Health authorities from the Americas discuss how to achieve universal health leaving no one behind


Geneva, 22 May 2019 (PAHO/WHO) - How to achieve universal health coverage without leaving anyone behind was the main topic of presentations made by the Ministers of Health from throughout the world this week in the plenary of the 72nd World Health Assembly.

Health authorities from the Region shared their experiences in the achievement of universal health leaving no one behind

A total of 29 delegations from the Americas took the floor in the plenary, which began on 20 May and culminated two days later.

A summary of their presentations follows below: 

United States: To prevent future challenges, countries must do a better job of educating the public about vaccine safety

The U.S. Secretary of Health and Human Services, Alex Azar, said that thanks to the efforts of many nations, international organizations such as WHO, and the private sector, the world is now “safer from the perpetual threat of infectious diseases,” but that we are not as safe we ought to be, and a reminder of that fact is the ongoing outbreak of Ebola in the Democratic Republic of the Congo. He emphasized that this is a priority for his country, that the outbreak is still not under control, and that there is an urgent need for the donors to commit to purchasing more vaccines to prevent the disease from spreading.

Azar also said that to prevent future challenges, “we must all do a better job of educating the public about vaccine safety.” He mentioned the measles outbreak in several countries of the Americas and said that even in countries with functional health systems, including the United States, vaccination rates are still too low. “We cannot say this enough: vaccines are safe, effective and vital to public health.”

The secretary added that the U.S. supports universal health coverage, and believes this means “focusing on access to a high-quality, people-centered health care system, not selectively focusing on controversial issues that do not help us reach this goal.”

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Argentina: Universal health coverage means effective health coverage 

Argentina’s Secretary of Government for Health, Adolfo Rubinstein, stated that access to health is universal in that country, which means that all people have the right to use health services at no cost at points of service in any sector of the public health system. “In Argentina, universal health coverage means effective health coverage,” he said, which is why they are working to expand effective coverage to the third of the population that is farthest behind in terms of health, which is roughly 16 million people.

Rubinstein indicated that this expansion of health coverage is based on expanding the areas where primary health care with family and community health teams is available; on offering more services with new lines of care focused on the prevention, treatment, and control of noncommunicable diseases, without neglecting other ailments; and on expanding digital coverage, such as sharing medical records. He thanked WHO and PAHO for their support in helping Argentina obtain malaria-free certification, which was presented at an event during the Assembly.

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Cuba: Health cooperation programs on medical education and Cuban medical products available to WHO and Member States 

Cuba’s Minister of Health, José Ángel Portal, said that the country is making its health cooperation programs available to WHO and its Member States, including the ability to attend university programs in medicine and medical products, “as a way of contributing to the achievement of universal coverage.”

Portal described the health system that has been created in Cuba, which is people-centered, free, accessible, and integrated, has community participation, and “is based on primary health care, with the family doctor and nurse the system’s principal strength.” He described the country’s contribution to the training of medical personnel from other countries and the teams of doctors that support other countries in the world.

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Peru: Humanize health care, give it a human face, and provide warm, quality service 

Peru’s Minister of Health, Zulema Tomás, said that being left behind when it comes to health is same as being left behind in development and being excluded from wellness. She said that the right to health is a responsibility of those who use health services, as well as a State obligation to offer those services under the principles of quality, equity, accessibility, and availability.

“We need to humanize health care, give it a human face, and provide warm, quality service,” the minister said, adding that the country is drafting an updated national health policy known as the Peru Initiative that features an integrated care model.

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Bolivia: Universal health can be a factor of social change

The Bolivian Minister of Health, Gabriela Montaño said that Bolivia has worked on building a universal health system, thanks to “political maturity” that has made it possible to agree on the broad terms for achieving it. In February of this year, Bolivia enacted a law to expand the beneficiary population that had previously not been covered by any system. “The sustainability of this system will be based on an integrated, primary health care model,” Montaño said.

The minister pointed out that within two months after this reform was implemented, 1 million services had already been provided, two-thirds of which were for women. She urged not forgetting that health policies must include policies for women. “The impact of universal health coverage is not just individual, but also provides an opportunity to become a factor of social change. She urged the international community to take the road to universal health based on primary health care.

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Brazil: Commitment to vaccination and appeal for all countries to ensure high coverage

Brazil’s Minister of Health, Luiz Henrique Mandetta, said it is no accident that countries throughout the world are increasingly focused on achieving universal health, so that more people have access to health systems. He said that preventable diseases are coming back and pose “threats that are looming over everyone.” He stressed that primary care must be strengthened “as a pillar of health systems.”

Mandetta called for expanding vaccination coverage and urged all countries to identify vaccination actions to keep preventable diseases from coming back, and to ensure high vaccination coverage rates. “This is the path that unites us,” he said. The minister reported that Brazil has implemented several measures in this regard, which integrate the public and private sectors due to the importance of this issue. He also said that the country is committed to treating neglected diseases, which involves providing a social service and ensuring timely service and treatment. He added that there must be an increased dialogue with the pharmaceutical industry to reduce the cost of medicines.

The Brazilian Minister of Health also spoke on behalf of the BRICS countries, noting that the commitment to provide quality, equitable, and sustained services is one of their priorities. Other topics of interest included the promotion of breastfeeding, and he  reiterated the bloc’s commitment to vaccination. “We know that vaccination rates in many countries are not very high, which paves the way for vaccine-preventable diseases to spread,” Mandetta said.

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Colombia: Migration is a challenge to health systems and achieving universal health

Colombia’s Minister of Health and Social Protection, Juan Pablo Uribe, said that health coverage in Colombia exceeds 95%. “After achieving universal coverage, the challenge is three-fold: ensuring access to services throughout the country, providing quality service, and making it sustainable,” he declared. Uribe said that Colombia is working with people and communities so that they have a better health care experience and to make the system more efficient and financially sustainable.

Uribe stated that the system is being “tested” with all the migrants coming into the country, which poses a challenge to the health system and its consolidation. However, he added that it is also an opportunity to test the system’s resilience, and emphasized the country’s solidarity regarding the migrant situation. He said that solutions to progressively and sustainably address this health situation must be found.

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Ecuador: Inequality sickens and kills more than any disease

Ecuador’s Minister of Health, Verónica Espinosa, said that even if the countries know what is working and what needs to be done to achieve universal health, inequalities must not get worse when achieving health for all. “Inequality sickens and kills more than any disease,” she asserted.

Although much has been done around the world to achieve universal health, it is not enough, Espinosa said. She urged participants to “stop discussing whether or not health is a fundamental right, whether it involves separating access to universal coverage, or whether or not the State is responsible for people having the right to health.” She added that Ecuador has been working in that direction, but that half of the world’s population still does not have access to these services. She cautioned that “health should not be minimized” because “that is not what the countries deserve.” Espinosa said that if the goal is to leave no one behind, renewing political commitment while addressing health inequities is imperative.

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Mexico: United Nations resolution on universal health coverage must reflect consensus reached by the Region of the Americas

Mexico’s ambassador to the United Nations in Geneva, Socorro Flores Liera, stressed the value of primary health care in achieving universal coverage. She said that the most vulnerable groups must be at the heart of health care, without discrimination, and that this is Mexico’s “unequivocal commitment.”

Flores Liera referred to the report of the Commission on Universal Health convened by PAHO, which made ten recommendations to countries in the region on how to achieve universal health coverage and access. She said that she hopes these recommendations are reflected in the resolution that is adopted to be presented in September at the United Nations High-level Meeting on Universal Health Coverage. “Universal health coverage is the goal and the means to achieving other health objectives,” she added.

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Paraguay: Commitment to reforming the tax system and laying the groundwork to reform the national health system in order to achieve health for all

Paraguay’s Minister of Health, Julio Daniel Mazzoleni, said that his country is committed to reforming the tax system and laying the groundwork for health reform in order to achieve quality universal health. He explained that the emphasis will be on controlling noncommunicable diseases and addressing their risk factors to reduce the burden of these diseases.

Mazzoleni also described the progress that has been made in areas such as health services infrastructure, the training of human resources, the incorporation of new technologies, and the reorganization of medical supply logistics. He thanked PAHO for its support through the Revolving Fund for Vaccine Procurement, which helped bridge a historical gap in immunization coverage.

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