Director-General's Office

Closing remarks: Global Conference on Primary Health Care

Dr Tedros Adhanom Ghebreyesus

Astana, Kazakhstan
26 October 2018

Excellencies, distinguished guests, ladies and gentlemen,

It has been such a privilege to be here in Astana with all of you for this historic conference.

I want to once again express my deep thanks to the Government of Kazakhstan for hosting this landmark event.

I thank all who have brought us to where we are today.

Thank you for the spirit of cooperation and solidarity you have shown in the leadup to this conference.

Together, we have endorsed a strong declaration that gives us a clear path, with clear commitments.

When I was health minister in Ethiopia, if you ask me one thing I did, I would say primary health care.

That’s my mission.

And I feel now that it can happen, I feel like we are ready, and that’s why I shared with Carissa ‘The time is now’ and it’s true.

We have reaffirmed that vibrant, strong and sustainable primary health care is essential if we are to achieve universal health coverage and the Sustainable Development Goals.

Our shared vision is that the Declaration of Astana will be a living promise by every country on earth.

But we cannot afford for the declaration to remain a declaration.

We must make sure we translate it into action – into better health for all people.

Importantly, the declaration is not just our guide for what must be done, but how it must be done.

That is what Margaret Thatcher said: “I know the what, tell me the how.”

So the ‘how’ is also included in the document.

It calls us to action in four specific areas:

First, it calls us to harness the power of science and evidence.

This will require us first to ensure that the services we deliver are the services people want and need, not the services someone else thinks they should have.

We must pay careful attention to what communities are telling us.

I am really glad all of us are speaking about our youth, this includes listening to the voices of young people.

Their future health will be determined by the choices we make today.

This week I was delighted to attend the youth conference, that was actually my first meeting as soon as I set my foot in Astana.

And to also visit their display in the exhibition area.

To our youth delegates I say – it was inspiring to listen to your views, and our colleague, panelist also here.

And I hear you loud and clear, it was very clear.

We must pay careful attention to all voices.

We must also learn lessons from what works and what doesn’t, not only from our own experience, but from the experience of others globally.

There are already many countries showing the way. There is a wealth of experience from which to draw.

I am glad we converged on Rwanda, me and Henrietta.

I think of Rwanda, and the community health workers I met when I visited who serve their people so diligently.

I think of Greece, which has not historically had a strong primary health care system, but has recently embarked on an ambitious project to establish primary care units throughout the country, with multi-disciplinary teams of health workers.

During my visit I was really impressed.

And I think of my own country, Ethiopia. In the early two-thousands we recognized that unless we invested in primary health care, people would continue to die from entirely preventable causes – especially the poorest and most vulnerable.

We trained tens of thousands of health extension workers to provide community-level services, with a specific focus on women and children.

Instead of making people in remote villages come to urban centres for care, we took health care to the villages and put communities in the driver’s seat of their own health. That is what people-centred care means.

As a result, maternal and child mortality plummeted, we saw great improvements in hygiene and sanitation, and the burden of communicable diseases fell sharply.

Everything we did was based on sound evidence. That will be essential in all countries for achieving health for all.

Second, the declaration calls on us to harness the power of health workers.

Currently, the world is facing a shortfall of 18 million health workers to achieve and sustain universal health coverage by 2030.

Most of that shortfall will be felt in low- and middle-income countries.

So new investments are needed to close that gap.

But we must do more than just create jobs. We must create decent jobs with good conditions.

And we must create the right jobs in the right places, to deliver the right care at the right time.

This will require us to invest in the education, training and development of health workers.

And we must make sure that when health workers migrate, wealthier countries do not benefit at the expense of poorer countries.

Third, the declaration calls on us to harness the power of technology.

We must expand access to medicines, vaccines, diagnostics and other health technologies.

We must use electronic health records to ensure continuity of care.

We must use big data to collect, analyse and protect data.

We must build health information systems to enable health systems to be responsive to changing needs.

And we must use digital technologies to improve access to, and the quality of, health information and services.

Fourth, we must harness the power of finance.

All countries at all income levels must invest in primary health care. Even for the highest-performing health systems, there is always room for improvement. There are always unmet needs. There are always people being left behind.

We must ensure people are not pushed into poverty by the costs of paying for their own care.

Instead, health care must be a launching pad for people, communities and nations to thrive.

So it’s crucial that we see these investments as exactly that – investments, not costs.

They’re investments in a healthy population. And healthy populations are productive populations.

And that’s why we say “investment in primary health care is the smartest investment’.

Low cost, but high return on investment.

Harness the power of science and evidence.

Harness the power of health workers.

Harness the power of technology.

Harness the power of finance.

This is the task ahead of us.

These are the ‘hows’ we have agreed in our declaration today.

Excellencies, ladies and gentlemen,

The Astana Declaration is a powerful statement of where we want to go, and how we plan to get there.

But there is also a wealth of technical material behind the declaration to enable us to translate our commitments into action.

The background document and the operational framework are rich resources that give all countries the tools to make progress, starting now.

This declaration lays a vital foundation for the High-Level Meeting on universal health coverage at the United Nations General Assembly next year.

And it will also form a key part of the Global Action Plan on Healthy Lives and Well-Being, which we are now developing and will also launch in New York next September.

The coming together of these various initiatives gives me great hope that we are more likely than ever before to succeed in realizing the vision of health for all.

We are leaving Astana with a new declaration, but we are leaving with so much more – we are leaving with unprecedented political commitment, a clear path ahead, a wealth of experience on which to draw and the opportunity to change the lives of billions of people.

This time, we cannot fail. This time, we will not fail.

It’s time to make it happen, and we can.

I believe it will happen. I believe, and so do you.

Thank you so much. Rakmet!