World Health Assembly kicks off with focus on health workers, universal coverage

GENEVA — The 71st World Health Assembly kicked off Monday with the Ebola outbreak in DRC and support for universal health coverage in the spotlight.

But it was a call to better support interns at the United Nations’ health agency that drew the loudest applause at the opening of the event in Geneva.

“We must treat our interns much better than we do,” World Health Organization Director-General Tedros Adhanom Ghebreyesus told hundreds of delegates during the opening session. “Too often we use them as free labor, rather than an investment in youth, and in developing the health leaders of the future.”

He flagged steps that have already been taken, such as giving interns health insurance, lunch vouchers, and time off like full-time staff have, and said WHO is considering a stipend by 2020 for interns who cannot support themselves. “We also have plans to re-launch the WHO scholarship to enable students from low- and middle-income countries to study abroad,” Tedros added.

Honoring health workers proved a theme on the first morning of the week-long gathering, with Tedros dedicating his speech to Dr. Carlo Urbani, a WHO doctor who died from the SARS virus in 2003. Urbani’s son, Tommaso Urbani, took to the stage with Rwandan President Paul Kagame and Tedros for the unveiling of a plaque in honor of his father, who worked in Cambodia, Laos, and Vietnam, and who assisted in the early detection of SARS.

On Ebola, Tedros expressed his concern over the virus reaching an urban area but insisted the organization is “much better placed to deal with this outbreak than we were in 2014,” with vaccinations now underway. He said he was “proud” of the WHO’s response so far, with partners including Médecins Sans Frontières, the World Food Programme, and the Red Cross.

Tedros said the outbreak showed that “health security and universal health coverage are two sides of the same coin. The best thing we can do to prevent future outbreaks is to strengthen health systems everywhere.”

That’s the aim of the Global Programme of Work, the WHO’s 2019-2023 agenda, which Tedros hopes to see approved by member states this week. Its “triple billion” targets are to have by 2023: 1 billion more people benefitting from universal health coverage; 1 billion more people better protected from health emergencies; and 1 billion more people enjoying better health and well-being.

“Our new GPW is not about reinventing the wheel,” Tedros said. “It’s about making a bigger impact than we already make.”

Tedros also dismissed the idea that WHO is under threat from new actors in global health.

“By leveraging the experience, skills, resources, and networks of our partners, our impact can be exponentially larger than if we were acting alone,” he said. “To truly fulfil our mandate, we must make our partnerships even deeper and stronger.”

That extends to private sector engagement. In talking about the Framework of Engagement with Nonstate Actors, Tedros said: “The FENSA, adopted by this assembly last year, provides the guardrails for that engagement, but FENSA is not a fence. We must use whatever partnerships are open to us, in whatever way we can, to achieve our goal.”

The WHO chief reiterated his call for financing changes, saying the quality of funding matters just as much as its quality.

“We cannot achieve our mission if earmarking continues at the current level,” he said, referring to the practice of countries dictating where they want their contributions spent. “Instead of breaking down silos, earmarking creates silos and fuels internal competition for funds. Instead of building a single, coherent WHO, earmarking drives us apart. To execute the GPW, we urge all countries to support WHO with high-quality, flexible funds.”

Kagame used his address to welcome the WHO’s emphasis on achieving universal health coverage.

“Specifying an interim goal of an additional 1 billion people getting coverage by 2023 is a good innovation. This may sound like a lot, but the truth is that it reflects the minimum pace required to meet the 2030 goal, and we are already behind schedule,” he said.

The Rwandan leader said Africa has an advantage in the fight against noncommunicable diseases given its low levels of tobacco use. Historically, NCDs and tobacco use were less prevalent in Africa, although research shows that levels of both are rising. But Kagame said the continent was lagging behind in the battle to improve health coverage, particularly in service capacity and access.

“We simply lack the personnel and the facilities required for universal coverage,” he said. “Addressing this gap has to be main focus of African member states and our partners.”

He also used the opportunity to speak before member states to advocate for a fully funded WHO that has budget flexibilities.

“The World Health Organization is aligned with Africa and with my country, Rwanda. It is a trusted source of technical advice and helps keep our people safe from harm,” he said. “We should return that trust by ensuring that the WHO has the resources needed to carry out the missions that member states have assigned to it. This means diversifying funding sources, so that costs are more equitably shared. It also means reducing earmarks in favor of united contributions. We must also commit to paying our assessments on time and in full.”

Devex is on the ground at the 71st World Health Assembly in Geneva. Follow reporters @JennyLeiRavelo and @vchadw for updates, and keep an eye out for more stories to follow.