1. A Wake-up Call Lessons from Ebola for the World’s Health Systems 1 G7/G20 Parliamentarians‘ Conference, 17 April 2015

2. A Wake-up Call 1.Ebola - Learning the Lessons 2.2015 Health Access Index - Prevention is Better than Cure 3.Universal Health Coverage - The Need to ‘Build Back Stronger’ 4.Recommendations

3. 1. Ebola - Learning the Lessons “Had there been effective [health services] in the countries of origin of the disease, this problem could have been mitigated or even eliminated.” Amartya Sen

4. Lesson: Importance of Health Systems 4 Weak health systems Ebola Spread Further weakening of health systems Limited access to health services Impact on health outcomes 828 affected health workers, 499 reported deaths Surge of measles in affected countries (rates 3 to 4 times higher*) Half less pregnant women received prenatal care in Liberia* *between 2014 and 2015 (over 5 months)

5. State of Health Systems Before the Outbreak Critical shortages of health workers 1 health worker/1,598 people in Guinea 1 health worker/3,472 people in Liberia 1 health worker/5,319 people in Sierra Leone Inadequate financing Guinea $9 per person each yearGuinea $9 per person each year Liberia $20 per person each yearLiberia $20 per person each year Sierra Leone $16 per person each yearSierra Leone $16 per person each year Lack of access to medical products, vaccines & quality health services Drastic shortages of medicines, inadequate knowledge of International Health Regulations

6. Lesson: Cost of Ebola 3x Cost of Health System 6

7. 2. 2015 Health Access Index - Prevention is Better than Cure “The state of the health workforce and health systems [in Guinea, Liberia and Sierra Leone] has hampered the ability of these countries to respond to the Ebola epidemic – but these countries are hardly alone in having inadequate training, support and numbers of health workers.” Dr Ariel Pablos-Mendez, USAID’s Assistant Administrator for Global Health

8. 2015 Health Access Index: Ranking 1Brazil 2Kyrgyzstan 3Uzbekistan 4Azerbaijan 5Egypt 6South Africa 7Tajikistan 8Turkmenistan 9Gabon 10Peru 11Solomon Islands 12China 13Sao Tome and Principe 14Viet Nam 15Botswana 16Congo 17Indonesia 18Mexico 19Morocco 20Philippines 21Rwanda 22Iraq 23Swaziland 24Bolivia 25Cambodia 26Uganda 27Benin 28Gambia 29Malawi 30Comoros 31Equatorial Guinea 32Guatemala 33Senegal 34Burkina Faso 35Burundi 36Djibouti 37Myanmar 38Tanzania 39Ghana 40Madagascar 41Angola 42Côte d'Ivoire 43DRC 44Liberia 45Mauritania 46Sierra Leone 47Kenya 48Lesotho 49Nepal 50Papua New Guinea 51Yemen 52Zambia 53Bangladesh 54Eritrea 55India 56Cameroon 57Pakistan 58Sudan 59Togo 60Lao, PDR 61Mozambique 62Guinea-Bissau 63Mali 64Niger 65Guinea 66Central African Republic 67Ethiopia 68Haiti 69Afghanistan 70Nigeria 71Chad 72Somalia Access and quality of health services

9. 2015 Health Access Index: Risks for Outbreaks “The risk of new diseases quickly spreading worldwide has never been greater.” Judith Rodin, President of the Rockefeller Foundation Estimations from the University of Washington: today, 51–81 million deaths globally might be caused by an influenza strain similar to Spanish flu of 1918-1920 The 28 countries that fell below Liberia in the Index could account for more than 31 million deaths

10. 2015 Health Access Index: Risk for Children and Women 17,000 children die every day New-born mortality rate remains high Unequal progresses towards MDG4 and MDG5

11. 3. Universal Health Coverage - The Need to ‘Build Back Stronger’ “Well-functioning health systems are not a luxury. Well-functioning health systems are the cushion that keeps sudden shocks from reverberating throughout the fabric that holds societies together, ripping them apart.” Margaret Chan, World Health Organization Director-General, 2015

12. Universal Health Coverage: An Affordable Reality $86 per year per capita for essential services package delivery $101 billion additionally would be required annually for 75 countries with highest maternal and child mortality Increase health investments (to 15% of budget), increase health ODA (to 0.1% GNI) for 26 of 75 countries with highest child and maternal mortality 12

13. Universal Health Coverage: Best Investment into Child and Maternal Health  Calling for: o 100% coverage of essential services o 100% financial protection from out-of-pocket- payments (OOPs) for health o for all people Best measure: o Skilled birth attendance for all segments of population (in particular poorest 1/5)

14. Recommendations 1.Maintain the international response to help Guinea, Liberia and Sierra Leone achieve zero new Ebola cases 2.Political leaders in countries with low rates of health coverage should make public commitments and increase investment to 15% of budgets in comprehensive health services 3.International institutions and donors should ensure that aid and global support is increased to 0.1% GNI and better aligned to help build suitable and comprehensive health services 4.Civil society organisations should advocate for progressive tax reforms and increased transparency, more equitable revenue and health expenditure 5.The Sustainable Development Goals should commit the world to support universal health coverage and ending preventable maternal, newborn and child deaths, with no target met unless met for all  German Government with G7 Presidency can set a clear signal during June Summit ahead of FFD and UNGA

15. Thank you 15

17. Beyond Ebola: 2015 Health Access Index 17