The FGHI process was part of several discussions at the 78th session of the UN General Assembly in New York.
Dr. Mercy Mwangangi, co-chair of the FGHI steering group, was honored to be part of the 21 September UN High-Level Meeting on Universal Health Coverage, taking part in a multi-stakeholder panel discussion: “Aligning our investments for health and well-being in a post-COVID world”, alongside Dr. Sania Nishtar, Member of the Senate of Pakistan; Dr. Werner Hoyer, President, European Investment Bank; and Ms. Inger Ashing, Chief Executive Officer, Save the Children.
In response to the question “In your role as co-chair of the Future of Global Health Initiatives, and building from your experience as the former Chief Administrative Secretary in the Kenyan Ministry of Health, how can we better align investments to unblock progress post-COVID on health and well-being?”, Dr Mwangangi gave the following remarks:
Thank you, your excellency, co-chairs, distinguished guest, and members present here today.
Thank you for this opportunity to be able to share our views on what better aligned investments look like.
I couldn’t help but borrow from your opening remarks: four years ago, 2019, we had our last high-level meeting and at that time, COVID-19 was yet to strike, but even then, the world was facing significant epidemiological and demographic challenges, and of course the continued and significant chronic underinvestment in health.
And four years later, today, the challenges have grown, and progress has stagnated. Half of the world’s population is still not covered by essential health services; we have a continuing tightening fiscal environment and climate change. This magnifies the challenges.
And so your excellency, to borrow your words, there is a cost of doing nothing, and therefore we do need to change the status quo.
That is why Kenya and Norway embarked on a process known as the Future of Global Health Initiatives, which I co-chair alongside John-Arne Røttingen, Ambassador for Global Health, Norway.
The vision of the process is for a global health system where all actors contribute effectively to the achievement of country-led UHC, and hence equitable population health and wellbeing.
Global health initiatives are an important part of the ecosystem. They’re agile, have supported countries to achieve significant health gains, and have enormous experience in tackling disease areas and strengthening health systems. Because of this, we believe they can be change-agents for the larger system to improve.
And so through the FGHI process we aim to identify long-term, strategic shifts, towards 2030 and beyond – with the aim of achieving greater overarching, system-level coordination, to deliver sustainable outcomes at country level. We aim to identify prioritised near-term commitments to set a pathway – and be a catalyst – for longer-term change.
So your excellency, you answer your question: how can we better align investments? The FGHI process is centred on two key principles.
The first one is: country priorities must be supported. The agency of countries needs to be centrefold when it comes to investing in the different programmatic areas.
Number two: we believe, and I think we’ve all experienced this, that the health financing landscape is fragmented. This is not a smart use of money, and we need to change by working more collaboratively.
So, firstly, through this process, we’ve identified that collaboration is key, alignment in service to country priorities is key.
We recognise of course that not all countries are the same, and therefore what we do request, and what I do know, and what we’ve heard from countries through this process is that implementing countries need GHIs to be more flexible, to be more efficient, and to act differently together.
And donors, through their board seats, need to allow GHI secretariats to respond to these needs.
Secondly, achieving the vision will require an evolution of the GHI ecosystem. This could include moving beyond short-term grant cycles towards longer-term investments that are more predictable and that prioritize the strengthening of local institutions.
Thirdly, we need to encourage coherent and diverse modalities for co-investment, to streamline and simplify transactions. And countries need to increase of course their own investments in health.
Many alignment initiatives have come before this one, we do recognise that, but not many have been successful.
Again, borrowing your words, your excellency: there is a cost of doing nothing.
We do believe that through this FGHI process, that political accountability is critical to success, and this process is committed to building accountability to ensure commitments turn into action.
Getting there of course requires strong political leadership from all members states, and we shall continue to rely on your support to make this come into a reality.
I do repeat: there is a cost of doing nothing, and the status quo cannot remain. Thank you, your excellency.
Following remarks by member states, Dr Mercy Mwangangi summarized as follows:
Thank you, your excellency, and co-chairs for leading us through this session. Thank you to all the submissions from the member states.
I do reflect and really thank all our world leaders for signing onto the political declaration on UHC, which happened this morning. In this signing, I recognise that we all have a role to play in advancing UHC and in ensuring that every person has access to the healthcare they need to survive and thrive.
But we can only do this together. We can only be successful if we do this together. Each and every one of us has to play our part.
In terms of defining our roles and responsibilities…
Implementing countries need to take increasing responsibility in priority setting of equitable, essential and cost-effective interventions and delivery platforms like integrated primary healthcare, and we need to increase financing for health, and we do have the capacity to do so. We need to ensure that there is involvement of CSOs as this is critical to ensuring accountability and transparency.
Donors need to need to shift accountability for delivery and implementation to countries, we need to demonstrate a higher risk appetite, and we need to move towards broader primary healthcare-oriented UHC results.
Global health initiatives need to support countries in this effort, we need to embed sustainability, and build greater operational flexibilities.
CSOs have a critical role to play in advocating for the most marginalised, and holding implementing governments and GHIs accountable to these commitments.
The FGHI process is of course about GHIs, but it is also about the broader global health system, the future of all people.
Let us use this process to be a catalyst for bigger change.
I do thank all the friends of the FGHI process: WHO, UNICEF, the World Bank, and country leadership demonstrated by the UK, Canadian, Ghanaian, Malawian, Indonesian, Japanese, Norwegian, and Kenyan governments. Thank you.
Wider response to the FGHI process at the session
More broadly, the FGHI process was referenced throughout the session, with Norway, the UK and Canada each calling out their support for the FGHI process in their interventions.
