DEBATE PACKCDP-0180 (2019) | 5 July 2019

Universal health coverage

Compiled by: Tim Robinson

Subject specialist: Jon

Westminster HallWednesday 10 July 20199.30am to 11.00amDebate initiated by Alistair Burt MP

The proceeding of this debate can be viewed on Parliamentlive.tv

Contents1. Background1.1 Statistics on global

healthcare coverage1.2 Aid spending on

healthcare2. Press Articles3. Press releases4. PQs5. Other

Parliamentary material

5.1 Debates5.2 Written Statements6. Further reading

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1. BackgroundPractitioners and campaigners today are increasingly strongly focused on achieving ‘Universal Health Coverage’ – based on the conviction that all people should receive the health services they need without suffering financial hardship when paying for them. For some time it has been a priority objective for World Health Organization (WHO). Since 2015, much of this effort has taken place in the context of achieving the Sustainable Development Goals (Goal 3: Ensure healthy lives and promote wellbeing for all at all ages). See, for example, the WHO’s annual publication, ‘World Health Statistics 2019’. Below are two extracts:SDG indicators of health service coverage and financing Populations in low-income countries generally have less access to essential health services; values of the universal health coverage (UHC) service coverage index are lower, as are indicators such as skilled birth attendance, women who have their need for family planning satisfied with modern methods of contraception, and immunization coverage. Low-income countries also experience greater shortages of health care professionals […] and domestic government health expenditure as a proportion of total general government expenditures is lower (despite lower absolute levels of general government expenditure and greater health needs). The proportion of the population that suffer catastrophic health expenditures (>10% or >25% of total household expenditures or income) is higher in middle-income countries than in low- or high-income countries. However, at all income levels people can suffer catastrophic health expenditures, even in high-income countries and in countries where most of the out-of-pocket health spending is due to medicines.Achieve universal health coverage For many conditions, particularly in low-income countries, premature deaths can be averted by improving access to and use of preventive and curative health services. This may require a strengthened health workforce and increased provision of health facilities, equipment, medicines and vaccines. It will also require removing barriers to accessing services including economic barriers (as a consequence of out-of-pocket expenditures and insufficient public financing) and cultural barriers (where the workforce providing services

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does not have the necessary cultural sensitivity). Efforts in support of UHC must focus on reaching those whom services are not reaching, such as marginalized, stigmatized and geographically isolated people of all ages and genders. In some countries, health and social systems are strained by natural disasters or conflict, and the populations affected can account for a large proportion of unmet SDG need. Stronger and more resilient national health systems need to be backed by the regional and global alert and response mechanisms that will mitigate the impact of health emergencies.Under the auspices of the UN, governments are currently negotiating a ‘Universal Healthcare Agreement’ which is intended to boost international and national efforts to achieve this objective. It is due to be signed at the UN General Assembly in September 2019. This will be a political declaration. A ‘zero draft’ is currently being discussed. According to the website Devex.com:

The current “zero draft” of the UHC agreement, published in May, recognizes the need for a “paradigm shift” and a boost in domestic investment to guarantee health care access for all. But it does not include specific domestic funding commitments, which will be key for full UHC implementation […]

Peter Sands, director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said in June:

The pathway to UHC is not something you reach by investing in something called UHC. You make that pathway by building parts of the health systems, addressing the health care needs of a specific population and by addressing specific conditions. It will inevitably involve a mix of focusing on specific segments of populations, specific diseases and functional components of the system. The good thing about it is that the UHC discussion is putting a lot of attention on, “How does one think about that journey towards a broad set of care services for all populations, through a system that is financially sustainable?” You are still going to come down to, “OK, so what are we going to do tomorrow and where will we put the dollars?”

In a 1 July Written Statement, Secretary of State for International Development Rory Stewart said:

The UK pioneered Universal Health Coverage through the establishment of the National Health Service and we continue to host many of the best medical scientists and practitioners in the world. Good health is a foundation for development; it enables people to go to school, go to work, and contribute to the economy. It is firmly in the UK’s national interest to work with countries to promote good health, to prevent and respond to disease outbreaks, and to contribute to the fight against antimicrobial resistance […] The UK will also support the High-Level meeting on Universal Health Coverage at the UN General Assembly in September […]

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1.1 Statistics on global healthcare coverage

Target 3.8 of the Sustainable Development Goals is “Achieve universal health coverage”. SDG-Tracker, a project looking at progress towards meeting these goals created by the University of Oxford and the Global Change Data Lab, tracks this target by using the Healthcare Access and Quality (HAQ) Index. This Index uses death rates from causes of death that could be prevented through timely and effective medical care to create a numerical representation of the quality and availability of health care in particular countries or regions.The HAQ index goes from 0 (worst) to 100 (best). The highest-scoring countries are, unsurprisingly, typically fairly wealthy; in 2015 the highest-ranked countries were Andorra (at an index level of 94.6), Iceland (93.6) and Switzerland (91.8), with the lowest being Somalia (34.2), Afghanistan (32.5) and the Central African Republic (28.6). For comparison, the UK was ranked 30th in 2015 (84.6) and the US was ranked 35th (81.3).According to this index, access to healthcare has been increasing fairly steadily over the past 35 years, with almost all countries represented in the index seeing at least some improvement.

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1990 1995 2000 2005 2010 2015Source: Healthcare Access and Quality Index 2015, Institute for Health Metrics and Evaluation, 2017

HealthcareAccess and Quality IndexQuartilesof all countries in each year; 100 = best

Global average

Top quartile

Bottom quartile

This chart shows that all quartiles of countries have seen some improvement. However, it also shows that there has been little change in the range of access to healthcare – that

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is, the countries with the worst healthcare are a long way behind those with the best, and this gap is showing little sign of closing.

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1990 1995 2000 2005 2010 2015Source: HealthcareAccess and Quality Index 2015, Institute for Health Metrics and Evaluation, 2017

Increases and decreases in healthcare provisionHealthcare Access and Quality Index, 100 = best

LaosEthiopia

Eswatini

Lesotho

Global average

Both the biggest and smallest changes in healthcare have been seen in relatively poor countries. The biggest increases in percentage terms have been seen in Ethiopia and Laos, both of which have seen improvements of around 90% between 1990 and 2015; the smallest increase was in Eswatini (1%) and the only decrease was in Lesotho (-13%). For comparison, the global average increased 32% over this period.Further information on access to healthcare, and the financing behind it, is available in the Our World in Data article Financing Healthcare.

1.2 Aid spending on healthcareIn 2017, the most recent year for which we have data, the UK provided £926 million in bilateral aid for health.1 This

1 DFID, Statistics on International Development: Final UK Aid Spend 2017, 29 November 2018. Health represented by broad sector codes 121 and 122.

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represents 10.5% of all bilateral aid; a similar proportion (11.6%) of UK multilateral aid in 2016 was spent on health.Aid spending on health is generally higher now than in previous years, although its highest level was £946 million in 2013:

393 448551

651

946

754661 716

926

0100200300400500600700800900

1,000

2009 2010 2011 2012 2013 2014 2015 2016 2017Notes: Includes bilateral through multilateral spending. Broad sector codes 121 and 122.Source: DFID, Statistics on International Development: Final UK Aid Spend 2017, 29 November 2018

UK bilateral aid spending on healthcare£ millions, not adjusted for inflation

The country where the most bilateral aid was spent on health in 2017 was Nigeria, with £46.7 million, followed by the West Bank and Gaza Strip (£45.0 million). Looking further afield, the Institute for Health Metrics and Evaluation has estimated that across the world nearly $58 billion has been provided in health aid (“development assistance for health”) between 1990 and 2017. The biggest recipient of this aid was Nigeria, with $1.8 billion; the biggest donor was the Bill and Melinda Gates Foundation, which gave a total of nearly $15 billion over the same timeframe. The largest national donor was the US, at just under $12 billion, and the second largest was the UK at $5 billion.2

2 IHME, Development Assistance for Health Database 1990-2018, 19 June 2019

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2. Press ArticlesThe following is a selection of press and media articles relevant to this debate.

Please note: the Library is not responsible for either the views or the accuracy of external content.

Healthy people drive strong economiesWorld Bank BlogsKristalina Georgieva28 June 2019

How Nigeria can achieve universal health coverage by 2030Nigerian GuardianChukwuma Muanya, Adaku Onyenucheya and Njadvara Musa8 April 2019

Universal health coverage: breakthrough or great white elephant?The LancetIrene A Agyepong8 October 2018

The promise and peril of universal health careScienceDavid E. Bloom, Alexander Khoury and Ramnath Subbaraman24 August 2018

How to achieve universal health coverage? Focus on primary careDevexMalia Politzer11 September 2017

Health Care: A Universal Problem Without A Universal SolutionForbesRebecca Keller8 August 2017

How to make global universal healthcare a realityThe GuardianRachel Banning-Lover7 July 2017

Universal health coverage in a generation is achievableWorld Bank BlogsBertrand Badré15 September 2015

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Universal healthcare: the affordable dreamThe GuardianAmartya Sen6 January 2015

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3. Press releasesPeople Spend Half a Trillion Dollars Out-Of-Pocket on Health in Developing Countries AnnuallyWorld Bank27 June 2019

People in developing countries spend half a trillion dollars annually — over $80 per person -- out of their own pockets to access health services, and such expenses hit the poor the hardest, according to a new report by the World Bank Group launched ahead of the G20 Summit. It says that lack of universal access to quality, affordable health services threatens decades-long progress on health, endangers countries’ long-term economic prospects, and makes them more vulnerable to pandemic risks.

Financing Universal Health Coverage (UHC) in developing countries is a priority for the G20 Presidency of Japan. The World Bank report will inform a first-ever G20 Finance and Health Ministers joint session hosted by Japan on June 28 in Osaka, after being discussed by G20 Finance Ministers earlier this month. Globally, health is an important economic sector that accounts for 11 percent of GDP and generates millions of jobs, many of them for women.

“UHC is not just about better health, it is fundamental to inclusive growth,” said Taro Aso, Finance Minister of Japan. “Japan’s adoption of a system that provided quality, affordable healthcare in 1961 helped drive decades of social and economic progress. We believe UHC is essential for all developing countries and the G20 has a critical role to play to enable it.”

The report, titled High-Performance Health Financing for Universal Health Coverage, projects that by the year 2030, the target date of the Sustainable Development Goals (SDGs), there will be a $176 billion gap in the 54 poorest countries between the financing needed to provide their populations with quality, affordable health services and funding that is actually available. Without urgent action, developing countries faced with aging populations and growing burdens of non-communicable diseases will find themselves increasingly challenged to close the gap between the demand for health spending and available public resources, and will prolong the reliance on out-of-pocket spending by patients and their families.

“Health is an essential human capital investment that countries must make for their people to succeed at school and at work,” said Kristalina Georgieva, CEO of the World Bank. “We must act urgently to fix the insufficient, inefficient, and inequitable financing of health that is holding back people and countries.”

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The report calls for increases in national investments in health and making investment in health a whole-of-government priority, improving financial sustainability by scaling proven investments like primary health services that reach the poorest, and taxing tobacco, alcohol and sugary drinks to raise revenue and improve health. It says international assistance for health should be increased, focused on countries and populations that are furthest behind and on building national institutions and capacities.

“The African Union has made a commitment in February 2019 to increase national investments in health on the continent, and to institutionalize collaboration between Ministers of Finance and Health in Africa,” said Mohamed Maait, Minister of Finance of Egypt, which is currently chair of the African Union and invited to the G20 special Ministerial session in Osaka. “We welcome this G20 and World Bank Group initiative and intend to take this agenda forward at the regional level in Africa over the next year during Egypt’s Presidency of the AU.”

Even in the best-case scenario with greater, more efficient and more equitable country and international investments, the report projects that the 2030 UHC financing gap will not be closed. It urges that health financing therefore be a major priority for innovation over the next decade to help bridge the gap.

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4. PQsDeveloping Countries: Tuberculosis 13 Jun 2019 | 261205

Asked by: Nic DakinTo ask the Secretary of State for International Development, what assessment he has made of the potential effect of strengthening TB prevention, diagnosis and treatment on (a) rates of antimicrobial resistance and (b) health systems around the world.

Answering member: Dr Andrew Murrison | Department for International Development The UK Government recognises that strengthening TB prevention, diagnosis and treatment contributes to preventing antimicrobial resistance (AMR) and strengthening health systems.

Drug-resistant TB currently accounts for one-third of all deaths from AMR. The UK is leading work on development of new antibiotics and treatment combinations and new ways to rapidly test for drug resistance. DFID’s support to the Global Fund helps to ensure rapid rollout of new tools. For example, UK funding has helped to roll out a new multi-drug-resistant TB treatment regimen in 30 countries where the Global Fund operates.

Strengthening TB prevention, diagnosis and treatment also contributes to strengthening broader health systems. The UK’s investment in the Global Fund is building national capability to deliver quality health services and contributing to Universal Health Coverage and to ensuring that no country and no person is left behind.

Developing Countries: Health Services 14 May 2019 | HL15456

Asked by: Lord Crisp To ask Her Majesty's Government whether they will ensure that child survival and the proposal that 2020 be designated the Year of the Nurse and Midwife are on the agendas at all relevant meetings of (1) the United Nations, (2) the Commonwealth, (3) international health conferences and (4) international development conferences.

Answering member: Baroness Sugg | Department for International Development The UK is a strong advocate for the strengthening of health systems to achieve universal health coverage (UHC). Child survival and investment in health workers such as nurses and midwives are central to UHC and therefore we promote

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these and related initiatives through our advocacy for UHC at all relevant international meetings.

Developing Countries: Health Services 08 May 2019 | HL15453

Asked by: Lord CrispTo ask Her Majesty's Government what funding the Department for International Development has allocated to the promotion of Universal Health Coverage.

Answering member: Baroness Sugg | Department for International Development DFID is the world’s second largest health donor. Strengthening health systems to deliver universal health coverage (UHC) is a priority for the UK and an overarching goal for DFID health investments. However, we do not classify spend on promoting UHC separately from other health investments.

Developing Countries: Health Services 07 May 2019 | 249293

Asked by: Jim ShannonTo ask the Secretary of State for International Development, what steps the is Government taking to support Commonwealth governments to establish universal health coverage systems to ensure that children do not die from preventable diseases.

Answering member: Harriett Baldwin | Department for International Development The UK is a strong advocate for the achievement of universal health coverage to ensure child survival, through strengthening health systems. DFID provides technical assistance and financial support directly to countries, including Commonwealth governments. The UK invests around £1 billion per year through bilateral aid programmes in reproductive, maternal, newborn, child, and adolescent health, and our support to Gavi, the Vaccine Alliance, has contributed to the safe vaccination of over 700 million children.

Commonwealth: Health Services 30 Apr 2019 | 245725

Asked by: Rosie Cooper

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To ask the Secretary of State for Health and Social Care, what plans he has made to prepare for the upcoming Commonwealth Health Ministers meeting.

Answering member: Seema Kennedy | Department of Health and Social Care The Department of Health and Social Care will be sending a delegation to represent the United Kingdom at the Commonwealth Health Ministers’ Meeting. As in previous years the Department of Health and Social Care is working with the Department for International Development and the Foreign and Commonwealth Office on our preparations for the wide ranging agenda items, which this year come under the theme of ‘Universal Health Coverage: Reaching the unreached, ensuring no one is left behind’. This will include preparing cross-Government views on the papers for discussion at the meeting, and examples of UK practices we might want to share. We will also be encouraging follow up on the health commitments made at the Commonwealth Summit in London last year.

Developing Countries: Infant Mortality 29 Apr 2019 | 245727

Asked by: Rosie CooperTo ask the Secretary of State for International Development, what steps her Department is taking to ensure that child survival is on the agenda at this year’s high-level global meetings.

Answering member: Harriett Baldwin | Department for International Development The UK is a strong advocate for the achievement of universal health coverage to ensure child survival, though strengthening health systems – a key issue for this year’s UN General Assembly. The UK invests around £1 billion per year through bilateral aid programmes in reproductive, maternal, newborn, child, and adolescent health, and our support to Gavi, the vaccines alliance, has contributed to the safe vaccination of over 700 million children. The UK will host Gavi’s replenishment in 2020, a demonstration of our continuing commitment to support efforts to save children’s lives from preventable diseases.

Developing Countries: Health Services 11 Apr 2019 | 241478

Asked by: Lloyd Russell-MoyleTo ask the Secretary of State for International Development, how much funding her Department has allocated to the promotion of universal health coverage in each of the last five years.

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Answering member: Harriett Baldwin | Department for International Development DFID is the world’s second largest health donor. Strengthening health systems to deliver universal health coverage (UHC) is a priority for the UK and an overarching goal for DFID health investments. However, we do not classify spend on promoting UHC separately from other health investments.

World Health Day 27 Feb 2019 | HL13700

Asked by: Baroness Mone To ask Her Majesty's Government what plans they have to mark World Health Day on 7 April.

Answering member: Baroness Blackwood of North Oxford | Department of Health and Social Care World Health Day is a key event to recognise, promote, and raise awareness of global health matters around the world. It falls on 7 April each year and marks the anniversary of the founding of the World Health Organization (WHO) in 1948. Each year it has a theme to highlight a global health issue. The theme for the 2019 World Health Day is Universal Health Coverage.

The Department works closely with the WHO and will support World Health Day through promotion of the day and its key messages on social media platforms. We have done this for other global health days, including World Health Day 2018.

Developing Countries: Health Services 11 Dec 2018 | 198914

Asked by: Lloyd Russell-MoyleTo ask the Secretary of State for International Development, with reference to the Government’s response to the Fifth Report of the International Development Committee, HC246 of Session 2014-15 on Strengthening Health Systems in Developing Countries, when her Department plans to publish its position paper on health systems strengthening.

Answering member: Alistair Burt | Department for International Development DFID will publish a health systems strengthening position paper in 2019 outlining our approach to provision of quality, accessible services, ensuring respect for people’s rights and leaving no one behind. Across the world, countries will need stronger health systems if we are to make progress towards the UN Global Goal for health and well-being, including achieving universal health coverage.

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Health Services: Developing Countries 11 Sep 2018 | 169188

Asked by: Rosie Cooper To ask the Secretary of State for Health and Social Care, what plans his Department has made to prepare for the High-Level Meeting at the UN General Assembly on universal health care in 2019.

Answering member: Steve Brine | Department of Health and Social Care The Department of Health and Social Care (DHSC) works closely with the Department for International Development (DFID) engaging regularly and at all levels to promote a shared agenda on the importance of achieving universal health coverage. We take a “one HMG” approach on all aspects of global health. This includes through international fora such as the World Health Organization (WHO), where DHSC leads the United Kingdom relationship, working in partnership with DFID and others; including sending joint delegations to WHO meetings.Achieving Global Goal 3 by 2030, including universal health coverage (UHC), is a priority for the UK. At the World Health Assembly this year, the former Secretary of State for Health and Social Care (the Rt. hon. Jeremy Hunt MP) stressed the importance of universal access to basic healthcare in the UK National Address. We also supported the agreement of WHO’s thirteenth General Programme of Work, with its strong focus on UHC. Preparations for the United Nations (UN) high-level meeting on UHC at the UN General Assembly in 2019 are still at an early stage but DHSC is engaging closely in the work led by DFID to identify clear deliverables that will enhance greater collective action to achieve UHC. We are working with DFID to ensure that UHC, and the steps to achieve it, are discussed in international fora, such as the G7 and G20, ahead of the High-Level Meeting.

Developing Countries: Health Services 10 Sep 2018 | 169899

Asked by: Rosie Cooper To ask the Secretary of State for International Development, what steps the Government is taking to support developing countries to achieve universal health coverage and develop programmes to prevent diseases such as pneumonia.

Answering member: Alistair Burt | Department for International Development The UK supports countries to build the strong and resilient health systems needed to achieve universal health coverage. DFID provides technical assistance and financial support directly to countries, promotes the technical leadership of

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the World Health Organisation, and funds research and new products that increase access and reduce prices for essential quality medicines and other commodities. Through health partnerships, we share UK experience and expertise in providing UHC through the NHS. Stronger health systems are better able to address all causes of ill health, including pneumonia.

Developing Countries: Health Services 05 Jul 2018 | 158188

Asked by: Andrew Gwynne To ask the Secretary of State for International Development, whether her Department facilitates knowledge-sharing between the NHS and health minsters in developing countries.

Answering member: Alistair Burt | Department for International Development DFID funds health partnerships with developing countries to share NHS expertise. These partnerships engage with ministries of health at all levels to share learning, on nurse training and clinical audits for example.

As my Hon Friend the Parliamentary Under-Secretary of State for Public Health and Primary Care at the Department of Health and Social Care (DHSC) outlined in his response to you in PQ 158190, the UK government liaises with health ministers through international forums including the G20, World Health Assembly and UN High Level Meetings, sharing our lessons from the NHS to promote progress towards achieving universal health coverage. Several DFID country programmes include NHS partnerships in response to ministry demand, such as Ghana and Zambia. DFID also supports the DHSC’s high level engagement on global health security and antimicrobial resistance, patient safety and mental health with developing countries, including the upcoming first Global Ministerial Summit on Mental Health.

Developing Countries: Health Services 04 Jul 2018 | 158187

Asked by: Andrew GwynneTo ask the Secretary of State for International Development, what steps the Government is taking to support governments in developing countries to build universal healthcare for children.

Answering member: Alistair Burt | Department for International Development The UK supports countries to make progress in universal health coverage through building health systems that meet essential needs for all, including mother and children’s

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healthcare and prevention of diseases. DFID provides technical assistance and financial support directly to countries. For example, DFID is supporting Ethiopia’s health system by improving primary healthcare services to accelerate gains in adolescent, maternal and child health. In 2016-17, the programme contributed to over 1.3 million children receiving vaccinations against preventable childhood diseases. DFID’s investments in water, sanitation and hygiene and in nutrition also contribute to achieving universal health coverage and are essential for improving child health. DFID is also a leading donor to global health organisations such as Gavi the Vaccine Alliance, Unitaid and the World Health Organisation, and funds research and product development including for child health.

Developing Countries: Health Services 17 May 2018 | 143196

Asked by: Chris Law To ask the Secretary of State for International Development, what steps her Department is taking to support developing countries to establish universal health coverage.

Answering member: Alistair Burt | Department for International Development Achieving Global Goal 3 by 2030, including universal health coverage (UHC), is a priority for the UK. The UK supports countries to move more rapidly towards UHC by building strong and resilient health systems that meet essential needs for all. To achieve this, DFID provides technical assistance and financial support directly to countries, political and financial support to the World Health Organisation, and funding for research and new products that reduce the prices countries pay for essential commodities. Through health partnerships the UK enables others to learn from the UK’s own experience and expertise in providing UHC through the NHS.

Developing Countries: Malaria 09 May 2018 | 140073

Asked by: Jeremy Lefroy, To ask the Secretary of State for International Development, given the UK Government’s recent recommitment to defeating malaria, if her Department will increase investment in community-based primary healthcare programmes in remote, rural communities.

Answering member: Alistair Burt | Department for International Development DFID supports low income countries to make faster progress towards universal health coverage, with a particular focus on improving access to good quality primary care in poorer,

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very often remote areas. This support to strengthening health systems helps to ensure that countries are better able to prevent, detect and treat all causes of ill health, including malaria.

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5. Other Parliamentary material

5.1 DebatesUniversal Health Coverage 05 July 2018 | 644 cc193-211WH

5.2 Written StatementsThe Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) 01 July 2019 | HCWS1680

I would like to update the House on the UK’s contribution to the Sixth Replenishment of the Global Fund as announced by my right honourable friend the Prime Minister at the G20 Osaka Summit.The UK pioneered Universal Health Coverage through the establishment of the National Health Service and we continue to host many of the best medical scientists and practitioners in the world. Good health is a foundation for development; it enables people to go to school, go to work, and contribute to the economy. It is firmly in the UK’s national interest to work with countries to promote good health, to prevent and respond to disease outbreaks, and to contribute to the fight against antimicrobial resistance.More than 2.5 million people died from AIDS-related illnesses, tuberculosis and malaria in 2017. Every day nearly 1,000 adolescent girls and young women in Africa become infected with HIV. A child still dies of malaria every two minutes. Tuberculosis is still one of the world’s top ten causes of death. The progress made so far is being threatened by growing drug and insecticide resistance, wavering political will, and the difficulties of meeting the needs of neglected and vulnerable populations.Tackling these challenges is essential to achieving Sustainable Development Goal 3: Ensure healthy lives and promote wellbeing for all at all ages. The UK’s support to the Global Fund is an important contribution towards achieving this goal. I am proud of the UK’s commitment to the Sustainable Development Goals and this July we look forward to setting out our progress through our first Voluntary National Review. The UK will also support the High-Level meeting on Universal Health Coverage at the UN General

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Assembly in September and host the replenishment of Gavi, the vaccine alliance in 2020.The Global Fund is an extremely successful public-private partnership which was rated as one of the top three performers in the UK’s Multilateral Development Review. This partnership has so far helped to save 27 million lives, reducing deaths from AIDS-related illness, tuberculosis and malaria by one third in the countries where it invests. Joining forces with other donors to negotiate low prices for life saving health technologies, the Global Fund has saved $855 million in procurement over the last five years. It is the leading international financer of the fight against multi-drug resistant tuberculosis, a disease which causes a third of all deaths due to antimicrobial resistance.I am pleased that the UK will pledge up to £1.4 billion to the Sixth Replenishment of the Global Fund which will be hosted by France in October. The UK’s investment will help to:

o Provide life-saving antiretroviral therapy for more than 3.3 million people living with HIV;

o Support treatment and care for 2.3 million people with tuberculosis;

o Distribute 92 million mosquito nets to protect children and families from malaria;

o Make countries’ health systems stronger, promote global health security and tackle antimicrobial resistance.

I am particularly concerned that the number of malaria cases is at risk of increasing due to growing resistance to our current tools and the potential impacts of population growth and climate change. I have agreed to double the value of private sector contributions to the Global Fund for malaria up to a maximum of £200 million, providing £2 for every £1 contributed by the private sector. This will help us to meet our target to spend £500 million a year on malaria over the five years from 2016-17 to 2020-21. Our previous malaria match funds have so far raised almost £200 million in additional private sector contributions to the Global Fund.The UK pledge to the previous Global Fund replenishment included, for the first time, a £90 million published performance agreement which set out areas where the Global Fund needed to do even more. I am pleased to report that the Global Fund has performed well against these priorities, including by making significant savings. This has enabled us to release all performance payments on time and in full.

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For this replenishment I have agreed a £100 million performance agreement with the Global Fund. This sets out the priorities for further improvement: working with governments to integrate Global Fund programmes into national systems and strengthening these systems to support achievement of Universal Health Coverage; a greater focus on disease prevention; strengthening the focus on the poorest, most vulnerable and marginalised, including women and girls; and antimicrobial resistance and global health security. These are all critical to the Global Fund’s long-term success. Each year my officials will speak with the Global Fund's senior management to review their progress on these critical areas and make sure that we are working together as effectively as possible.A successful replenishment will help the Global Fund partnership to save 16 million lives, avert 234 million cases or new infections, and strengthen countries’ health systems to accelerate progress towards universal health coverage. To reach the Global Fund’s ambitious target of at least $14 billion and get the world back on track to end the epidemics of AIDS, tuberculosis and malaria by 2030, as called for in the Sustainable Development Goals, everyone must step up.We will use our early decision to encourage other donors, new and existing, to make ambitious commitments. Meanwhile our commitment to a new £200 million malaria match fund is an invitation to the private sector to contribute to and play an essential role in delivering the Sustainable Development Goals. Ultimately, though, protecting the health of citizens is the responsibility of national governments. We expect them to play their part and further increase their public spending on health.I am aware of the significant degree of interest in this issue from members across the House, whose advice and support on this issue have been invaluable for the Government. For the convenience of Members, I am depositing a copy of the performance agreement in the libraries of both Houses.

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6. Further readingZero draft of political declaration on UHC, General Assembly of the United Nations, 17 May 2019Ensuring Healthy Lives for All: Noncommunicable Diseases and Universal Health Coverage, NCD Alliance, December 2018Tracking universal health coverage: 2017 Global Monitoring Report, WHO/World Bank Group report, December 2017Together on the road to universal health coverage: A call to action, WHO, 2017Universal health coverage (UHC) (WHO webpage)Universal Healthcare: One place, many paths, KPMG, 20 July 2016Strengthening Health Systems in Developing Countries: Government Response to the Committee's Fifth Report of Session 2014–15, Sixth Special Report of Session 2014–15, International Development Committee, HC 816, 21 November 2014Strengthening Health Systems in Developing Countries, Fifth Report of Session 2014–15, International Development Committee, HC 246, 12 September 2014

DEBATE PACK Number CDP 2019-0180 5 July 2019

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