When terrorists struck Sri Lanka on Easter Sunday this year, murdering over 250 people and seriously injuring hundreds more, three public hospitals in the area of the attack immediately implemented disaster-response plans, enabling them to successfully manage nearly 500 victims in just one to two hours.
“It was a textbook example of leadership and efficient management,” says Dr. Ravi Rannan-Eliya, Director of the Institute of Public Policy in Sri Lanka. “Those two skills are not only essential for dealing with major disasters but also for successfully developing and establishing universal health coverage.”
They are also skills that the Leadership for Universal Health Coverage (L4UHC) programme will be fostering in various countries across Asia over the next two years. Launched in 2016, the programme develops the leadership skills that are needed to broker the different interests of national stakeholders behind a common vision for UHC, and to create coalitions for change to bring that vision to life. Sri Lanka is one of the host countries for the programme in Asia, showcasing how it has made outstanding progress on UHC with a health budget of just 2% of GDP.
“Establishing UHC in a country is fundamentally a political economy issue, not a technical problem, as most of the solutions to the technical challenges are known,” says Dr. Ravi Rannan-Eliya. “As the support and resources of multiple agencies in the health sector and beyond are required, from planning and social affairs through to finance, you need the skills to bring together the various actors to form coalitions and to make the case for the UHC.”
“In a lot of countries, you have multiple actors but often with different goals and visions,” adds Professor Sophie Witter, a UHC specialist at Queen Margaret University in Edinburgh, UK, and the Monitoring and Evaluation lead for L4UHC. “Countries that have done well with UHC have a clear, coordinated vision and pathway, which is monitored and adjusted over time.”
L4UHC not only brings together senior national UHC stakeholders, from health providers and government representatives through to members of civil society and the private sector, but also their counterparts from other countries so that they can learn from different countries’ experiences. Under the guidance of experienced facilitators, participants learn and, crucially, put into practice the skills to forge coalitions for change with a common vision and with a focused action plan. It is not simply a course for acquiring skills but a practical catalyst for advancing UHC in the participants’ countries.
The one-year programme – which is implemented by GIZ, Expertise France, USAID, the WHO and World Bank – develops the necessary skills and momentum for change in two main ways:
- First, over the course of the year, there are three, intensive four-day modules in which participants from different countries come together in a host country that has successfully developed UHC in order to understand the complexities of UHC, develop leadership and personal skills, and establish visions and ‘collective action initiatives’ to implement in their countries. Host countries provide insights and inspiration. For the Asian roll-out of L4UHC in 2019, the host countries are Sri Lanka, Kazakhstan and Japan.
- Second, in the time between the modules, participants spend at least 150 days in their home countries applying the skills they have learned, gradually developing the coalitions and implementing their collective action initiatives over this time. Throughout these periods, they are supported by in-country coaches. Participating countries of the 2019-2020 cycle in Asia are Myanmar, Pakistan and Vietnam. In Africa, the countries are Burkina Faso, Cameroon, Niger and Senegal.