PARALLEL SESSION 1.4 ADDRESSING THE POLITICAL ECONOMY OF UHC | BACKGROUND

Experiences from pioneering countries in their Universal Health Coverage (UHC) journey present valuable learning opportunities for others. The journey towards UHC is path dependent and context-specific, and at times, it is not an easy path as each country may have their own specific challenges of expansion of the three dimensions of the UHC cube, population coverage, benefit coverage, and financial risk protection.

The political decisions on UHC, inter alia, are not always evidence based as intended. Decisions are often the results of intentional and unintentional power-plays amongst various stakeholders, including how to manage the resistance of interest groups, shifting entrenched positions, and redistributing resources for health. All of these issues are within the scope of ‘political economy’. A better understanding of political economy is vital to accelerate UHC progression. Debates about expanding UHC within a country involve competing visions about the appropriate roles of the public and private sectors; market and state; the commitment and worldview of society, local and central government; the duties and entitlements of youth and elderly, sick and healthy, and rich and poor; and the contribution of health to the advancement of society. Considerations of politics and power shape the decision of a country’s leaders to commit to UHC.

This session will interrogate the political economy of reform in these and other areas, drawing on personal experiences with reform implementation and analysis.

| OBJECTIVES

This session engages longstanding themes in the UHC discussion, including questions of universality versus targeting, a generous benefit package versus limited service coverage, high versus low level of financial protection, the appropriate relative roles of the public and private sectors and, importantly, provider payment methods of closed versus open-ended methods. By drawing on the experiences of panelists, this session will illuminate specific examples of these general challenges and discuss the strategies that were used to navigate them. To do this, we pursue four objectives:

To illustrate different approaches to financing UHC and critically analyse the roles and strategies of different actors in shaping these approaches; To describe the scope of different packages of benefits provided through UHC, including the extent of treatment offered as well as preventive and promotive dimensions. The roles and relative weights of different actors (public, private, commercial) in determining these benefit packages will be interrogated; To assess from current experience the extent to which risk protection has been achieved and to analyse why such coverage has not been achieved in different settings. The roles of key actors, especially governments, will be explored. To discuss and prioritise the combination of actions (e.g. political commitment, research, advocacy, social mobilization) required to move towards UHC, i.e. expansion of population coverage to all with leaving no one behind, improved access to health services, enlarged scope and improved quality of services and financial risk protection. Moderator

Gabriel Leung

Dean of Medicine

The University of China

Gabriel Leung is the fortieth Dean of Medicine (2013-), inaugural Helen and Francis Zimmern Professor in Population Health and holds the Chair of Medicine at the (HKU). He was Hong Kong's first Under Secretary for Food and Health (2008-11) and fifth Director of the Chief Executive's Office (2011-2) in government.

Leung is one of Asia’s leading epidemiologists and global health exponents, having authored more than 480 scholarly papers with an h-index of 61 (Scopus). He is an elected member of the US National Academy of Medicine (NAM).

He was inaugural Chair (2010-4) of the Asia Pacific Observatory on Health Systems and Policies and continues to chair its Strategic and Technical Advisory Committee (2018-). Leung regularly advises national and international agencies including the World Health Organization, World Bank, Asian Development Bank, Boao Forum for Asia, Institut Pasteur, Japan Center for International Exchange and China Centers for Disease Control and Prevention. He is an Adjunct Professor of Peking Union Medical College and Adjunct Professorial Researcher of the China National Health Development Research Center. He edited the Journal of Public Health (2007-14) and was co-editor/associate editor for Epidemics and Health Policy. He currently serves on the editorial boards of six journals, including the British Medical Journal. Panelist

Beverly Ho

Special Assistant to the Secretary of Health for Universal Health Coverage

Department of Health Philippines

Beverly “Bev” Lorraine Ho is the Special Assistant to the Secretary of Health for Universal Health Coverage at the Department of Health - Philippines. Immediately prior to this full-time designation, she was Chief of Research Division of the Health Policy Development and Planning Bureau where she worked to provide the evidence needed to support health system reform by designing innovative research grants and building institutional capacity for policy research. These efforts have significantly contributed to the passage of key legislation on sugar-sweetened beverage tax, tobacco tax and universal health care, and the institutionalisation of the health technology assessment process. She has also worked in the Philippine Health Insurance Corporation and has provided technical assistance to the government of the Philippines and the Greater Mekong Subregion on health financing, maternal and child health, and health impact assessment. Bev is a fellow of the Maurice Greenberg World Fellows Program at Yale University, the Equity Initiative and the Atlantic Institute. She holds an MD from the University of the Philippines and an MPH in Health Policy and Management from the Harvard T.H. Chan School of Public Health as a Fulbright Scholar. Panelist

Chalermsak Kittitrakul

Coordinator for Access Campaign

AIDS Access Foundation Thailand

Biography

Mr. Chalermsak Kittitrakul started his career related to intellectual property (IP) and access to medicines when he worked with an international NGO, Oxfam Great Britain, in 2003. It had an aim to overcome inaccessibility to affordable anti- retroviral medicines due to the IP barriers. He joined the Thai civil society’s policy advocacy to oppose negotiations of the Free Trade Agreements proposed by the USA and the EU, which proposed IP provisions more stringent than the WTO’s Agreement on Trade-related Aspects of Intellectual Property Rights (TRIPs). In addition, he worked with academics and civic groups to encourage the Thai government to implement the Government Use License to promote access to lifesaving drugs.

Since 2013 he has worked with AIDS Access Foundation, as Coordinator for Access to Medicines Campaign, and continues monitoring policies affecting access to medicines, including negotiations of on-going Free Trade Agreements (e.g. the Trans-Pacific Partnership Agreement (TPP), the Regional Comprehensive Economic Partnership Agreement (RCEP), and the Free Trade Agreement between Thailand and the European Union). In last 5 years, he has been involved in the civil society’s policy-advocacy movement to promote access to hepatitis C direct acting anti-retrovirals (HCV DAAs) by filling patent opposition against unmeritted patent applications for those drugs and having policy dialogues with the relevant government health agencies to including HCV DAAs in the health benefit packages of the national health insurance schemes. Panelist

Jacqueline Kitulu

President

Kenya Medical Association Kenya

DR JACQUELINE KITULU MB.Ch.B, MBA 2019 BIO Dr Jacqueline Kitulu is the President of the Kenya Medical Association. KMA is the umbrella professional association for doctors in Kenya. She is the first female to chair the 51 year old association. She also chaired the Kenya Medical Women’s Association between 2008 and 2012. She is the 1st Deputy Governor of the Kenya Red Cross Society and sits on several other boards – National Hospital Insurance Fund (NHIF), the Kenya Healthcare Federation (KHF) which is the Health sector board of the Kenya Private sector alliance, the Mater Misericordiae Hospital, Kenya Consumer Protection Advisory Committee, Safaricom Health Advisory Board, TechCare For All Advisory Board and Curafa Advisory Board. She is privileged to have served as a presidential appointee to the National Economic and Social Council – a high level advisory body to the Government of Kenya between 2008 and 2014. She is a Family for the last more than 15 years running a private practice despite a very busy schedule. She is an MBA -Healthcare Management alumnus of Strathmore Business School and believes that this has gone a long way in bridging the communication gap between her health background and her current policy influencing position in a bid to transform the Health sector in Kenya. She is the recipient of the Distinguished Service Award from the Kenya Medical Association 2019, Jacob’s Well Award for Women Living Deliberately 2017, Annual Best Communicators 2016, Africa Most Astounding Female Professional Award 2012 and OWIT (Organisation of Women in International Trade) Woman of the year 2010. Aside from her busy career she spends quality time with her husband and two teenage sons. Panelist

Jesse Bump

Lecturer on Global Health Policy

Harvard T.H. Chan School of Public Health United States of America

Jesse B. Bump is Executive Director of the Takemi Program in International Health and Lecturer on Global Health Policy in the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health. He leads the global health field of study in the Master of Public Health degree and teaches on the political economy of global health.

His research focuses on the intellectual ecology of global health, examining the historical, political, and economic forces that are among the most fundamental determinants of ill health, and the most significant contextual factors that shape institutions and the approaches they embrace. This work addresses major themes in global health history, and in the political economy of global health to analyze these macro forces and develop strategies for navigating solutions within them.

Projects have investigated the history of child health problems such as diarrheal disease and congenital syphilis to explain how issues rise and fall on the global health agenda and to produce strategies to better align political visibility with health needs; the historical development of health systems and the implications for development assistance in that area; and the political economy of policy making and implementation in areas such as universal health coverage, humanitarian assistance, tobacco control, and nutrition governance.