP) has been included in Thai UHC, roll-out of which will begin later in October this year.
“Thai researchers, policy makers, health economists and others, have moved forward HIV to become something beyond just treatment or disease but also about prevention and well being” emphasized Dr Nittaya Phanuphak.
Dr Ishwar Gilada, Governing Council member of International AIDS Society (IAS) and President of AIDS Society of India (ASI), said: “In India, Pradhan Mantri Jan Arogya Yojana is operational to reduce the financial burden on poor and vulnerable groups arising out of catastrophic hospital visits, and ensure their access to quality health services. This UHC initiative in India, provides financial protection to over 100 million poor people, deprived rural families and identified occupational categories of urban workers’ families.
Mahatma Gandhi had shared a talisman: “I will give you a talisman. Whenever you are in doubt, or when the self becomes too much with you, apply the following test. Recall the face of the poorest and the weakest man [woman] whom you may have seen, and ask yourself, if the step you contemplate is going to be of any use to him [her].” If all decisions related to public health and sustainable development in general, are made using this Gandhi’s talisman, probably we may see a positive impact towards delivering on UHC and other goals and targets of Agenda 2030.
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