Tuesday, June 4, 2019 — The annual Commonwealth Health Ministers Meeting gathered officials from 53 countries in Geneva, Switzerland on 19 May 2019, to discuss the acceleration of Universal Health Coverage (UHC). Four of the six independent Member States of the OECS were represented at the meeting, namely Antigua and Barbuda, St Kitts and Nevis, Saint Lucia and Grenada. 

The theme of the meeting, “Universal Health Coverage: Reaching the unreached, ensuring no one is left behind”, emphasised the importance of UHC as a means of securing a more sustainable future for Commonwealth citizens.

This entailed the inclusion of women, young people, adolescents and other vulnerable populations, such as those with mental health challenges or disabilities, not only as recipients of health services, but also as sources of innovative solutions and equal partners in service delivery.

The objectives of the Commonwealth Health Ministers Meeting were:

• To provide member countries with an opportunity to share experience and lessons in relation to unreached populations in the Commonwealth, regionally and nationally, and how to best reach these populations;
• To provide an opportunity to build consensus on collective and national actions, agree commitments and make recommendations to ensure the identified unreached populations are not left behind in the socio-economic and human development agenda;
• To discuss updates and reports from the commitments and recommendations considered at the 2018 ministerial meeting and previous meetings; and
• To contribute to the collective Commonwealth perspective on these issues and other matters, which will be articulated at diverse international fora, including the 72nd World Health Assembly, 12th Commonwealth Women’s Affairs Ministers Meeting and UN High Level Meeting on Universal Health Coverage.

The Meetingwas chaired by Fiji’s Minister for Health and Medical Services, Dr Ifereimi Waqainabete

Official Ministerial Statement

(A) Commonwealth Health Ministers held their 31st Meeting in Geneva, Switzerland, on the eve of the 72nd World Health Assembly. The theme of the meeting was “Universal Health Coverage: Reaching the Unreached, ensuring no one is left behind”.

(B) Commonwealth Health Ministers, emphasising the global commitment to ensure that no one is left behind

1. Noted that the global community is almost a third of the way towards the 2030 SDG deadline and were concerned that half of the world’s population still did not have full coverage of essential health services and almost 100 million people are still being pushed into extreme poverty (living on $1:90 or less per day) because of health care expenses.
2. Noted that too often women and children, people with disabilities, older persons and other vulnerable groups, are left behind in accessing comprehensive health care across their life course especially at critical times in their lives.
3. Ministers noted the progress made since 2018,40% of pregnant women were still not receiving early antenatal care, two-thirds of women experiencing gender-based violence were not accessing any services, and many did not have access to sexual and reproductive health services. They also noted that neonatal and under-5 mortality averages are 18 deaths per 1,000 live births and 39 deaths per 1000 live births, respectively which is still unacceptably high. Additionally, only 26% of children living with HIV receive effective treatment.
4. Highlighted the impact of poor mental health on adults and whole communities and were concerned that 1.1 billion people were living with mental health challenges and substance abuse disorders, and that major depressive disorders ranked in the top 10 causes of ill health in all but 4 countries worldwide. They also acknowledged the impact of mental health challenges and psychosocial disabilities on young people, noting with concern the increasing prevalence of mental health challenges among adolescents, and the level of violence they face in different parts of the Commonwealth.
5. ​​​​​​​Concerned that 1 billion people suffer from disability, across the world and 1 in 6 adults in developing countries are estimated to have discernible disability that is too often associated with poverty and inequality.
6. Recognised that universal health coverage (UHC) cannot be achieved without addressing the determinants of health.
7. Concerned about the impact of climate change on the health and well-being of the people of the Commonwealth as well as the resilience and preparedness of countries in the face of unexpected adverse weather conditions in particular the Small Island Developing States.
8. Reiterated the need to tackle communicable diseases and Antimicrobial Resistance and redouble our efforts on NCDs.

(C) Commonwealth Health Ministers therefore acknowledged the continued need for collaboration and innovation, to leverage the convening power of the Commonwealth to accelerate progress towards universal health coverage in the context of primary health care to include the whole population and increase the range of services covered, so that previously unreached groups can also be included, without financial hardship to the individual and so that

1. all women across the Commonwealth can access affordable and comprehensive health services, in order to improve their health and well-being, but also boost their empowerment and ability to take care of themselves;
2. ​​​​​​​these services are holistic and fit for purpose for young people, so that they can access the continuum of care, as well as access social services and community support;
3. Mental health policy and legislation is either developed or reviewed and updated, in accordance with the National contexts; and
4. UHC and social services includes the need of people with disability, as well as the rights of women, young people and other vulnerable groups, such as rural and hard-to-reach populations, who may have inadequate access to good quality health services.

(D) Commonwealth Health Ministers recalled the policy options they considered at their 2018 meeting, and recognised progress on agreed actions, particularly achievements, experiences and lessons such as

• The progress by a number of Commonwealth countries in strengthening high-level political commitment to achieving UHC, with some countries placing UHC implementation under the office of the Head of Government, to give the highest possible support and the role of setting targets to achieve UHC;
• The progress and innovation in expanding national health schemes, as per national needs and as a means of not only financing UHC, but also of promoting inclusion and ensuring that the unreached are reached and no one is left behind;
• Innovative ways of ensuring Communities are proactively engaged in the planning and delivery of interventions to accelerate UHC; and
• Pan-Commonwealth efforts for health to be considered in all policies and to address the risk factors of non-communicable diseases, focusing on prevention and screening.

(E) Commonwealth Health Ministers noted the importance of setting context specific UHC goals aligned with concrete actions including:

• Strengthening the health workforce not only by increasing their numbers and securing the appropriate distribution of health workers with the right competencies but also to support all health workers to be knowledgeable about, and committed to promoting and protecting the rights and dignity of all people;
• Recognising primary healthcare close to the community as a gateway to leaving no one behind; and
• Expanding and adapting health services and human resources for health, according to national need, from promotion to prevention to treatment and rehabilitation and palliative care, paying particular attention to unreached populations, ensuring services are accessible and inclusive and the most vulnerable population are able to contribute and participate in their development.

(F) Appreciating the role played by the Commonwealth Advisory Committee on Health (CACH), Ministers agreed with recommendations from the Committee, particularly the focus on supporting progress towards UHC, and noted the importance of the Committee’s involvement in advising on the Secretariat’s work programme. Ministers commended the work of the Secretariat, particularly noting the emphasis on practical tools to assist member countries, such as the UHC Financing Toolkit, price-sharing database and planned scorecard to track and monitor gender-based violence across the Commonwealth and decided that such efforts to support member states, relevant to their needs should continue. The recommendation to strengthen the human and financial capacity of the Secretariat to ensure sustainable financing of the Commonwealth Secretariat, was noted.

(G) Affirming the reports from the Civil Society Policy Forum and Commonwealth Youth Health Network, Ministers acknowledged that strategies that allow inclusivity will result in improvements in health system equity and that UHC financing needs to take into account the needs of those people who are hardest to reach, and to ensure no-one is left behind. Ministers also noted the work undertaken by the Commonwealth Youth Health Network in empowering young people to advocate for youth-friendly health services and welcomed the wide-range of innovations spearheaded by young people across the Commonwealth. Ministers also recognised the importance of strategic partnership and welcomed those established with development partners, civil society and other stakeholders, including beyond the health sector, to further the delivery of the health programme. Ministers also welcomed the building and strengthening of cross-sectoral partnerships, plans and ideas to raise extra-budgetary funds from traditional and non-traditional sources.

(H) Ministers agreed to discuss at the 2020 CHMM the health commitments from the 2018 Commonwealth Heads of Government Meeting in London including the progress made on indicators related to the commitments.

(I) Ministers agreed that Strengthening Health Systems for achieving Universal Health Coverage through Sustainable Health Financing and Human Resources would be an appropriate theme for the 2020 Commonwealth Health Ministers Meeting.