A Wake-up CallLessons from Ebola for the World’s Health Systems

1G7/G20 Parliamentarians‘ Conference, 17 April 2015

A Wake-up Call

1. Ebola - Learning the Lessons

2. 2015 Health Access Index - Prevention is Better than Cure

3. Universal Health Coverage - The Need to ‘Build Back Stronger’

4. Recommendations

1. Ebola - Learning the Lessons

“Had there been effective [health services] in the countries of origin of the disease, this problem could have been mitigated or even eliminated.”

Amartya Sen

Lesson: Importance of Health Systems

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Weak health systems

Ebola Spread

Further weakeni

ng of health

systems

Limited access

to health services

Impact on

health outcom

es

828 affected health workers, 499 reported deaths

Surge of measles in affected countries (rates

3 to 4 times higher*)

Half less pregnant women received prenatal care in Liberia*

*between 2014 and 2015 (over 5 months)

State of Health Systems Before the Outbreak

Critical shortages of health workers• 1 health worker/1,598 people in Guinea• 1 health worker/3,472 people in Liberia• 1 health worker/5,319 people in Sierra Leone

Inadequate financing• Guinea $9 per person each year• Liberia $20 per person each year• Sierra Leone $16 per person each year

Lack of access to medical products, vaccines & quality health services• Drastic shortages of medicines, inadequate knowledge of International Health Regulations

Lesson: Cost of Ebola 3x Cost of Health System

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2. 2015 Health Access Index - Prevention is Better than Cure

“The state of the health workforce and health systems [in Guinea, Liberia and Sierra Leone] has hampered the ability of these countries to respond to the Ebola epidemic – but these countries are hardly alone in having inadequate training, support and numbers of health workers.”

Dr Ariel Pablos-Mendez, USAID’s Assistant Administrator for Global Health

2015 Health Access Index: Ranking

1 Brazil

2 Kyrgyzstan

3 Uzbekistan

4 Azerbaijan

5 Egypt

6 South Africa

7 Tajikistan

8 Turkmenistan

9 Gabon

10 Peru

11 Solomon Islands

12 China

13 Sao Tome and Principe

14 Viet Nam

15 Botswana

16 Congo

17 Indonesia

18 Mexico

19 Morocco

20 Philippines

21 Rwanda

22 Iraq

23 Swaziland

24 Bolivia

25 Cambodia

26 Uganda

27 Benin

28 Gambia

29 Malawi

30 Comoros

31 Equatorial Guinea

32 Guatemala

33 Senegal

34 Burkina Faso

35 Burundi

36 Djibouti

37 Myanmar

38 Tanzania

39 Ghana

40 Madagascar

41 Angola

42 Côte d'Ivoire

43 DRC

44 Liberia

45 Mauritania

46 Sierra Leone

47 Kenya

48 Lesotho

49 Nepal

50 Papua New Guinea

51 Yemen

52 Zambia

53 Bangladesh

54 Eritrea

55 India

56 Cameroon

57 Pakistan

58 Sudan

59 Togo

60 Lao, PDR

61 Mozambique

62 Guinea-Bissau

63 Mali

64 Niger

65 Guinea

66 Central African Republic

67 Ethiopia

68 Haiti

69 Afghanistan

70 Nigeria

71 Chad

72 Somalia

Access and quality of health services

2015 Health Access Index: Risks for Outbreaks

“The risk of new diseases quickly spreading worldwide

has never been greater.” Judith Rodin, President of the Rockefeller Foundation

• Estimations from the University of Washington: today, 51–81 million deaths globally might be caused by an influenza strain similar to Spanish flu of 1918-1920

• The 28 countries that fell below Liberia in the Index could account for more than 31 million deaths

2015 Health Access Index: Risk for Children and Women

17,000 children die every day

New-born mortality

rate remains high

Unequal progresses

towards MDG4 and

MDG5

3. Universal Health Coverage - The Need to ‘Build Back Stronger’

“Well-functioning health systems are not a luxury. Well-functioning health systems are the cushion that keeps sudden shocks from reverberating throughout the fabric that holds societies together, ripping them apart.”

Margaret Chan, World Health Organization

Director-General, 2015

Universal Health Coverage: An Affordable Reality

$86 per year per capita for essential services package delivery

$101 billion additionally would be required annually for 75 countries with highest maternal and child mortality

Increase health investments (to 15% of budget), increase health ODA (to 0.1% GNI) for 26 of 75 countries with highest child and maternal mortality

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Universal Health Coverage: Best Investment into Child and Maternal Health

Calling for:o 100% coverage of essential services o 100% financial protection from out-of-

pocket-payments (OOPs) for healtho for all people

Best measure:o Skilled birth attendance for all segments of

population (in particular poorest 1/5)

Recommendations 1. Maintain the international response to help Guinea, Liberia and Sierra

Leone achieve zero new Ebola cases

2. Political leaders in countries with low rates of health coverage should make public commitments and increase investment to 15% of budgets in comprehensive health services

3. International institutions and donors should ensure that aid and global support is increased to 0.1% GNI and better aligned to help build suitable and comprehensive health services

4. Civil society organisations should advocate for progressive tax reforms and increased transparency, more equitable revenue and health expenditure

5. The Sustainable Development Goals should commit the world to support universal health coverage and ending preventable maternal, newborn and child deaths, with no target met unless met for all

German Government with G7 Presidency can set a clear signal during June Summit ahead of FFD and UNGA

Thank you

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Beyond Ebola: 2015 Health Access Index

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