UNICEF Executive Director Henrietta Fore's remarks at the opening of the Global Conference on Primary Health Care

As prepared for delivery

25 October 2018
A doctor and mother look at a baby

ASTANA, 25 October 2018 - “Excellencies, honoured guests, ladies and gentlemen.

“On behalf of UNICEF’s staff members in 190 countries around the world, I’d like to thank our co-hosts —  the Government of Kazakhstan and the World Health Organization — for working together with UNICEF to gather around this important and essential issue of primary health care for all. 

“Four decades ago, the world made a promise in Alma Ata — a promise to recognize that health is a fundamental right for every person.

“Now, in 2018, the world has come together once again to renew this promise, with a new vision — the Astana Declaration on Primary Health Care. Today in Astana, we stand together to reaffirm our commitment to the promises the Declaration contains, by reforming and strengthening health-care systems around the world. Making them fit-for-purpose today, but also prepared for the challenges of tomorrow.

“This new vision is inspired and informed by the great progress we’ve made since 1978. Today, by every measure, the world is a healthier place. People are living longer than ever before. The rate of child mortality below the age of five has fallen by almost 60 per cent since 1990. Child malnutrition rates continue to decline. And science, development and technology have made detecting, treating and even eliminating some diseases a reality. 

“But as we mark this progress, we — as a global community — must also face a difficult fact: for hundreds of millions of people around the world, the full promise of Alma Ata remains unfulfilled.

“We know who these people are.

“The new mother unable to deliver her child in a proper health facility, or with a trained midwife, nurse or doctor — at risk of infection and even death.

“The child growing up unvaccinated, at risk of preventable disease, because he or she lives in a conflict zone.

“The teenage girl living with HIV, but unable to receive treatment because the nearest clinic is too far away.

“The tens of millions of children who grow up with their bodies and brains underdeveloped, because their communities lack the ability to diagnose and treat severe acute malnutrition.
“And tragically, the poorest and most disadvantaged children. Compared to children from the wealthiest households, the poorest children are twice as likely to die before reaching their fifth birthdays…and twice as likely to be stunted.

“Our task this week is to close the gaps between these lives and the help and hope that they deserve. To join-up the lessons we’ve learned since 1978 with the work still to be done. And to find — together — new ways to reach those people still being left behind.

“The potential is huge. The World Bank estimates that the deaths of almost four million women and children could be averted each year by investing in well-functioning health systems — especially through stronger primary health care.

“But only if we reject “business as usual.” Because at our current rate, we will not reach the SDG 3 targets unless we dramatically accelerate our progress in two key areas — quality community-based health care…and innovation.

“First — we must accelerate our work to deliver quality, community-based health care. 

“The SDG vision of “health for all” must be exactly that — for all. No matter where people live, no matter what barriers stand in the way.

“Bringing services, care and robust health systems closer to those who need it not only makes sense and drives demand for these services. It also provides an excellent return on investment.

“The WHO estimates that increasing the availability of community health workers in poor, remote communities can yield a 10-to-one return on investment. Savings achieved through future health costs averted and less dependence on social assistance.

“Which is why UNICEF is working closely with governments and civil society to build health systems that can reliably and seamlessly deliver these community-based services — including in humanitarian emergencies.

“In Afghanistan, for example, many rural communities had no access to basic services like vaccinations, sick child care and antenatal screening.

 “With the support of Japan and South Korea, UNICEF supported the delivery of primary care services to almost one million women, children and newborns last year, through 70 mobile health teams linked to — and supplied by — local community health services. A great example of how we can combine investment with the expertise and local reach of governments and partners — to provide not just temporary relief, but to begin building systems that can last for the future.

“As we sustainably improve access to health services, we must also work to improve their quality. We cannot accept “poor care” for “poor people.” No matter how basic the service, quality of care is essential. It builds confidence — and demand — while improving health outcomes for the children and families we serve.

“This also means finding new approaches to support front-line health workers who are well-trained, have the tools and equipment they need, and are paid and integrated into their communities. This could involve — for example — new partnerships with private sector suppliers and their delivery systems.

“Which brings me to my second point — innovation in all areas of our work. An important pathway to improve both access and quality. 

“Of course, innovation is about researching and developing new medicines, diagnostics and vaccines. For example, UNICEF is working with the private sector to develop product innovations to scale-up the use of pneumonia diagnostics and oxygen therapy in disadvantaged communities. And we’re working with companies to develop new and less costly formulations of ready-to-use therapeutic foods to treat children with severe malnutrition. These efforts will continue.

“But innovation is also about applying existing technology in new ways, to bring vital services closer to hard-to-reach populations.

“For example, through RapidPro, we’re using digital technology to improve the quality, reach and feedback of vital health information. From helping us monitor the immunization of millions of children in Indonesia. To training health workers in Senegal. To providing support for Palestinian children with disabilities.

“We must also be innovative in how we actually deliver health services.

“For example, in Malawi, Vanuatu and here in Kazakhstan, we’re establishing drone corridors to more quickly deliver — for example — blood test results and other vital health services.

“Another approach is integration — to deliver a number of key interventions in one place, at the same time. For example, UNICEF and our partners are using the community networks built to deliver the polio vaccine to scale-up other immunization campaigns, HIV testing, and nutrition screening. And India’s national folic-acid supplementation programme combines weekly supplementation for young people in school or community centres, with monthly nutrition and health education, along with other specialized health services. 

“Early Childhood Development is another area where providing integrated, quality care across a number of sectors — like birth registration, nutrition, early education and protection in the earliest years of a child’s life — can avert health, growth and development problems and their related costs down the road.

“We must also strengthen our collaboration with global health partners and national governments at country level, to reduce fragmentation among our various programmes and initiatives, and move towards a more co-ordinated approach as we support governments’ efforts to deliver primary health care. 

“And we should seek out new opportunities with private healthcare providers to deliver services more effectively. For example, in Kenya, UNICEF is working with a group of six private-sector partners to deliver vital child and maternal health services in the six counties that account for almost half of the country’s maternal deaths. Together, we’re managing supply-chains, training health officials, and equipping facilities with basic amenities, such as running water and electricity. 

“These are just a few examples of how we can combine quality, community-based health care and innovation in all areas of our work as we pursue the SDG vision of “health for all.”
“As we move forward, we must also remember another unfulfilled promise the world made in 1978 — participation. The success of primary health care depends on the participation and engagement of individuals, families, communities and — of course — young people, to whom the future belongs.

“In the months leading up to this conference, UNICEF launched a global poll — using a popular mobile technology called U-Report — to learn about the experiences, concerns and hopes of young people when it came to their health.

“The response was unprecedented. We heard from almost 400,000 people in 25 countries — the highest number of responses ever for a U-report poll. A clear demonstration that young people care deeply about this issue.

“And so, I’d like to finish my remarks this morning with a short video presenting some of the key findings from that poll. I know you’ll find it not only useful — but inspiring.”

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