Universal Health Care

The First Step to Global Health Equity

A Pre-General Assembly Workshop

IFMSA General Assembly August Meeting 2012 August 5-9, 2012 Mumbai, India

IFMSA Global Health Equity Initiative

Background
Last year, the International Federation of Medical Students Associations (IFMSA) renewed its commitment to the vision of Alma Ata a world where health is a fundamental human right, a universal societal goal, and a state of well-being enjoyed by everyone. In short, health is and should be for all. In March Meeting 2011 in Jakarta, we looked into the gross disparities in health that continue to afflict the majority of the worlds peoples. During our 60th anniversary conference in Copenhagen last August 2011, we imagined the future of health and looked into various ways towards achieving a healthier and more just world. And this March 2012 in Ghana, we recognized action on social determinants of health as the key intervention for achieving global health equity.

But where do we start in addressing health inequalities through action on social determinants of health? The WHO Commission on Social Determinants of Health identified the health system as one of the crucial determinants of health within countries, and proposed that universal access to health care as a starting point. Today, nearly 100 countries are investing huge resources, establishing agencies, commissioning researches, and holding consultations as they all rush towards the finish line of universal health coverage.

The Pre-GA Workshop on Universal Health Care

This workshop on Universal Health Care matches the theme of the IFMSA General Assembly this August 2012. India is a perfect place to sit together and discuss about universal health care, as the country now experiences a gradual transition towards provision of easily accessible and affordable health care to all Indians by 2022. A national health-insurance scheme geared towards increasing access for the poor started rolling in April 2008, and so far it has enabled 100 million to have cashless, paperless, portable access to inpatient health care provided by more than 8,000 public and private hospitals across the country.

During this workshop, around 30 participants will sit together to learn about the fundamentals of health systems, the basis as well as the pathways to universal health care, its connection with the social determinants approach to health, and how can this movement be pushed forward by medical students. Participants will give special attention to the Indian example while they also bring their knowledge and experience of their respective countries struggles towards health for all.

General Objectives
By the end of the workshop, participants should be able to: Appreciate the concept of universal health care, its importance, models, and pathways Understand the national and global contexts surrounding the worldwide movement towards universal health care Recognize the role of medical students in advocating for and influencing policies geared towards universal health care

Specific Objectives
Under each general objective, specific questions will be answered throughout the workshop: Appreciate the concept of universal health care, its importance, models, and pathways o What is universal health care? Does it differ from universal health coverage? Health for all? Health equity? o Why should countries aim to achieve universal health care? What are the bases for achieving health for all? o What is a health system, and how can it be strengthened to achieve universal health care?

Understand the national and global contexts surrounding the worldwide movement towards universal health care o How is universal health care related to social determinants of health? o What are the push and pull factors for universal health care in national and global contexts? o What are the similarities as well as differences of experiences of various countries in their struggle for universal health care?

Recognize the role of medical students in advocating for and influencing policies geared towards universal health care o How can we encourage people to support the cause of universal health care? o How can we convince national leaders and policy makers that universal health care must be achieved now? o How can we better prepare medical doctors for universal health care?

Methodology
The five-day workshop will utilize a wide array of methods, including interactive lectures, small and large group discussions, film showing, field trips, and individual and group presentations. A special feature is a policy analysis of selected cases of projects aiming to address universal health care issues. This will enable participants to apply first-hand the basic knowledge and skills they acquired during the earlier parts of the workshop.

Even before the pre-GA, the workshop trainers will begin interacting with the participants by giving them background reading materials, allowing them to introduce themselves to others, and throwing in initial ideas and insights about the subject matter. We will also advise them to prepare for the session on comparative health systems, where participants will briefly talk about their countrys health system.

Participants
We aim to gather 20-30 participants from around the world, ensuring regional representation and bringing in both newcomers and old timers in IFMSA. We envision this cohort to launch a small working group that will focus on universal health care within the IFMSA Global Health Equity Initiative. All participants will be requested to prepare for the pre-GA workshop and continue their passion and action for universal health care even beyond the workshop.

Workshop Trainers
Renzo R. Guinto (Workshop Director) from the Philippines is the Regional Coordinator for the AsiaPacific of IFMSA and the Founding Coordinator of the IFMSA Global Health Equity Initiative. He was also the facilitator of the Small Working Group on Health Inequities and led the IFMSA delegation to the World Conference on Social Determinants of Health last October 19-21, 2011 in Rio de Janeiro, Brazil. Since 2011 he has been involved with the Universal Health Care Study Group of the University of the Philippines National Institutes of Health. Renzo is also a Youth Commissioner of the Commission on Global Governance for Health convened by The Lancet, University of Oslo, and Harvard Global Health Institute.

Altagracia Mares de Leon (Workshop Co-Director) from Mexico is a member of the IFMSA Global Health Equity Initiative and its forerunner Small Working Group on Health Inequities. A proud SCOPHian, she was also part of the IFMSA delegation to the World Conference on Social Determinants of Health last October 19-21, 2011 in Rio de Janeiro, Brazil.

Proposed Agenda
Time 7:30-8:00 8:00-8:30 8:30-9:00 9:00-9:30 9:30-10:00 10:00-10:30 10:30-11:00 11:00-11:30 11:30-12:00 12:00-12:30 12:30-1:00 1:00-1:30 1:30-2:00 2:00-2:30 2:30-3:00 3:00-3:30 3:30-4:00 4:00-4:30 4:30-5:00 5:00-5:30 5:30-6:00 6:00-6:30 6:30-7:00 7:00-7:30 7:30-8:00 8:00-8:30 8:30-9:00 August 5 August 6 Breakfast Energizer Welcome, Orientation, Getting to Know, Expectations Setting Universal Health Care: Perceptions and Values Lunch The Health System: Financing, Delivery, Regulation The Road to Universal Health Coverage (Film) August 7 Breakfast Energizer/Recap August 8 Breakfast Energizer/Recap Influencing Policy Change Policy Analysis: Case Studies on Universal Health Care Lunch Policy Analysis Presentations What Medical Students Can Do? Closing and Synthesis General Assembly Lunch August 9 Breakfast

Arrival and Registration

Field Trip: Health Care in India

Free Time

Lunch Comparative Health Systems The International Political Economy of Universal Health Care

Informal Meet and Greet/ Arrival and Registration

Dinner/Free Time

Dinner/Free Time

Dinner/Free Time

Dinner/Free Time

Detailed Curriculum
Activity Welcome, Orientation, Getting to Know, Expectations Setting Objective Provide an introduction about the pre-GA workshop Set the house rules for the 3-day workshop Enable participants to meet each other Gauge the expectations of participants Enable sharing of relevant backgrounds and experiences Gauge the perceptions of participants about UHC Provide the definition(s) of UHC Explore the value basis for UHC Briefly recap the history of UHC Introduce current/ emerging questions about UHC Introduce the concept of health systems Discuss the six building blocks of the health system Discuss basic concepts and issues around 1) health financing 2) health care delivery 3) regulation and management of health workforce and pharmaceutics See varying stages of universal health care as depicted by different country examples in the film Understand the struggles as well as external forces encountered by the countries in the film as they race towards universal health care Gain an overview of the Indian health care system Understand current and emerging issues in health care in India Witness first-hand the delivery of health care services in India Share about the health care systems of the countries represented by participants Identify common challenges as well as unique features of the various health systems Methods Short presentations from facilitators Energizers Small group discussion Large group discussion Resource Person Renzo/Altagracia

Universal Health Care: Perceptions and Values

Interactive lecture

Renzo

The Health System: Financing, Delivery, Regulation

Interactive lecture

Renzo

The Road to Universal Health Coverage

Film showing Large group discussion

Altagracia

Field Trip: Health Care in India

Field visit Small and large group discussions

Courtesy of AM2012 organizing committee

Comparative Health Systems

Participant presentations Large group discussion

Altagracia

The International Political Economy of Universal Health Care

Influencing Policy Change

Policy Analysis: Case Studies on Universal Health Care What Medical Students Can Do?

Closing and Synthesis

Trace the stories of different countries in their pursuit to achieve universal health care Understand the national and global context influencing the worldwide movement towards universal health care the push and pull factors Explore the links between universal health care and social determinants of health Understand social change and the policy process Develop basic skills on how to influence policy change (advocacy, campaigning, lobbying) Simulate how to influence policy change Experience first-hand how to analyze a policy pertaining to universal health care Present ideas to classmates about universal health care based on the given case Discuss the role of medical students in the worldwide movement for universal health care Explore how universal health care can be integrated in the medical curriculum Devise an IFMSA strategy for advocacy towards universal health care Summarize the key learning points from the past three days Seal the commitment of participants to continue learning about and working for universal health care Launch the universal health care working group within the IFMSA Global Health Equity Initiative

Interactive lecture

Renzo

Interactive lecture

Ravi Duggal International Budget Partnership Renzo/Altagracia/Ravi (facilitator)

Small group discussions Group presentations Large group discussion Small group discussions Group presentations

Altagracia

Large group discussion Commitment ceremony

Renzo/Altagracia

References for the Workshop

Ahoobim O, Altman D, Garrett L, Hausman V, and Huang Y. The New Global Health Agenda: Universal Health Coverage. Council on Foreign Relations, April 2012. Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010; 376: 192358. Garrett L, Chowdhury AMR, and Pablos-Mndez A. All for universal health coverage. Lancet 2009; 374: 129499. Huang, Y. World Momentum Builds for Universal Health Coverage. Yale Global, 9 March 2012. International Federation of Medical Students' Associations. Policy statement on health inequity and the social determinants of health. Jakarta, Indonesia, 60th March General Assembly of the International Federation of Medical Students' Associations. March, 2011. Available from: http://www.ifmsa.org. Ooms, G, Hammonds R, and Van Damme W. The International Political Economy of Global Universal Health Coverage. Background paper for the Global Symposium on Health Systems Research, November 16-19, 2010, Montreux, Switzerland. Resolution WHA58.33. Sustainable health financing, universal coverage and social health insurance. Geneva: World Health Organization, 2005. Srinath Reddy K, Patel V, et al. Towards achievement of universal health care in India by 2020: a call to action. Lancet 2011; 377: 76068. World Health Organization Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Geneva: World Health Organization, 2008. World Health Organization, United Nations Childrens Fund. Declaration of Alma-Ata. Alma-Ata, USSR, 1978. Available from: http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf. World Health Organization. Everybodys business: strengthening health systems to improve health outcomes WHOs framework for action. Geneva: World Health Organization, 2007. World Health Organization. World Health Report 2008: Primary Health Care Now More Than Ever. Geneva: World Health Organization, 2008. World Health Organization. World Health Report 2010: Health systems financing, the path to universal coverage. Geneva: World Health Organization, 2010.

Expected Outcomes
For Participants Better understanding of universal health care and health systems, as well as the national and global contexts shaping universal health care (social determinants of health) Development of skills for influencing policy change, especially policies and programs related to universal health care

For the Federation A new group of IFMSA members with enhanced knowledge of universal health care who will lead discussions and advocacy efforts within the IFMSA Global Health Equity Initiative New advocacy and project ideas pertaining to universal health care A newly-designed pioneering workshop on universal health care that can be replicated by NMOs and various groups within IFMSA

Follow-up Plan
Creation of a googlegroup that will continue discussions and interaction among participants even after the General Assembly Encouragement of preGA participants to initiate local projects and activities pertaining to universal health care in their own countries Possible linking up with international NGOs, advocacy groups, and research institutions focused on universal health care, its implementation and evaluation

Contact Details
Renzo Guinto Founding Coordinator, IFMSA Global Health Equity Initiative Regional Coordinator for the Asia-Pacific, IFMSA globalhealthequity@ifmsa.org / rcasiapacific@ifmsa.org /renzo.guinto@gmail.com