Universal Health

Through the Civil-20 (C20) engagement group, Angsamerah was involved in the recently concluded G20. Plays an active role in compiling a policy package in the Vaccine Access and Global Health working group, which has been submitted to the Ministry of Health of the Republic of Indonesia. The policy pack was negotiated through recommendation of the President of the Republic of Indonesia at the G20 Presidential Summit on November 15-16.

C20 Vaccine Access and Global Health Working Group aims to fulfil the right of everyone to achieve and obtain the best and basic standard of physical, mental and social health which becomes community-centred universal health coverage. Achieving this health through a rights-based, inclusive, cross-generational approach, and gender transformation, which is of course economically profitable and sustainable. There needs to be a transparent and accountable mechanism/process for the resulting health policies and solutions.

Very often, health policies and solutions produced by the government forget about groups in society, such as marginalized groups, vulnerable groups, and key populations. This happens because it is not optimal to involve these groups in the centre of global health strategy and action.

Active and inclusive participation of community-based groups/organizations and/or community leaders at all political levels in decision-making, the manufacturing process, implementation, and monitoring, can result in fair and equal health policies and solutions to achieve universal health for all.

C20 emphasizes that every decision that affects and impacts the global community, must be made inclusively by not widening existing gaps or widening gaps in the expected recovery path. Recommendations and decisions that impact the global community (including strengthening the global health architecture) need to be made inclusively by all member states; by actively involving communities and civil society.

After holding several meetings/discussions with community groups/C20, several priorities were generated. It is expected that this priority will receive special attention from the government/G20 so as to achieve universal health for all.

Some of the things that are the priorities of the Vaccine Access and Global Health working group:

1. Building the resilience of global health systems.
2. Aligning global health protocol standards.
3. Expanding global production and research centers for pandemic prevention, preparedness and response (PPPR).

C20 through the Vaccine Access and Global Health working group provides policy priority directions as the main recommendations of the G20.

1. Global Health Architecture Inclusivity.
   The diversity of various types of community organizations as representatives that shape/create the Global Health Architecture based on equality and inclusiveness. Also ensure greater engagement with strong representatives from organizations and civil society. Contributions from diversity can produce/create a Global Health Architecture that is robust, transparent, accountable, and flexible that can be applied in various climates/countries/world organizations.

2. Expanding access to all health and COVID-19 commodities.
   To ensure the availability and accessibility of health commodities at the right time, in the right quantity, on target, which can save many lives during the pandemic, medical devices, vaccines, new drugs and their reagents must be diversified and stop the monopoly on patents, practices, and unclear commercial prices. G20 countries should recognize all life-saving technologies, medical devices, reagents, medical consumables as global public goods during emergencies and enforce existing mechanisms (or legislative mechanisms) to ensure that these are provided in a fair and impartial manner or suspending all intellectual property rights (IPR) during a global health emergency.

3. Community Health Ecosystem Reinforcement.
   Ownership and full involvement of the state is needed to drive demand and identify needs, in order to balance prescriptions in strengthening the health ecosystem. Creating and compiling a holistic health system must be accompanied by readiness and cover all aspects of life in emergency and non-emergency situations, integrated with other institutions, groups and organizations. Thus, when an unexpected disaster/event occurs, all elements of the nation already know their respective roles and functions. We can respond to unknown threats in the future, by learning from past pandemics and the current COVID-19. As we have seen in the HIV response (including informal means of community monitoring and data collection), COVID-19 has worsen and shifted global direction and attitudes off track towards achieving certain SDG targets (including SDG 3.3 to end the HIV, TB epidemic, and malaria). It is imperative that the G20 recognize that everyone’s health depends on the interaction between people, animals and the environment, and that we must prevent the spread of disease from animals to humans. The G20 must ensure that we monitor policy and data availability—including sex- and gender-disaggregated data through ethical, regulatory and permitting channels that take into account gender implications for the safety, efficacy and effectiveness, availability, accessibility and quality of all health commodities provided during an emergency.

4. Achieving Universal Health Coverage (UHC).
   COVID-19 will not be the last pandemic the world faces, and we cannot delay the critical actions needed to strengthen the health response to achieve UHC. The following notes regarding the continued impact of COVID-19 on health systems and the ability of countries to achieve SDG 3 by 2030:

• • Access to qualified health and medical services.
    Political will and ability—and more importantly—leadership and action, are needed to overcome obstacles, including laws and statutory practices as well as cultural and social norms, that legitimize stigma and discrimination, which discourage and criminalize individuals in access health services. There is an urgent need to strengthen primary health care and services, including qualified mental/early mental health services, where all financing is strengthened/augmented in the health/BPJS health/insurance budget.

• • Sustainable Health Financing.
    Long-term domestic financing of the health system must be addressed urgently. Introducing/implementing progressive taxation to increase the fiscal space needed in a sustainable manner, by obtaining sources of health financing through collective funds from individuals/communities/businesses/government by placing management under one systemic authority (FIF) or through crowdfunding for other civil organizations.

During the meeting and drafting of C20, the policy package working group Vaccine Access and Global Health, we kept reminding G20 leaders of their commitment to leave no one behind. Collectively, we as governments, communities and civil society must find a way to overcome barriers in solidarity with a rights-based, gender-transformative, inclusive framework in an equitable way to revitalize the Global Health Architecture that will strengthen the public health ecosystem to achieve the best health for all. In order to adequately anticipate and prepare for the mitigation of future pandemics, the IHR (International Health Regulation), which is currently a legally binding agreement of 196 countries, must be strengthened so that it can adequately handle and support global countries’ efforts to anticipate and respond to future pandemics, especially in controlling the spread of disease across national borders — of course in a way that is based on human rights.

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Translated by: Nadya Joan Sinda