Your Excellency, Parnpree Bahiddha-Nukara, Deputy Prime Minister and Minister of Foreign Affairs, Thailand; Your Excellency, Dr Cholnan Srikaew, Minister of Public Health, Thailand; My fellow keynote speakers, hon’ble representatives, partners and friends,
Good morning and my best wishes for an inspiring International Universal Health Coverage (UHC) Day. My utmost gratitude also to the Ministry of Foreign Affairs and Ministry of Public Health, Government of Thailand, for inviting me to deliver this keynote address, and for convening this conference in what is a critical year for the global UHC movement.
Today, eleven years ago, the UN General Assembly (UNGA) endorsed a ground-breaking resolution that urged all countries – whatever their income or development status – to accelerate progress towards UHC.
It was tabled by just eight Member States globally, two from the WHO South-East Asia Region – Thailand and Indonesia. And just three years later, in 2015, it became not just central to but the founding principle of the health-related Sustainable Development Goals (SDGs).
In 2017, the UNGA passed another resolution to make today, 12 December, an annual advocacy and awareness day, and in 2019 and 2023, held successive high-level meetings to accelerate whole-of-government, whole-of-society action to achieve UHC – the key that unlocks health security and Health for All.
At every step – and seizing every opportunity – Thailand has played a critical role, leading not just through words but through actions, and serving as a beacon of hope amid rough and unchartered waters.
But I also commend Thailand on its many contributions in our Region, where since 2014, achieving UHC has been a Flagship Priority, with a focus on strengthening human resources for health and increasing access to essential medicines.
That Priority – and our Regional commitment – was again expressed at our recently concluded Regional Committee meeting, where ministers of health – including Your Excellency Dr Cholnan – unanimously adopted the Delhi Declaration on strengthening primary health care, which is central to our post-COVID-19 Build Back Better vision.
So where are we today, just seven years shy of our 2030 deadline, and in the final year of our Regional Flagship Priorities?
Globally, progress has been modest, and is currently off track, exacerbated by the COVID-19 crisis.
Since 2015, improvements to essential health services coverage have almost stagnated, and as of 2021, some 4.5 billion people still lack access.
On financial protection, progress has reversed, with an estimated 2 billion people globally plunged into financial hardship due to out-of-pocket expenses.
Regionally, between 2015 and 2021, the average service coverage index increased from 54 to 62.
Between 2014 and 2020, out-of-pocket (OOP) spending as a share of current health spending decreased from 42.8% to 37.9%.
Between 2015 and 2019, the total population both impoverished and further impoverished in the Region due to OOP health spending significantly reduced, from 12.4% to about 6.6%.
Since 2014, the density of doctors, nurses and midwives in the Region has improved by over 30%, and today, all countries regularly update national Essential Medicine Lists, which guide health care resource allocation and rational medicine usage.
Even accounting for the COVID-19 crisis, of the 270 million additional people projected to be covered by UHC between 2018 and 2025, 110 million – more than 40% – are from our Region.
This is a formidable achievement, but an achievement that must not obscure just how far we’ve got to go, both in terms of access to essential health services, as well as financial protection.
The exception, of course – both globally and in the Region – is Thailand.
The latest estimates show that between 2000 and 2021, Thailand more than doubled its service coverage index, to 82, meaning that it has achieved the 80 and above target.
In the same period – and despite its middle-income status – Thailand reduced catastrophic health spending from 5.3% of households to 1.9%, which is among the world’s lowest.
But dramatic as these achievements are, they did not happen overnight. Rather, they were the result of consistent and prioritized investments in health, especially primary health, and the steady expansion of health care capacity, beginning in the 1970s.
This was then accelerated in the wake of the 1997 Asian Financial Crisis, when public health insurance was dramatically expanded, when the National Health Security Office was established, when multisectoral platforms were founded, and when the Right to Health became a national priority.
The lesson here is that crisis brings opportunity – yes, but only to those who seize it.
For Thailand, the Asian Financial Crisis. But for all other countries, what has to be the COVID-19 crisis.
But the other lesson is that the work doesn’t stop.
In 2019, the Thai Parliament endorsed the Primary Health Care Act, which has become an innovative legal tool to ensure Health for All, with a focus on strengthening human resources for health.
In 2022, amid the COVID-19 response, Thailand was among the first four countries globally to conduct the Universal Health and Preparedness Review Initiative, and in the same year, became the first country in the Region to complete a Joint Review of Health System Capacity to address the needs of migrants – what it truly means to leave no one behind.
In that spirit, I close by highlighting four key areas where Thailand and almost all other countries – both in the Region and globally – can continue to push the needle, for ongoing, incremental improvements.
First, maintaining and strengthening investments in health, especially primary health – where most people’s health needs can be met throughout the life-course.
Second, addressing the weakest link in UHC – noncommunicable diseases (NCDs). For this, countries must rapidly improve access to quality NCD services, and rigorously address key social and commercial determinants.
Third, identifying and mitigating the causes of health inequities, with a focus on obtaining high-quality, disaggregated data, and including affected communities not just in finding but implementing solutions.
And fourth, accelerating whole-of-government, whole-of-society commitment to UHC, recognizing that to achieve Health for All we must be All for Health.
I once again congratulate the Government of Thailand, wish you a happy UHC Day, and reiterate WHO’s steadfast support, for a Region and world in which every person, everywhere can access quality, essential health services, without financial hardship.
I thank you.