Cautioning against imbalanced health spending as the world recovers from the COVID-19 pandemic, Gro Harlem Brundtland calls on leaders to accelerate progress on achieving Universal Health Coverage.

This speech was delivered at "Investing in Health, The Key to Building Back Better from COVID-19 and Accelerating Progress for UHC and Sustainable Development" - an official virtual side event of the High-Level Political Forum on 9 July 2020. It was organised by WHO, the Group of Friends of Universal Health Coverage and Global Health (co-chaired by Japan, Thailand and Georgia) and UHC 2030.

Distinguished panellists, ladies and gentleman, greetings from Norway.

I would have liked to join you in person. But the COVID-19 pandemic has changed the face of the world and disrupted the calendars and dynamics of international diplomacy.

We are fortunate that advances in digital technology mean it is possible to hold these virtual meetings. But given the devastating impact of the pandemic on global health and prosperity, we need to show comparable innovation and resourcefulness to maintain momentum in the fight for Universal Health Coverage and the wider SDG agenda.

No-one can say this pandemic arrived out of the blue. The last time I visited New York was in September 2019, for the launch of a report by the Global Preparedness Monitoring Board, which I co-chair.  This report warned of the risk of an air-borne pathogen and the lack of global preparedness for a subsequent pandemic. It also highlighted that there had been a lack of political commitment and public financing for vital public health services at both national and global levels.

On the same visit last September, I addressed the UN High-Level Meeting on Universal Health Coverage. At this, Heads of State from across the world committed themselves and their governments to achieving UHC. But it was noticeable in their speeches how many of them focussed on scaling up access to in-patient hospital services, and how few of them stressed the importance of protecting their people from infectious diseases and preventing illness.

I fear we are all paying the consequences of this imbalance of health priorities today.

With the number of COVID-19 cases and fatalities continuing to rise on a daily basis, we are clearly not through this crisis yet. But even at this stage there are obvious lessons for the UHC movement and for the global health community.

First, we must hold our political leaders to account for their verbal pledges to achieve UHC, and expect demonstrable increases in domestic public spending for health. As I said last September, if there is one lesson the world has learnt, it is that you can only reach UHC through public financing. Furthermore, as WHO has been highlighting recently, countries should remove health service user fees and ensure that everyone can access services free at the point of delivery. Removing financial barriers to health services is particularly important in the midst of a pandemic, especially for disadvantaged groups such as women, children and the elderly.

Second, a large proportion of additional resources should be spent on primary healthcare services, including on vital public health services, which must be better integrated within overall UHC reforms. For far too long, public health has been the poor relation compared to hospital services - this imbalance needs to be rectified as a priority.

Given these dual priorities, I find it bewildering that the government of Nigeria, the largest country in Africa, has just cut its national primary healthcare budget by 43% for the coming year. To me this demonstrates not only a lack of commitment to UHC, but represents a threat to national and regional health security.

Finally, with COVID-19 threatening the health and livelihoods of everybody on the planet, it shows more than ever why we need a coordinated and integrated international response to combatting infectious diseases and advancing towards UHC. This should include strengthening and increasing financing for the World Health Organisation, which has been spearheading the global UHC campaign. WHO has been explicitly integrating UHC with improving health security and building healthy societies, through tackling the social determinants of health, and this needs to be continued and supported.

As we look to “build back better” after COVID-19, this integrated approach to developing health systems will be the best strategy to achieve SDG 3 and get the world back on track to attain all the SDGs by 2030.