One Person, Multiple Diseases — Reimagining Integration and Sustaining Progress to the End of AIDS, TB and Malaria

Good afternoon, everybody.
Thank you very much for choosing to be with us during your lunch hour.
We're about 10 minutes behind, so we've got quite a lot of catching up to do.
I want to welcome everybody here to this one person multi diseases, reimagining integration and sustaining progress to the end of AIDS, TB, and malaria.
To acknowledge our four co conveners, the governments of the Philippines and Georgia, UNAD Stop TB Partnership, RBM Partnership to End malaria.
I'm James Chan, the President of the China United States Exchange Foundation, which is a non profit Hong Kong and I also serve as a WO goodwill ambassador previously for UN AIDS.
Today, we're going to be looking at one person multiple diseases.
It's a really novel way of reimagining the challenges that we have, which are multifold.
Health systems built around a single disease miss the whole person, but integration is how we put the person, not the diagnosis at the center.
The global AIDS strategy sends a really powerful message at this time, the future of the HIV response.
Obviously going to be reshaped by bold reforms, stronger partnerships, and decisive action to strengthen systems that are truly multi sectoral, self religned and sustainable within countries, but also we take that broader picture right around the world as well.
At the heart of the transformation that we're talking about is integration.
Countries are already moving forward, as we know, at different paces, at different stages of their journey, but also forging new pathways to connect HIV responses with broader health and development systems to address that whole person that we're here to speak about.
Now, at the same time, in parallel, there is the financing landscape, which of course is fast, rapidly changing, an era that was once defined by more predictability, by abundant donor funding for HIV is obviously shifting, creating an urgent need for countries to all step up to domestic investment and diversify financing sources.
W substantial international resources for HIV, TB, and malaria remain available.
Ing these epidemics by 2030, which as I said yesterday, is only four years away.
We keep on talking about this magic number, but it's right around the corner.
It's less and less likely and is going to depend on how countries mobilize new funding through tax reforms, health taxes, insurance schemes, dedicated health funds, and other innovative financing strategies.
Now, at the same time, we're going to go back to integration, how it's redefining health services so they can deliver for better, more integrated person centered care and let's not forget that close linkage between HIV and TB, which has already shown in many situations, the power of coordinated responses, providing a strong underpinning foundation of experience and guidance.
The challenge is obviously there.
It's even bigger, building resilient primary health care systems that can develop prevention, treatment and care for HIV, TB malaria and other diseases.
This is the idea of the multiple diseases through people centered services that meet communities wherever and whenver they are.
I would like to invite first the Ambassador Enrique Manolo, permanent representative of the Philippines to welcome us here today.
The Philippines, of course, is playing multiple important roles at chair and vice chair level and that will be followed by video message from the Honorable doctor Teodoro E Bosa, the Secretary of Health of the Philippines Ambassador.
Thank you very much, James.
Colleagues, partners, on behalf of the Philippines and our partners in UN AIDS, the Stop TB Partnership, and the RBM Partnership to End Malaria, it is my pleasure to welcome all the distinguished panelists, delegates, and participants this afternoon.
We gathered at a pivotal moment.
While remarkable gains have been achieved against HIV, TB, and malaria, shifting financing realities, persistent inequalities, and growing demands on health systems require us to rethink how we deliver health services and sustain progress.
The answer lies not in working in silos, but in building integrated, people centered and resilient health systems that respond comprehensively to the needs of the human person and the communities to which they belong.
For the Philippines, this approach is both practical and necessary.
Continue to confront one of the faster growing HIV rates in the Asia Pacific region, while also carrying a high tuberculosis burden.
These challenges have reinforced the importance of strengthening primary health care, expanding universal health care coverage, integrating HIV and TB services, and addressing the social determinants that shape health outcomes.
Through increased domestic investments, national insurance benefit packages, innovative screening technologies, community led responses, and partnerships with organizations and bilateral partners, we are working to ensure that no one is left behind.
Integration is not merely a technical solution.
It is a political commitment to equity, sustainability, and dignity.
It recognizes that people do not experience diseases in isolation, and therefore, our responses must be targeted and multidimensional.
During discussions today, let us look forward to learning from one another's experiences and identifying concrete actions that will help sustain gains and accelerate progress towards ending AIDS, TB, and malaria.
In closing, let me once again thank all the participants and the sponsors and wish you a fruitful exchange this afternoon.
Thank you very much.
Thank you very much to the permanent representative from the Philippines Ambassador Enrique Manolo, and we will now listen to a video message from the Honorable doctor Teodoro Evoso, the Secretary of Health of the Philippines, please.
Excellencies, distinguished colleagues and partners, warm greetings from the Philippines.
I thank you and HS the SOP TB Global Partnership, the Rollback Malaria Partnership to End Malaria, and all our partners for convening this important discussion on integration, sustainability, and the future of the global response to HIV, tuberculosis and malaria.
Today, I speak not only as the Secretary of Health of the Philippines, but also as the Chair of the Stop TB Partnership Board and Vice Chair of the UN AIDS Program Coordinating Board.
These rules have been given to me as a unique perspective on a simple but profound reality.
People do not experience diseases in silos, and therefore, our health systems should not respond in silos.
A person living with HIV may also be at risk for tuberculosis.
A pregnant woman seeking maternal care may need HIV testing.
A child screened for malnutrition may require TB evaluation.
A traveler returning from an endemic area may present with malaria.
Health systems must be designed around people, not programs.
The Philippines continues to face significant challenges across all three diseases.
We are confronting one of the fastest growing HIV epidemics in the world with approximately 50 new HIV reported every day Tuberculosis remains one of our leading public health concerns, and we continue to rank among the world's highest TB burdened countries.
At the same time, while malaria cases have fallen dramatically over the past two decades, we remain vigilant as active transmission persists in limited areas, particularly in the island of Palawan.
Yet, these challenges have also taught us valuable lessons.
First, Integration works.
In the Philippines, we are increasingly integrating HIV services with primary care, maternal and child health services, and tuberculosis programs.
Our active PB case finding initiatives are being linked with HIV services, nutrition programs, non communicable disease screening, and community based care.
We are moving away from fragmented service delivery towards a more person centered approach that meets people where they are.
Second, communities are indispensable.
No government can end HIV, TB, or malaria alone.
Community organizations, civil society, faith based groups, and people with lived experience are often the first to reach those left behind.
They build trust, fight stigma, support treatment adherence, and ensure accountability.
Sustainability is not only about financing, it is also about sustaining community leadership.
Third, domestic ownership and South South cooperation matters.
The global financial landscape is changing.
While international solidarity remains essential, countries must strengthen domestic investment and build resilient systems capable of sustaining gains over the long term.
In the Philippines, we are working to strengthen social health insurance, improve procurement and supply chains, expand digital health systems, and enhance local government ownership of health programs.
These investments benefit not only HIV, TB, and malaria responses, but the health system as a whole.
Finally, political leadership remains the most important ingredient.
Progress does not happen by accident.
It requires leaders willing to invest, reform, innovate, and make difficult decisions.
It requires sustained commitment, even when resources are constrained and priorities compete for attention.
The Philippines stands ready to work with all partners in advancing this shared vision a future where integrated, people centered and sustainable health systems enable us not only to control HIV, tuberculosis and malaria, but ultimately to end this epidemics as public health firms.
I wish you a productive and meaningful discussion ahead.
Ma B Saba.
Thank you very much to the secretary and the ambassador, more so to the Philippines for its action, that the Philippines own people centered integration and universal health coverage journey and also how it's using these to bridge upwards to the global picture ambassador.
I very much noted what you said that integration is not just a technical point, but it's a commitment to individual and collective human dignity.
It gives me great pleasure now to I invite the Ambassador David Bratzi from Georgia, the Pent Representative, Georgia, say a few words to us.
Of course, this is a very important couple of hours ahead for everybody and you as one of the co facilitators, the other co facilitator, thank you very much for joining this session today.
Thank you very much.
It's a pleasure to be here.
Apologies for being a little late.
As you have mentioned, it has been quite important couple of hours left as we look ahead for the coming 45 years of the work.
Our Excellencies, dear colleagues and dear friends, first of all, let me share that with my esteemed colleague from Botswana, Masa Masole and myself.
We spent the last several weeks facilitating the negotiations on the political declaration for the high level meeting on HIV and AIDS and a We are not technical experts in this field, but it has been quite a crash course for us on many things.
Among many important things that we have learned is the effort to end the global AIDS epidemic, the efforts to end TB and malaria are at a critical juncture.
On the one hand, so much has been achieved since the turn of the century driven first by millennium development goals and later by sustainable development goals and we should all be proud of this, but on the other hand, we have not achieved our goals and there is more to do.
I and that is why we gather together this week to show the progress.
Meanwhile, the global context is changing.
Some of these changes are positive.
We have made great progress on socioeconomic development, global health, global extreme poverty and inequality between countries have been greatly reduced as have global deaths from HIV and TB.
However, inequality within countries is rising.
Our progress on global health was severely disrupted by COVID 19 and the resources available through traditional development cooperation mechanisms and assistance are declining as countries grapple with climate change conflicts.
So some suggestions that I wanted to make, some points that I wanted to make about moving forward.
First, leveraging the HIV infrastructure as a blueprint for universal health coverage.
The response to HIV has built robust, resilient primary health care infrastructure, spanning laboratory networks, community led delivery channels, data tracking, and supply chains.
Transitioning from c disease specific funding to integrated care models allows countries to use the proven HIV foundation to tackle broader health priorities, effectively turning HIV investment into a bridge for universal health coverage.
Second, multi epidemic defense network, by embedding HIV services within broader clinical networks.
Health care systems can simultaneously combat overlapping syndemics, including tuberculosis, hepatitis C, non communicable diseases, and emerging pandemic threats.
Patient centered integrated system screens, prevents and treats multiple conditions during a single visit, drastically improving overall population survival rates.
Third point is human rights and community led responses as essential public health pillars.
The global HIV response proved that public health initiatives only succeed when built on equity, human rights, and destigmatization is present.
Championing this integration means bringing vulnerable marginalized populations into the formal healthcare ecosystem, establishing a trust based model essential for controlling any future epidemic.
Four, driving sustainable health financing and economic resilience.
Shifting from parallel disease specific programs to integrated health care models eliminates costly duplications, optimizes workforce distribution, and offers a higher return on donor and domestic investments.
Integrated systems are fundamentally more financially sustainable and safeguard national economies against the shock of the future health emergencies.
F, Georgia's leadership opportunity in regional health security.
A country that has made significant strides in managing HIV, TB, HepC, Georgia is uniquely positioned at the UN to champion the transition from crisis driven funding to resilient, integrated national health system.
Advancing this agenda cements Georgia's role as a strategic leader in the global health security and a driving force to end both current and future epidemics.
And I want to thank you all for active contribution to this discussion and with the best of the hopes for the outcome of today's high level meeting with this, I will stop and looking forward to further discussion.
Thank you.
Thank you very much, Ambassador.
We're going to move swiftly on to a couple of key notes, starting with Winibanima then doctor Lucha Diu, and doctor Michael Akkuni Charles.
Let's start with Winibanea, the Executive Director of UNAIDS.
Thank you.
Thank you, moderator James Chao, a leader in the HIV response we've worked so closely with.
Thank you for being here for us.
Excellency, colleagues and friends, thank you for being here.
I must start by thanking the co conveners of this session.
The government of the Philippines, stop TB and the Roback Malaria Partnership and us at UN AIDS, thank you for putting this together.
I have to make a special mention of Ambassador Bkrazzi, co facilitator of the negotiation of this high level meeting together with Ambassador Masole.
You're amazing.
I can't even imagine that you can be here when all this is still going on and we don't know whether we're going to have it governed in.
But thank you for all that you have done.
We are talking about integration.
This session is about integration, integration and why now.
Because the world is in a very particular complex political situation here at the United Nations.
Because past agreements that were reached here at the United Nations, member states trustee so hardly able to agree to keep them going.
They are unraveling them.
It's a difficult political context we are in.
Development financing has disappeared suddenly.
And that has created a very special situation for those countries that were still dependent on external assistance for their HIV programs.
My colleagues from Rob malaria and STB will be experiencing the same.
This has created a new situation where developing countries must step in and quickly find resources to fill gaps where external assistance was helping.
Hence the discussion on health sovereignty.
Hence the discussion on integration because integration is a way to bring together many strategies to address different diseases together to achieve cost efficiencies and be able to deliver.
We're talking about integration.
It's a particular context for developing countries that were depending a lot on assistance to be able to Roll out strategies, responses for HIV and other diseases.
I thought I should put that context there.
Now, I would like to talk about our disease, HIV.
We've come 25 years of a global HIV response, making progress steadily and putting now 32.1 million people living with HIV on treatment able to live long lives, healthy lives out of 40 million.
Still a job to do, but great success coming out of the world coming together.
It came together to do what? It came together to close the gaps for every country so that every country can give its people what they need to stop this disease, new infections and deaths.
How did this happen? It was about closing the inequalities that drive the HIV pandemic.
The key areas of inequality that were addressed by member states coming together and agreeing.
One was in access to medicines, agreeing to work with companies to bring new innovations for testing, for prevention for treatment, and ensuring that those new innovations are priced affordably so that everyone in the world, wherever they are, can get the best for testing, for prevention, for treatment.
Today, if you are in Wgadgu, Bukina Faso, or you are in London, UK, you can access the same pill for prevention It does not matter the economy of your country, the size of your country, and so on.
You can access the same.
That was an important agreement reached by member states to work together to bring prices down to get everyone to access.
It's still an issue of discussion here.
The second was to agree to close the gap on financing that those countries, developing countries that can't put the money down to build these huge beautiful health systems that address every issue can have resources to fight this disease.
Global Fund was created and we raised money and the American program PEPFAR was created and financing was brought in to help developing countries.
This is what is now going off the table, financing, closing the gap on financing.
The third was closing the gap on rights.
Agreeing that everyone, whatever your identity, what kind of sex you have, however you define yourself sexually, whatever you work you do, if you're a sex worker, whether you inject drugs, that you are a human being with the right to access what you need to save your life.
Human rights.
We agreed and we moved the framework of human rights to ensure that all those at risk and people living with HIV can have their rights to get what they need to test, to prevent, treat.
Those are the three areas.
Now I want to quickly come to integration because integration now is about how to manage with limited resources.
Here, So we are concerned as UN aids because we see that as integration is happening, as HIV responses are being brought into broader health systems, some things are not happening, and this is dangerous and this is going to cost lives if not already.
We are seeing that while we built success based on communities, creating their own organizations and delivering services to their own people in dignity, that these are not being integrated, they are being closed off and not being brought into the system.
Communities are the backbone of the success of the HIV response.
People living with HIV, gay men making their own organizations, LGBTQ people, sex workers in their own organizations, young people, girls and young women, youth creating organizations where people can safely come, not feel discriminated, not experience stigma, not fear harsh, criminal laws, come and get what they need.
These services have been cut.
The cuts have Almost say eliminated community responses.
Now, integration must be about bringing them back.
Governments finding resources, social contracting communities to continue serving their people.
Because if I'm a gay man in Uganda and I'm afraid of the criminal law there, I'm a Ugandan, I'm talking about my country, I will not show up to a government clinic because I'm afraid I'll be identified, I will be arrested, but I can show up at a gay center where other gay men are handing out the condoms, the ARVs that I need.
It's not rocket science.
This is simple.
We need human rights, we need communities.
Integration must mean that guaranteeing human rights, bringing communities into the health system.
Without that, we will not end AIDS.
The second thing about integration that I want to mention is that HIV is not just a health issue.
It's an issue of inequality and poverty and exclusion.
If you do not address all the sectors that touch on these issues, you will not end AIDS if you consider it just as a disease.
We've always had multi sectoral approaches.
Integration must go beyond integration in health sector.
It has to be integration across sectors.
That means You're addressing the real issues that drive vulnerability.
These are in households, in communities, in classrooms, in the economy itself, in the workplaces.
We need multi sexual approaches, we need integration across sectors.
Keeping girls in school is a major prevention strategy for HIV.
So we must look at integration as looking at education, look at social protection, look at law and rule of law, across the sectors.
That is really my last point here, that integration for us means integration across sectors, a multi sectoral approach, maintaining that, integration means integrating communities as service deliverers in the lead in fighting HIV.
Integration means integrating human rights in the response to HIV.
In conclusion, as we are here together with my colleagues from Stop TB, rollback malaria, we also have Global Fund perhaps in this room, Africa CDC, we all need each other.
We need to work together.
Each has a role to play.
We need to support countries to achieve their health sovereignty each in the space that we have.
But we also need to be bold in our advocacy about what needs to be done.
Thank you very much, Moget.
I probably have taken more times than I should have.
I apologize.
Well, thank you very much for Winnie Ban Na Executive Director of UN AID.
I think that acknowledgment recognizes not only the extraordinary work of the people at UNH, but going to the core of what you said regarding dignity, human rights being at the core of everything that we're here to discuss.
I'm going to move very quickly to the part that you just mentioned, Stop TB to doctor Lucka Du, who is a longtime leader of this organization and someone who and she says, I can say this.
Uses her loud voice or her outside voice to be a noisy advocate for people, not only TB, and for recognizing that co infections like TB are core to the AIDS agender.
They're not simply side issues or footnotes, Lucica.
Thank you.
Thank you very much, James and very esteemed panel and Winnie and co host from obviously the Philippines and ambassador of Georgia and Philippines being with us here, but also all the countries.
I'm really happy to have Nigeria, Swaini.
I know Kenya is in the Roman partners who chose, as you James said, chose to be here.
You could have been on the corridors doing some Global health architecture mapping.
That's what everybody does these days, but you chose to be here to listen to what we have to say and we know each other for a long time.
Our partnership aims to end TB by 2030, 2030 is around the corner.
We speak for a long time about TB HIV integration.
I look in the room and we actually grew together in a lot of this, including you, James, including the amazing team of NAs that worked on this because indeed, we speak for so long about TB HIV integration.
We all know that TB is the biggest killer for people living with HIV AIDS and it remains like that.
And we all know that you could do much more together.
But actually, as we all know, it worked very well in some places, it didn't work in others.
This integration of TBH HIV didn't work in some countries and it was not necessarily bad will or people didn't want to do.
The systems in the countries were not constructed for this intervention.
The funding going for TB and for HIV are going through different channels to different departments in the ministries of health.
The communities working and advocating for TB HIV and malaria and others are also funded through different streams.
So There is a lot to be unpacked when we discuss about integration and it is a lot to understand why it in some instances didn't work and what can be done to make it work and much better now.
I was listening to what Winnie was saying yesterday and today as well on the achievements on the HIV AIDS and we know the achievements on malaria as well on TB as well.
We are at the phase in which I think we reached with services, the low hanging fruits, if I can say, people that are easier to reach, people that we can easier engage.
I can speak for TB.
It's much more difficult to reach the people that are most vulnerable.
It are those that for which we have to do the extra mile to be reached out and they are probably the same living with all the three diseases.
So thinking of the way in which that can be done and listening to what countries did and do is the right way to go.
I don't want to go into what countries should do because we will listen from the plenary here.
But I can tell you that from the global level and as I said, people these days are more busy to discuss what organization should be merged with the other who will sunset will grow.
I can say that from the global level, we here did this event three groups, as we know, UNA, STB, and rollback malaria, because we believe that things can be done differently.
We all built strengths and capacities that we are very good at.
I really hope that we have all of us the maturity to maintain that and not immediately throw things out because it's very difficult to lose those expertise.
In STB, we are very proud of the innovation work.
We basically scope the landscape identify startups and private sector companies and help them navigating the system till they are getting introduced in countries.
We are not scaling up but introduced.
We are working very much with communities and civil societies, and we brought them up, including the TB survivors and the civil society organizations in a huge number as unheard before, and we do a lot of procurement and supply.
What I'm trying to say is, we should look at everybody's strength and put this together.
But we need to avoid two things and these are my last points to try and gain some time.
We need to ensure we don't duplicate and see where we can aggregate some things, but also we need to listen to the countries.
Too often, from the big capitals in the North, we dictated some directions to countries that was maybe not the best one for countries, but countries in a desire to have more visibility, support finances, listen to that and that's where the lack of sustainability came for.
We have to listen and not impose to the country that direction.
The last thing I want to say about the integration, which is so vast area to discuss and we all know about that is I want to use an example for all of us.
As you know when you paint and you put different colors on a palette and you have red and purple and blue and green, when you integrate all these colors, you get a muddy color.
Just try it and you lose the beauty of each of the colors, and then you remain with this muddy thing that can be messier and uglier.
So while we look for the future, I think it's extremely important to leave from here with a political declaration that I know our colleagues from Georgia and Botswana and many of you worked so hard to have and make sure that we leave the countries to lead and we behind them, try to support their efforts towards ending these diseases.
Too much money, effort, sweat, tears, and joy went into trying to end these diseases so far, we are not far from it and I believe very strong that together, the three of us here, but also with our friends from communities in the front line and the survivors, we are able to end these diseases by 2030 if we choose to.
Thank you.
Thank you very much to It's such an enthusiastic audience today.
Thank you very much to doctor Lucica Ditu.
On this note, because you mentioned the political declaration, we would excuse the ambassador of Georgia to get back to the last minute preparations for the adoption of that declaration as said by Winnie Banema, we really thank you for your personal and country's leadership as well as that of your co facilitator, Ambassador Masoli of Botswana.
Let's go now to our final speech from the co conveners doctor Michael Adunne Charles from ABN Partnership to end Belleria.
These are his prerecorded comments that he sends to us.
Good day, ladies and gentlemen.
My name is Michael Adré Charles, and I'm the RBM Partnership CEO.
First and foremost, I would really like to thank the government of the Philippines that is convening this important discussion together with us as RBM UN Aids and SO TV, and to really thank the other partners that are in the room.
The conversation around integration is important now more than ever.
Integration has to be done in a sustainable manner and in a manner that really builds on the communities and is country led.
From an RBM perspective, integration is key, and I, together with the Malaria ecosystem, we firmly believe in integration.
Integration, we've actually been doing for many years.
We've had bed net campaigns that are integrated with immunization vaccination campaigns.
We've had bed net campaigns that are integrated with vitamin A distribution.
We've had intermittent preventive treatment in pregnancies that is really tuned and integrated with maternal care, antennatal care.
Recently, I was in Nigeria where I witnessed firsthand a beth net distribution in the communities that was integrated with screening for tuberculosis between children between the age of zero and 14.
To my surprise, out of all the children that were screened, 10% actually had symptoms of tuberculosis and these were referred to the Nervous Health facility.
This is what integration means in practice.
It has to be community led, it has to be what the country wants, and we as partners need to commit to ensuring integration happens where it makes sense.
That is why the Albion Partnership have come up with a framework called the Big Push to end malaria by 2030.
This is again, really talking about integration at the community level, integration from the global health actors, integration when it comes to our collective collaboration and coordination, when it comes to finances, when it comes to data, when it comes to surveillance, when it comes to access, we really need to ensure that we work together behind a common goal, and that goal is the country agenda and the agenda of the community.
I firmly believe there's a lot we can continue to do together to ensure that we are working in a holistic manner.
The person that is sick is not only sick from one disease, so we shouldn't radicalize it and we shouldn't look at diseases in silent.
One thing is clear for me, collaboration is now and not in the future.
Within the Malaria ecosystem, we are ready to collaborate.
We are ready to work together with all of you and to ensure that we are supporting the country's agenda and the community's agenda.
Once again, I'd really like to thank you for being part of this conversation.
Thank you for your ongoing guidance, support as we continue to work together to bring our collective support to countries and to communities.
Together, we can, together, we must.
Thank you.
Thanks very much to doctor Michael Acne Charles from the RBM Partnership to End Malaria.
We're now going to transition into our first debate, which is looking at the external funding declines and the drive for self reliance.
As these conditions grow and as the challenges grow with them, we're going to ask about national leadership and how it's never mattered more before.
This panels the journey from that vision to action on the ground.
We're going to introduce you now to doctor Kelechi Ohiri, who is the Director General and CEO of the National Health Insurance Authority of Nigeria and doctor Nonumiu Kube, the Executive Director of NESA, the National Emergency Response Council on HIV and AIDS in Esuaini.
Welcome to you both.
Doctor Hiri, I'll just go to you first.
My question here is, how is the health insurance authority helping to deliver an integrated response and what will it take to make that reform sustainable, embedding HIV, TB, and malaria in primary health care and giving real financial protection to the poorest of the poor and the most marginalized in our world? Very easy question there.
Excellency, good afternoon.
I thank you for the opportunity.
I believe the fact that the chief executive of the National Health Insurance Authority is here today really underscores some of the challenge, the financing challenges that face us.
I'll respond to that by, first of all, giving a contextual background as to where we were as a country, what we've done so far, and then some reflections in terms of the way forward and the challenges that we have faced in dealing with this.
In Nigeria, we know that conversations had been going on about country ownership, around the need to reform a lot of our programs, and this preceded some of the recent changes in the global health landscape.
The decline in multilateralism and global solidarity didn't come as a transition.
It came quite as a shock and it was sudden and it was immediate and so many countries like ours had to really confront this new reality.
This reality started during the era of COVID, et cetera, that many countries began to learn from.
What was clear to us was that things had changed.
Nostalgia and hoping to go back to the status quo exen was not really responsible strategy for us as a country.
And so we had started some reforms.
When the government changed, there was a health sector renewal investment initiative that was led by the minister and this created a sector wide approach, where we began to look at different sources of financing for programs.
And this was why Nigeria 22 other countries sponsored a resolution at the WHA last year, looking at how we track financing globally, but also at the country level.
A what it meant well, for the first time we began to speak to all the partners in Nigeria.
We have a decentralized, fiscally devolved government.
At the federal level, the states, the local governments, the partners as well as civil society coming together to in one strategic direction, and that was the sector wide approach that had started.
It was auspicious that this had started because when the shocks came, there was already a platform for convening the different stakeholders and bring them around the table to discuss So what happened was immediately, we needed to know where were the funding sources and what was being funded and it wasn't as clear as one would expect because there was a lot of opacity in the way things were done.
With a level of advocacy, the Nigerian government mobilized about $200 million extra budgetary with the Senate and the House of Representatives coming on board.
Then we began to integrate roughly 20,000 health workers that were just let go off into the health system.
That was immediately because first of all, it was to stop the bleed and do no harm, bringing a medical balance into it.
Then secondly, we began to look at how we could build back better because certainly things were not going to happen one for one.
So we started looking at budgetary allocations.
We started with negotiating different memorandum of understanding with some of the critical stakeholders.
We began to pilot some integration of HIV and TB care into the National Health Insurance scheme, start with about five states in the country to see the feasibility of actually integrating this.
We began to redefine the benefit package and insurance, including TB and launched actuarial studies to look at what it would cost to fully integrate HIV and TB care into the benefit package that was being offered to Nigerians.
This has started a journey for us that's now culminated in the Senate in Nigeria, doubling the amount about 1% of the consolidated revenue in Nigeria goes towards primary care and towards caring for the poor and the vulnerable.
Recently, the Senate actually passed a bill doubling that amount to 2% that is taken off the top in addition to the health care budget that has also been increased.
In addition to that, fiscal policy reforms were ongoing and recently, again, sugar and sweetened beverage taxes that will be channeled and earmarked for health care has been passed.
All these were attempts to, first of all, mobilize additional resources towards health, but also secondly, to look at more efficient ways of allocating these resources.
It dawned on us that was not enough to just fix the financing and the demand side.
It was also important to begin to shape the market and look at the health sector from a value chain perspective.
So things like the way we procured had to change.
Whereas before we depended on procurement systems that were really external to our system.
We began to build things like maybe pool through a presidential mandate so that we can consolidate and pull procurement to drive down some of the costs of services because whatever system we build can't be as expensive as what existed before.
We've also began to look into realistic local manufacturing, whether it's for bednets.
We're the largest consumers of bed nets and now for test kits for HIV.
We've had companies come to Nigeria and break ground on these things.
Now, I think looking at all this, there are a few reflections that we need to think about as we go forward.
One is, it's not been easy and it's not a case of this has not been a transition, and this has been a disruption.
Your strategy has to be quick, it has to be realistic, and it has to be context specific.
The second thing is that it's not just enough to spend and to bring more money.
We need to get more value for what we spend.
So issues around public financial management have jumped to the fore, where it's not just enough to allocate the budget, it's also important to implement it and to ensure that it is appropriately directed.
The third thing is, as we redesign health systems, there was a comment made earlier on that health systems must be designed around people and not around programs, and that's very much resonates with how we see things.
We need to ensure that as we integrate, that we don't continue any form of zero sumness in our approach to financing.
It may be messy, it has to evolve, and it must be responsive to the needs of people.
We must ensure that it's equity focused and that rights are important and upheld and that it also brings multiple stakeholders together from both the public sector, the private sector, and the communities.
In conclusion, what we've seen has been the importance of preparing, being realistic, looking inwards to mobilize more resources, but also realizing that there are opportunities in this crisis to actually benefit from an actual dividend where we can expand benefit packages and ensure that priority conditions are integrated into it, and also ensuring that equity continues to be the organizing principle around which we rebuild the health system.
The health systems that we had before may not necessarily be the health systems that will serve us in this future.
That means that on the table, all the critical stakeholders have to come together to ensure that indeed, the health system that we're building and the way we finance it must be designed around the person and not programs that were vertical the way we were doing it before.
Thank you.
Thank you very much, doctor Kelo Hiri.
Thank you.
Thank you.
I would like to link his comments now to doctor Nnmiso M Kube, who, if we're just reminded is from Esuatini's National Emergency Response Council on HIV and AIDS.
Doctor Esuatii reached 905-90-5905 and has developed a roadmap to sustain impact to maintain lifesaving services during a period of funding disruptions as you shift to reduce dependence and a firm greater ownership, all of this, how are you pursuing integration not as a way to absorb cuts, but as a pathway to sustain gains with people remaining at the center.
We keep on hearing about this, about what it means to have people at the center at the core of everything that you do.
Thank you, Chairperson.
Excellence, distinguished guests and colleagues.
The Kingdom of Sowa in experience shows that real progress is possible when leadership, partnerships, community engagement, coordination, and integration come together.
We are led by a king who is at the forefront of HIV issues.
We were very much excited to launch Len Kapave last year in December and in January, he came out publicly to invite Ema Sowa to test for HIV and protect themselves from acquiring HIV by using La Kaavia.
Despite being a small resource constrained country, we have achieved the UN aid targets, and we are currently standing at 908-90-8908.
We have done this through strong political commitment, community ownership, and collaboration with both local and international partners.
A key lesson we would like to share is that sustainability must be built early.
Over the years, EMT has increased domestic financing by ring fencing funding for antiretroviral therapy.
Currently, we are procuring 94% of our art commodities.
We actually have enough funding to procure all commodities, but our pediatric quantities are small and as such, we utilize other pulled procurement mechanisms for price negotiation.
Also, most of our health care workers are government funded, another important step toward long term sustainability.
The second lesson I would like to share is that integration works.
We have moved beyond parallel systems by integrating HIV, TB, malaria, non communicable diseases, mental health, and other services into primary health care.
With support from the global fund, we have procured mobile trucks equipped with extra emissions and AI powered diagnostics.
Those trucks are helping us to bring people centered services, including TB and survival cancer screening to rural and under saved communities who need the services the most.
Another lesson is that strong coordination matters.
As a country, we have maintained the model of having a National AIDS Commission which operates as a coordinator for the HIV response.
The NAC has helped us integrate through cross ministry coordination with clear roles, shared priorities and one common results framework.
Our message to other countries is this, invest in country ownership, strengthen domestic financing.
Integrate services into resilience primary health care systems, and also build strong coordination mechanisms.
These are essential not only to sustain HIV gains, but also to respond effectively to broader health challenges with limited resources.
As I close, I want to say that we celebrate with these successes with caution because we witness about 402,000 new HIV infections per year and most of these are recorded amongst young people, particularly adolescent girls and young women.
Working with various stakeholders, sectors, ministries, communities in a multi sectoral approach, we are strengthening our prevention programs, including addressing social and structural barriers that continue to disadvantage our populations.
As a collective, let us continue to strengthen interventions that have proven to work while we embrace new technologies that will lead us to ending AIDS as a public health by 2030.
I thank you.
Thank you very much and thank you also to all of our speakers in this first panel.
As they leave the stage, we ask all the panel B speakers to come up as we listen to Ambassador Mark Del of Georgetown University where he serves as a professor of medicine.
Let's listen to his comments now.
Hi.
Sorry, I can't be with you in person.
Thanks for including me.
When we talk about transition, I think it's important to always begin with what are we trying to transition to? That is country sovereignty, but in a new international system with solidarity of equality of partners and partnerships.
In health, that means transition to universal health coverage, sharing of ideas, sharing of technology, sharing of how we grow together, not to achieve less health with less money, but more health with less money.
Across all categories, across all things, HIV, TB, malaria, maternal child health, non communicable diseases, everything.
That can be done, as you've been talking about, I'm sure, through integrated systems, country owned systems.
How do we get there for transition? Five quick points.
One, we have to recognize that countries are at different stages on their journey to independence from external financing.
Some can do it within five to seven years and there are about half a dozen or so that can.
Others will take 7-12 years and some will be in humanitarian crises, and it's not linear.
Countries that are doing well could slide back.
We have to have flexibility as we move along, but we have to understand that countries are starting in a different position and therefore, how we transition and how the countries transition will be quite different.
Second point is how transition happens will look fundamentally different in each country depending on their own governance structures, how government and non governmental actors work together, their current mix of international partners, finances, debt, many other things.
We can't have a one size fits all.
Third, one thing each country does need is some all of government, some all of society mechanism to act in real time to data and respond, react, pivot so that they can achieve their goals.
That mechanism has to be embedded within some structure likely the government.
So that it survives changes in personnel.
We have so many strong personnel in office right now, but they're going to change and they'll change down to the director level, down to the regional officers, down to the people managing district.
It has to be an all of government, all of society system that also responds and ensures that the most at risk are covered and that the whole system is moving together.
Otherwise, transition won't happen.
Pieces might happen, but the whole transition won't.
Fourth, a community of practice across countries to learn from each other, to share lessons that will accelerate the ability to transition, especially if failures are shared, which we're not very good at.
The fifth is an independent accountability mechanism, and this is critical and probably where we failed in the past.
The accountability mechanism has to include countries.
What are countries responsible for? International organizations, what are international organizations for and that I would include philanthropies and many others.
The third is that accountability mechanism.
What are they responsible for? Importantly, civil society needs to be deeply engaged in that, or we will fail.
In the end, it's going to take a lot of flexibility, a lot of learning, a lot of willingness to change, and a willingness to change is essential to all of this.
But this mere period reminds me of 2000 when all these massive things happened that so much has been achieved through that almost everyone thought was impossible.
As we look to transition, many people are saying, Oh, that's impossible, can't be done.
It absolutely can be done.
Just like 2000, if we all work together, if we're all united in solidarity again, we can achieve a better world, and in fact, the world we've been promising for 25 years.
Thank you very much for allowing me to be with you and have a great meeting.
Thank you, Ambassador Mark Diebol.
We're going to jump straight into our next panel and because of the shortage in time, I'm going to skip the over introductions and go straight to them one by one.
We're going to start with doctor Bill Steiger, who is the CEO of Malaria No More, whose experience spans diplomacy, partnership building, finance, and program integration, both across infectious diseases but also health systems.
Doctor Steiger, a disease that rebounds fast if attention slips.
Um, is malaria, of course.
As the programs integrate international systems, how can partners bridge the financing and innovation gaps to protect the most vulnerable and hold the line in progress? We're going to ask everyone to keep their comments only to 2 minutes, please.
Great.
Thank you so much, Chair.
I will give you five quick big ideas in 2 minutes.
The first is that if you only remember one thing that I have to say, it should be that we will know whether integration is working or not because of malaria.
Malaria is the barometer.
As the chair alluded, it is the disease that bounces back first that responds the best and the fastest to both action and interaction.
Idea two, Integration will not work without the deliberate application of innovation.
We've seen greater innovation in HIV TB and malaria in the last 18 months than we have in the previous 30 years, but we are not planning or budgeting properly to deploy these breakthroughs efficiently and its scale.
Idea number three, community health workers are the integrators who will bring these innovations to families.
They are the delivery platform for primary health care, as we've heard again and again this afternoon as part of a broader package of care.
They're excellent models across the African continent.
And they have the linkages, the ties, and increasingly the knowledge to be not only the line of defense for individual families, but the line of defense for all of us in health security because the common denominator that they see and understand and when properly equipped, can differentiate is fever.
They know and see and deal with fever faster than anyone.
Idea number four, the public sector is not enough.
We need to include and activate private sector channels, community pharmacies and drug shops, among others because they're the greatest access points, the first access points for the people who need these interventions most quickly.
But also, as we heard the Executive Director of UN AID say community based and faith based organizations are essential.
I will quote her again.
Integration must be about bringing them back.
Idea five, integration will only work if it saves time and eventually money.
Integration, most importantly, must save the time of clients, including by bringing services to them, as we heard in the example from Miatii and of the health system as a whole, but integration might not save time for every provider, like community health workers as we ask them to do more things in each visit.
Integration might not save money right now right away as they are upfront cost to many of these reforms, but they will lower costs going forward.
What needs to happen? Four quick ideas.
We need to empower frontline health workers, especially community health workers even more.
Have them do more We need transparent publication of disaggregated data on impact, not process to allow, as Mark Dible said, governments and partners to identify and fill gaps and understand progress and challenges.
Even as we integrate services across conditions, we must continue to track results by conditions and diseases.
We need to use new technologies that combine and analyze data to target new tools to the areas and communities where they can have the greatest impact.
We will not have the resources to do everything everywhere and the data suggests we do not need to.
Finally, we need regulatory reform at the national level and at the international level, including at the World Health Organization to speed access to innovations that lend themselves to integration.
Thank you, Chair.
Thank you very much to Bill Stigers.
If you may or may not notice, the name plate is not quite in the right order.
Bill is obviously not M and unless you haven't told us something else in their typos in these names as well.
But there are due to some capacity challenges today here, please excuse these nameplates and use your imagination to integrate us into different names.
Thanks very much, doctor Stiger.
Let's give 2 minutes now to Janet Ginard.
Janet, you're the director of strategy at Unate.
How can multi disease testing platforms break the silos between HIV, TB, and malaria at community level? When you really think about it, what are the main regulatory or supply chain bottlenecks towards scaling them up? Thank you, James, and thank you to the conveners of this event.
I'll start by slightly reframing the question and it's in response to some of the points we've heard from previous speakers.
When we talk about integrated diagnostics, we should start with the person, not the technology.
Last week, I was in Nigeria on behalf of UD, together with leadership of the Global Fund and RBM, and we were there on a malaria visit and what struck all of us was something very simple, that people do not experience HIV, TB, malaria, maternal health, or cervical cancer as separate programs.
They experience one health system.
It's been said by several before me, the same person who comes to a clinic or is reached by a community health care worker may have needs that cuts across multiple conditions.
Ms of a community are not living in disease silos.
Those silos are largely an artifact a reflection of how programs and financing has been organized.
So the opportunity is not simply to introduce a new diagnostic technology, it's to redesign services around people's needs.
In many ways, this is not new.
For years, the HIV response has been demonstrating the value of integration, the need for integration.
Luchica said it.
We know TV is the biggest killer of people living with HIV.
We know that women living with HIV are six times more likely to experience or acquire an HPV infection and six times more likely to develop cervical cancer.
With advanced HIV disease, we see the need for diagnostics and care across multiple opportunistic infections.
Of course, elimination of vertical transmission will happen only with antenatal care that delivers care and services across HIV, syphilis, hepatitis, and chagas.
Integration can succeed when it builds on where people already seek care and when expansion doesn't dilute the strength of the focus disease programs.
What's different today is that we're seeing a very exciting period of innovation in diagnostics, new near point of care and multi disease testing platforms that have the potential to allow a frontline health care worker to screen for several conditions during a single clinical encounter, reducing misdiagnosis, reducing repeat visits and reducing loss to follow up.
But one of the lessons that we've learned and embraced at Unitate is that technology alone doesn't create integration.
What creates integration is clear thinking about a clear use case.
A use case, what does that mean? It means understanding where a product will be used, by whom, for which populations, who procures it, with which funds, and how it fits into existing care pathways and services.
That use case definition is what allows regulators to assess products, manufacturers to invest and remain engaged, countries to plan procurement and government and financing partners to support sustainable scale up.
That does bring me to the barriers, James, the biggest bottlenecks are often not technical.
Systems for generating evidence, developing guidance, planning procurement, financing scale up.
They're still often organized around individual disease programs and integrated products require a much more coordinated approach.
Manufacturers need that confidence that there will be sustained demand.
Countries need evidence that integrated approaches deliver value that saves time, works with current workflows, and increases health outcomes.
Procurement and supply systems really have to be able to support products to serve multiple programs rather than just one.
That's exactly why Unit is launching new investments to support integrated diagnostics.
Not because we believe that integration starts and ends with a new test or a new product, but because we believe that innovation can really help accelerate a broader shift towards people centered care.
So if we can define the right use cases, align evidence and guidance around them and create sustainable pathways to scale, there are technologies that can be powerful enablers of integrated services across HIV, TB, malaria, and beyond.
Thank you.
Thank you, Janet.
Let's move straight on to doctor Judith Nquesa Barso who's on the Kenya Medical Association and Commonwealth Medical Association.
Doctor, what would it take to equip, support, and retain the frontline workforce that makes this transition work and how can medical associations help safeguard quality of care for the most vulnerable? All right.
Thank you, James.
Your excellencies and distinguished guests, all protocols observed.
Thank you.
From a health care perspective, allow me to speak today from the perspective of the Commonwealth Medical Association and also representing the medical associations across the Commonwealth.
We all know that the Commonwealth is home to almost one third of the world's population and carries the disproportionate burden of infectious diseases, recurrent epidemics and pandemics, and also an increasing burden of climate related health emergencies.
Um Um, similarly, as well.
A lot of our countries still struggle with shortages, maldistribution, and migration of health care workers and the staff that are supposed to see these very technical diseases.
We cannot continue to ignore the dynamics of the health workforce, especially in such disproportionate countries.
One lesson is clear, integration is very much welcome, but the health system Um, whether it succeeds or fails is solely based on the strength of the health workforce.
What would we want to see as the healthcare workforce? We need to equip the staff.
We need to invest in evidence based health workforce planning and intelligence systems.
We need to train the health workers for an integrated team based community oriented primary health care, We need to build the competencies in digital health, epidemic preparedness and management of both TB, malaria, and HIV and of course with continuous professional development and leadership training.
What we see is that the workforce we trained for yesterday's challenges cannot meet tomorrow's health needs.
With integration, it has come with a lot of need and uncertainty, especially in the world health workforce, and so it is very paramount that we prioritize the healthcare worker Their well being and the mental health.
We need to ensure safe staffing levels and decent working conditions.
A lot of these countries, I will speak about Kenya.
I think the doctors the ratio is one to 7,000 patients, and so with integration that already poses a challenge to the health staff, we need to strengthen the leadership capacity of this health workforce because remember with integration, the areas affected the most is to the patients and also to the health workforce.
I think we've focused so much on how we are going to support the patients, but we tend to forget that there is a very key stakeholder who is the health care worker that needs to be in the table, needs to be in the discussions prior on how they're going to integrate the TB, HIV and malaria.
Remember with integration, out of the three diseases, TB is a very unique disease in the aspect of the health workforce because let me use an example of one size fits all type of patient care.
Please, let's remember that with TB, it is quite different.
So for the health workforce, we need to protect them.
During any public health emergencies, any outbreaks, we need to address the workplace safety.
Remember, TB is really, really, um, strengthened when it comes to IPC measures that are taken into care.
We all know that in most of these countries or most of our public facilities or private facilities in such countries are not really well designed or are not equipped to take care of IPC issues when it comes to some of these diseases.
We also need to take that into care and it will enable us to build a resilient health system and a resilient health workforce.
Finally, as I finish off, we also need to address the inequitable distribution of the health workforce and invest in fair recognition and incentives for this workforce.
How can the medical associations also come in? I believe that the associations advocate for greater investment of the human resources, safeguard the quality through professional standards and continued dedication and amplify the frontline voices in workforce policy and planning when it comes to the integration of these three diseases.
Thank you, and I will end there.
Thank you very much.
Finally, let's go to doctor America Win Rock, head of Strategic Investment and Impact Division at the Global Fund, the leading donor reshaping how it accompanies transition.
Whilst doctor Wine Rox is speaking there we invite Philippe Nagana from the movement of men against AIDS in Kenya to join us up here.
You are here.
You preempted me.
Okay.
Let's go first to doctor M Win Rock and Philip will provide us with some closing reflections.
Thank you, James.
The global fund has often been criticized for being too vertical.
You have to acknowledge that the vertical approach has worked, has achieved tremendous results.
Since the global fund was established in 2002, 70 million lives have been saved.
The HIV related mortality went down 82% and overall mortality related to HIV to be a malaria went down 63%.
It also has delivered results beyond HGVTB a malaria.
We've seen that the investments to fight HIVTB and malaria have played a critical role in dealing with other infectious diseases, including COVID 19 epox and recently ebola again and it has resulted in overall system strengthening with lowering child and maternal mortality as a result.
So for funds have served an important purpose, but times have changed and we need to change.
Programs at country level have matured, as we've heard from all our country speakers.
Countries have a real wish to have greater country ownership and rightly so, and to move towards greater self reliance and less dependency on external funding.
And we have to be realistic.
There is less funding, we have to make sure that we use the available funding the best we can.
Then if you look at where we want to be in five or ten years time, I really would like to see that the control of HIVTB and Malaria is largely funded through domestic resources and external funding is less and really catalytic and focused on those elements that national governments can't or won't fund yet.
And then integration into primary health care is a very logical step forward.
Many countries, and we heard from all of the country speakers today are already moving that direction.
So for the global fund, it's really about looking what we can do better and differently to support countries to do that.
So for the Grand Cycle eight, the integration in primary health care is a key strategic shift.
And we have aligned all our tools to make it easier for countries, including some greater flexibilities for a subset of countries to decide how they want to spend the funding across diseases.
There's an important link strategic shift, which is the community systems strengthening of financing.
It's important the the high level of dependency of community systems on external funding has been a major risk and a major vulnerability.
It's important that those community systems are better linked to the formal health system, but also that increasingly those services are funded from domestic resources, moving towards social contracting, which a number of countries I heard are doing as they submit a proposal for TCA make sure that everyone has access, we need to address stigma and discrimination and make sure that access for those who are most vulnerable remains intact.
We will be working with countries to consolidate implementation arrangements so that the program management cost can be reduced and more money will be available for implementation.
In most countries, it means working more with Ministries of Health and funding true national systems and on budget, there'll be default wherever that's possible.
And we are also working more closely with partners, including Gavi, the World Bank, global financing facility, and key bilateral donors to optimize all the available resources for maximum impact and align with national country plans.
And ultimately, what we really want to achieve is to deliver better coverage of people centered services at lower cost and on a more sustainable footing.
Thank you.
Thanks.
Let's go now because we need to leave this room very shortly and everyone needs to get back to the General Assembly Hall.
Philippe Nakano is from the movement of men against AIDS.
Philip can help us to ground sustainability in the realities of community.
Philip, we're going to give you some time for the closing reflection, and I know that Winnie Bniemo would like to say a word at the end as well.
Thank you.
Thank you very much, Chair of the session, colleagues, those who have spoken before me.
I'm Philippe aka and I want to take this opportunity to speak as someone who has felt the impact of the three diseases and someone also has been at the center of the response in terms of community engagement and involvement across the TB, HIV and malaria in Kenya.
I come from Kenya.
In my reflection, I will be sharing at the same time asking some questions and allow my questions whether they come out of ignorance or not.
Because wherever we have the integration conversations, even currently in the GC eight, which is ongoing and I keep on asking questions that why are we talking of the integration now? Most of the time the answer is because global fund it's a requirement for GC eight implementation.
Then the question is, whose agenda are we implementing? Integration is whose agenda? Is it a do agenda? Is it country agenda, or is it a global agenda? These are issues that we may need answers around them as we go on with our integration agenda and that comes with a definition.
Again, if you ask people, what is your definition? If you close our eyes in this room and ask each one of us the definition of integration, we may end up having different answers for integration.
Then Why? There's something which is missing in our integration conversation.
The missing point is the framework.
Do we have an integration framework at the global level that can be cascaded to respond to the country needs? I think we need to have a conversation by looking at the framework that we have at the global level.
I hear people speak here and people talk about nice things, communities at the center, civil societies at the center, which part of the center are they? Are they at the front center, the back center, or the center of the center? Because those are some questions and some issues that we must ask because they define how we engage.
But the question again is, if we are at the center, what community engagement framework are we using that has the indicators that we can come and ask ourselves that our communities are at the center, and if we can measure those indicators, you can see out of ten we are at eight because we cannot have an engagement without the oversight.
We cannot have the engagement without the parameters, the indicators.
Which are our integration indicators that we can say one year down the line, two years down the line, in terms of maybe resource mobilization, this is where we are.
In terms of community engagement, this is where we are and therefore, we are on the right track.
So if we don't have that, then we risk operating like a marketplace where you come and everybody sell the way they want.
But we all see we are doing integration.
Our integration is based on what? That is a question that we may need to ask ourselves.
Most of the times, we say that in this integration, who is taking the leadership? Is it your needs? Is it rollback malaria? I can see Wen is nodding, shaking his head.
So who is taking the leadership of integration agenda? Because that must be asked and that must trickle down from bottom or up to bottom or bottom to up.
We must also know that who is leading this conversation and how do we fit in all of us as we move.
That comes with the resources.
I think I've been reminded that time is not on our side, but listening to our integration conversation, we put a lot of emphasis on systems, the system integration, operational efficiencies, and things with very little emphasis on human rights and gender.
We risk if we don't address some of those issues, and if you have integration that focuses only on system without addressing structural realities, then we risk reproducing the same inequalities within the new health architect.
How do we address human rights issues as we have conversations around integration? Otherwise, we might move there because resources are not there, but by the end of it, we have created more damage good.
How do we integrate human right? If we rightly put people, we need to have communities, we need to have civil societies at different levels of this conversation at the global, at the country level, and at the community level, where we draw their experiences, we draw their lessons learned, we listen to them.
But finally, integration is not 100 meters sprint.
It is a marathon.
Thank you.
That's why we must have a way of checking our processes and how they address and respond to the needs of the communities.
Thank you so much.
Thank you so much, Philip.
As everyone is a Moving in for the 3:00 P.M.
Session and to be fair to them, I'm going to wrap up over here and ask Winnie Bano to close.
So thank you to everybody as we make our way out and thank you to Winnie.
Good.
Thank you very much for excellent moderation and for our panelists for your insights.
It's very clear.
The question was put by the Kenyan delegate that what is integration? For me, it's clear from what I've heard.
It's really the pathway that a country chooses towards achieving its health sovereignty.
It's a political direction, it's a political agenda.
Our role, all of us are there to support governments to achieve that.
How we calculate our role and play it is very important in the support we provide.
We have also seen that integration takes us out of the health sector to finding solutions in so many other places.
We've heard about procurement systems and how to change those so that there is cost efficiencies realized.
We've heard about, local production of medicines.
This takes us the whole debate on both procurement, but also on transfer of technology.
We see that there are many areas of work to support integration.
D gave us a technical agenda of things to do for integration.
Very good.
But we know that it's more than those technical aspects.
It's a lot of other areas outside the health sector.
I want to thank everybody who, lastly, that because it's a very political process, it's so important for us to engage with regional organizations that are supporting their countries towards health sovereignty.
The Africa CDC, in the case of Africa is very important in shaping these journeys towards health sovereignty.
As we conclude, I want to thank our partners a Rob malaria, stop TB, and all the others whom we've worked together for this session.
Integration is really an issue we must continue this conversation on.
As Lucica said, we're spending so much time discussing global health architecture reform, which is just about ourselves and how we organize ourselves.
We could spend more time reflecting on how best to support countries to achieve their health sovereignty through integration.
Thank you so much.