As part of the Civil 20 (C20) Summit which was held 5th – 8th October 2021, the plenary event “Amidst COVID-19: Putting the Last Mile First” was held on 7th October 2021. This event was co-convened by Fundación Huésped, Global Health Italian Network, Global Fund Advocates Network Asia-Pacific (GFAN AP), Italian Association for Women in Development (AIDOS), and co-organised with Africa Japan Forum (AJF), Global TB Caucus, Impact Santé Afrique (ISA), and WACI Health.
The event was moderated by Rachel Ong, Regional Coordinator of GFAN AP and co-facilitator of the C20 Global Health Working. (More details of all speaker of the panel are available below). The event highlighted main barriers and provided recommendations towards coordinated, cohesive, and collaborative approaches towards achieving Universal Health Coverage (UHC) through strengthening health and community systems without leaving anyone behind. The event also called for approaches towards sustainable financing at global, regional, and national levels for health to overcome COVID-19, achieve UHC and health-related Sustainable Development Goals (SDGs) through people-centred, human-rights based, and gender transformative approaches amidst COVID-19 pandemic challenges to ensure that we leave no one one behind.
Welcoming the panellists and the participants, Stefania Burbo highlighted that all and every approach to “Leaving No One Behind” should be human rights-based, people-centred, equity-focused, and must include a gender transformative lens to overcome the limitations of current responses to health interventions and to address future emergencies. She further stressed that key populations and other marginalised groups should be at the centre of these health responses and they should be comprehensively coordinated and satisfactorily financed in order achieve UHC for all. In addition, she called for immediate equitable access to COVID-19 vaccines and stressed the role that G20 leaders had in realising this.
Reflecting on how to ensure that no one is left behind especially in the context of COVID-19, Dr MingHui Ren emphasised the importance of integrated and people- centred primary healthcare that is equitably accessible to all, especially to those from marginalised communities. He also underlined the need to be critical of the complacency showcased by world leaders on their health commitments and stressed on the need to hold each other accountable while putting the most vulnerable first in order to put the last mile first.
Dr Lucica Ditiu, commenting on the role of leaders in shifting gears in G20 countries where some of whom have the highest TB burdens, insisted on the political commitment from national leaders that had to immediately translate to action. COVID-19 proved that when required, political commitment can be mobilised as all states have invested and reallocated resources to address the COVID-19 pandemic. She further explained that such political commitment realised through actual allocation of financial resources for health systems, community systems and to community health workers is required to close the deadly divide in TB responses. She also emphasised the critical role of “shoulder-to-shoulder” action from communities and civil society, governments and other stakeholder to facilitate UHC for all.
We cannot allow ourselves to be complacent with respect to our commitments towards the SDG targets for ending HIV, TB and malaria, NCDs, NTDs and metal health, many of which – I am thinking in particular about NCDs and mental health – deserve to be called silent pandemics and are, like COVID-19, far away from the last mile.
Given this context, WHO will continue to support countries to progress towards UHV and primary healthcare as the foundation of UHC and robust and resilient health systems.
Making sure that UHC and primary healthcare work for all people and communities requires everyone- WHO, CSOs, partners – to use their comparative advantages in supporting countries, and their full and long-term commitment to this end.
Directing attention to further marginalised populations as well as young people, Lucas Saavedra, explained the inequities faced by populations such as young people living with HIV, whose access to COVID-19 vaccines and related other services – such as mental health and sexual and reproductive health (SRH) services have been severely interrupted due to stigma and discrimination associated with HIV. They also explained the human rights violations faced by key populations, adolescents and young people, young girls and women among other marginalised populations which make them further left behind in the health responses and insisted of repealing laws and policies that discriminate marginalised populations as a key step towards putting the last mile first. They further emphasised that laws and legislation reform need to happen to ensure that key and marginalised populations are not criminalised to ensure equitable access to healthcare and services.
Dr Zolelwa Sifumba stressed the significant role played by frontline health workers, including community health workers and medical staff combatting the COVID-19 pandemic, as well as responding to epidemics such as HIV, TB and malaria at the same time. She underlined that leaders need to listen to the “healers” and ensure that frontline health workers have to protected with COVID-19 commodities such as PPE so that they are supported and protected to save lives. She further stressed that mental health support is needed for frontline health workers, especially when they are also stigmatised and have to make decisions on whose lives to save when there were not enough oxygen therapeutics.
Commenting on the emergence of a new global health architecture alongside the COVID-19 pandemic, Dr Julitta Onabanjo highlighted that a better local and global recognition of UHC should invariably include SRH services. She explained that the high cost derived from lack of access to SRH services can be minimised by providing free and equal access to SRH services for marginalised communities including women and girls and cost savings can be invested to achieve UHC for all.
Daniel Marguari, relating the discussion to the G20 platform, commented on the role of G20 leaders in financing the global health responses and explained that G20 countries need to set example by meeting their ODA commitments, waiving loans of middle and lower middle income countries and increase financial commitments to Global Health Financing Facilities such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). He also insisted that G20 countries should set an example to the world by addressing and repealing laws and policies that discriminate against certain populations making them further left behind in health responses.
Reflecting on 20 years of Global Fund investments in over 100 countries, Peter Sands, highlighted the importance of community health workers in fighting current and future epidemics and pandemics alike. He emphasised that the successes of the Global Fund has been because of its efforts in putting communities and vulnerable populations at the centre of responses and investing in building strong community systems as part of larger health systems. He emphasised that any global health agenda should focus on addressing inequalities, protecting and promoting human rights and enabling gender transformative responses.
Providing closing remarks, Kurt Frieder, highlighted the critical role that needs to be played by world leaders in the current unprecedented situation to uphold health responses, widening fiscal space for development, supporting low and lower-middle income countries to recover economies and specially to ensure that global commitments on health and sustainable development continue to fashion heath and development agendas.
How close or far are we to the UHC Agenda? UHC is not only a health issues since it drives improves in most other SDGs.
We need sustained investments for health systems strengthening and infrastructure since it is a fact that globally our health systems are as strong as its weakest links. Health is not only a public good, it is an investment and not a cost!
And COVID-19 is proving that the cost of inaction is of great magnitude, without available resources no health system no development towards UHC will be possible.
Focal Point & Advocacy Officer, Global Health Italian Network
Stefania Burbo has been working as focal point and advocacy officer for the Global Health Italian Network since 2004. The network is composed of eleven civil society organisations promoting the right to health, focusing on countries with greater difficulty in accessing health care. She has been Co-Spokesperson of GCAP – Global Call to Action against Poverty Italy since 2017. The Coalition is an expression of the world`s largest civil society movement, calling for an end to poverty and inequality, promoting the adoption of sustainable policies respecting human rights, dignity, gender equality, social and environmental justice, in the framework of the 2030 Agenda. GCAP Italy is a key interlocutor for Italian institutions on G7/G20 processes, as well as for the 2030 Agenda debate. She was appointed Chair of the Civil 20 (C20) in 2021, as well as national coordinator of its GHWG. Stefania Burbo graduated with a degree in Political Science and has been working in the International Cooperation field since 1997. She began working in Sub-Saharan Africa, within both development and emergency projects.
Dr MingHui Ren
Assistant Director General for UHC / Communicable & Non-communicable Diseases, World Health
Dr Minghui Ren is a medical doctor and holds a Masters in Public Health and a PhD in Social Medicine and Health. He currently serves as Assistant Director-General for Universal Health Coverage/ Communicable and Noncommunicable Diseases at WHO headquarters. In this role, he oversees a complex portfolio of technical programmes covering HIV, viral hepatitis, tuberculosis, malaria, neglected tropical diseases, sexually transmitted infections, noncommunicable diseases, mental health, and substance use. He currently represents WHO on the boards of the Global Fund to Fight AIDS, TB and Malaria, UNAIDS, and UNITAID. Prior to his appointment as Assistant Director-General, he spent nearly 30 years working in public health, including as Director-General for International Cooperation in the National Health and Family Planning Commission of the People’s Republic of China. In China, his work initially focused on health policy and health reform, and later on international health cooperation and global health governance.
Dr Zolelwa Sifumba
Medical Doctor & Clinical Research Fellow, African Health Research Institute
Dr Zolelwa Sifumba is a young, passionate South African activist, Medical Doctor and Clinical Research Fellow at African Health Research Institute. She is an occupational survivor of both Multi Drug Resistant Tuberculosis and Covid-19, which she contracted fighting on the front lines due to poor infection prevention and control within health centres, advocating for both on national and international stages, as one of the Global Fund’s Faces of the Fight as well as her current role as an ACT Accelerator Therapeutics Pillar COVID-19 Community Representative. Over the years she has used her voice in the global fight against TB and Covid-19, her strong words appearing in Forbes, Reuters, The Scientific American, BBC news channels, to name a few, and a publication in The Lancet advocating for change; Now, the young South African trailblazer, who decided to leave the frontlines due to issues of safety, works to advocate for and assist in the provision tangible support to front line essential workers globally, something she believes has been lacking in humanity’s response to the various pandemics we face.
Dr Lucica Ditiu
Executive Director, Stop TB Partnership
Dr Lucica Ditiu has been the Executive Director of the Stop TB Partnership since May 2011. She is a Romanian Physician and public health expert who has devoted her career to helping and supporting people affected by TB, especially those most vulnerable, most stigmatised and living in impoverished communities. A firm believer in innovation, flexibility and change, Dr. Ditiu is relentless in pushing for the inclusion of all people affected by TB, with an ambitious agenda of transparency and accountability that continuously challenges the status quo. Lucica has led the Stop TB Partnership for the last 8 years. Under her leadership, the organization has gained a clear identity and evolved into a lean, innovative and progressive team that represents one of the most influential advocacy voices on global health and tuberculosis, providing support – financial as well as TB medicines and diagnostics – for a TB response towards a world without TB. Dr. Ditiu is a specialist in lung diseases and began practicing medicine in 1992 in Romania. She started her international career with the WHO in January 2000 as a medical officer for TB in Albania, Kosovo and FYR Macedonia within the disaster and preparedness unit. She has worked for the past 18 years in the WHO and UN system at every level: national, sub-regional, regional and global, and attributes her experience and expertise to deliver results while navigating all sorts of difficulties.
Lucas Josué Nuñez Saavedra
Designer, Jóvenes Positivos LAC (J+LAC)
Lucas Josué Nuñez Saavedra is a non-binary (neutral pronouns) visual artist and independent researcher.
They participate in the Círculo de Estudiantes Viviendo con VIH+ (CEVVIH) as Head of graphics and communications. They also work as a designer at J+LAC.
Lucas graduated from Pontificia Universidad Católica de Chile and is an artist and researcher of the affective dimensions in public life with a focus on the processes of mourning, the socialisation of pain, and the incidence of public discourse on HIV/AIDS.
Dr Julitta Onabanjo
Director of the Technical Division, UNFPA
Dr Julitta Onabanjo is the Director of the Technical Division, UNFPA Headquarters. A national of the US and Nigeria, Dr. Julitta took up this position in August 2021, bringing to the role her over 24 years of experience in programme management, development, advocacy, partnerships and leadership with UNFPA. Prior to her current position, Julitta was Director of UNFPA’s East and Southern Africa Region, where her leadership contributed immensely to resource mobilization efforts, partnership development and strengthening with regional actors, aligning the countries of the region behind a common Africa position on ICPD25. Since joining UNFPA in 1995, and again in 2001, Julitta has held several positions both at UNFPA headquarters and at country level; serving as Technical Adviser and Special Assistant to the Executive Director and as UNFPA Representative in Tanzania and the Republic of South Africa. Julitta holds a Master of Community Health in Developing Countries degree from the London School of Hygiene and Tropical Medicine, a Bachelor of Medicine and Surgery degree from the University of Zambia, and a Bachelor of Science in Applied Biology degree from the University of London.
Executive Director, Spiritia Foundation
Daniel Marguari is the Executive Director of Yayasan Spiritia (Spiritia Foundation) in Jakarta, Indonesia. Spiritia Foundation works closely to support networks of People Living with HIV and key populations – including people who use drugs, sex workers, transgenders, and men who have sex with men throughout Indonesia. Spiritia Foundation has been a recipient of the Global Fund from 2011 – 2016 as a sub-recipient and as a PR from 2016, it manages US$55 million to support key and vulnerable populations, working closely with their partners throughout Indonesia. Daniel has a degree in Business Administration and in the mid-1990s began his career in the private sector taking on the management of the personnel and general affairs department of a well-established company in Jakarta. He began to be involved in HIV advocacy when a close relative passed away from AIDS and began volunteering with Spiritia Foundation and in 2002, made the decision to devote himself to Spiritia Foundation after the passing away of one of the co-founders of Spiritia Foundation.
Executive Director, The Global Fund to Fight AIDS, Tuberculosis and Malaria
Peter Sands has been the Executive Director of the Global Fund since March 2018. Since June 2015, Peter has been a Research Fellow at Harvard University, dividing his time between the Mossavar-Rahmani Center for Business and Government at Harvard Kennedy School and the Havard Global Health Institute. Peter was Group CEO of Standard Chartered PLC from November 2006 to June 2015, having joined the Board of Standard Chartered as Group CFO in May 2002. Prior to joining Standard Chartered, Peter was a Senior Partner at McKinsey & Co., and has served on various boards and commissions, including the UK’s Department of Health, the World Economic Forum and the International Advisory Board of the Monetary Authority of Singapore. Peter graduated from Oxford University with a First-Class degree in Politics, Philosophy and Economics. He also received a Master’s in Public Administration from Harvard University, where he was a Harkness Fellow.
President, Fundación Huésped
Kurt Frieder was the previous Executive Director and is currently the President of Fundación Huésped, Argentina. He holds a degree in Business Administration and a Master’s degree in Public Health from Buenos Aires University. He was also the General Secretary of the Argentinean Aids Society and a CCM member of the Global Fund during both projects granted to Argentina. Until 2018, he presided over the Argentine Network for International Cooperation (RACI) working in the development of the social sector. Currently he is on the Board of the Argentinean Network of the United Nations Global Compact and is part of the Advisory Group of the Civil Society Engagement Mechanism for UHC2030. During 2018 and 2019 and this year again in Italy, he co-coordinates the C20 GHWG.