What's next for Japanese aid in UHC push

A number of nongovernmental and civil society actors are applauding Japan’s recent work in the global health space as the country makes a push for strengthening health systems and addressing the rising problem of antimicrobial resistance.

Under its leadership, the Group of Seven countries committed to a number of health-related concrete actions at the Ise-Shima Summit in May, including compliance to the International Health Regulations, as well as enhancing their support and coordination to strengthen health systems, especially in developing countries. The leaders also supported the proposal to establish UHC 2030, a platform envisioned to advance and rally behind the concept of health systems strengthening and universal health coverage.

This action stemmed from Japanese Prime Minister Shinzo Abe’s early pronouncements prior to Japan’s presidency of the G-7 for 2016. At the International Conference on Universal Health Coverage in the New Development Era: Toward Building Resilient Health Systems hosted by Japan in December 2015, Abe said: “I intend to take up health as a priority agenda at the G-7 Ise-Shima summit, and I would like to lead the discussion on the health challenges that the world faces in close cooperation with the other G-7 countries.”

The biggest question, however, is how this rhetoric will translate to concrete action on the ground. How will Japan’s commitment to address today’s global health challenges at the highest level of government translate to the way it disburses development assistance?

At the first consultation meeting in Geneva aimed at advancing UHC, Devex spoke to Ikuo Takizawa, deputy director general of the human development department at the Japan International Cooperation Agency.

As a donor, how do you view health systems strengthening?

I think the ultimate goal of health systems strengthening, particularly in developing countries, is to create a health system where they do not need our assistance anymore, and then really be autonomous in providing health care to everybody without causing excessive financial burden.

So in order to achieve that, you have to invest in the health service delivery side, including human resources — which is a big challenge in many countries still — and health facilities, which is sometimes not available in rural areas.

So those are things we need to keep on investing in, [as well as] other things like health information systems [and others that make up the] six building blocks of a health system.

But increasingly we are also aware that health is one of the risks which impoverish people. So, again, we also need to look in the financial protection side of universal health coverage. So I think we need to balance both. Sometimes, the argument can go too extreme to the other side — when they start talking about UHC, some people equate it with health insurance. But it is not.

As a donor, among your peers, is there an agreement and understanding of what UHC means?

I think so. The definition of universal health coverage is clearly out there, with WHO and others.

But the challenge is, I think the way to achieve it, can be very diverse, depending on the country context or historical background or political situation. So that’s where I think the challenge comes in, and then people start talking about different things.

One of the strengths of JICA has been in infrastructure. Given the push for universal health coverage at the highest level of your government, I’m wondering how that translates to your priorities?

We are increasingly supporting policy-level decision-making. For example, we are supporting Kenya as one of our very good partners in promoting universal health coverage. And in Kenyan programs, we provide technical assistance through the dispatch of an advisory expert within the ministry of health, and he’s the one who is regularly consulting with people from the government, and supporting their effort in developing policies like health financing strategy, for example. So he’s the one providing that technical input together with other partners.

And because Kenya’s health system is drastically decentralized or devolved … we are supporting, through another technical assistance, the capacity development of counties’ health management, like providing management training to county health officials, or in supporting the establishment of official or formalized communication channel between the central ministry of health and counties.

On top of that, we extend what we call “development policy loan.” It’s a concessional loan of about $35 million through budget support to support government efforts to introduce critical reforms to promote universal health coverage, like expanding health insurance schemes for the poor, or introducing results-based financing for the primary health care facilities, and also the development of health financing strategies as well.

So the development policy loan is a loan or budget support which is tied to certain policy actions to be fulfilled by the recipient side.

In Ghana, meanwhile, we are mainly focusing on the capacity development of the service delivery side. There, they have a national policy to expand what they call CHIPS, or community health planning and service, which is establishing health facilities closer to the community. And then they assign community health officers, and then they are the ones who are supposed to provide and promote basic and preventive health services via outreach. So we are supporting that national policy up in the northern part of Ghana.

In Ghana’s case we don’t provide concessional loan, but technical assistance plus grant financing for the construction of those health facilities. So it depends on country context.

This is what you’re currently doing. But will there be changes that we can expect?

I think we’re trying to mobilize more development policy loan or the loan in general, because UHC is costly. And then there is definitely a demand for financing. And with [the] loan, we can mobilize bigger amount of money, even though the recipient government has to repay it, but it is still very concessional, so some of the governments are willing to borrow. So for some of the countries we are trying to use more loan[s].

And then people started talking about domestic resource mobilization. And because [a] loan is money that government has to repay, that’s also kind of liberating the contribution from the recipient side as well.

There’s a lot of talk on multisectoral collaboration. How are you going to try to get partners within a country not just in the health sector to be proponents of UHC?

That’s a very interesting question. JICA is not a specialized agency, like WHO. So under our portfolio, we’ve supported very diverse sectors: agriculture, education, water, sanitation, etc.

So there is always an internal discussion that we should try to be more multisectoral, mobilizing the different sectors for common goals. But in reality this is kind of difficult with the kind of bureaucratic structure that we have. But also, the government structure on the recipient side is also [quite similar]. So I think it’s also a challenge.

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