 Global Health Watch is one of the main global programs of the People's Health Movement and it's about putting together the knowledge from the movement about clinical health issues and health struggles in the world into a publication. It's a collective work of many, many people in different countries. This edition, we called it in the shadow of the pandemic. It's the sixth edition and as soon as we started working on it the global pandemic happened in the world. So we had to take this into account both in the fact that people were dealing with very complex situations on the ground and also in our analysis because the pandemic in a way amplified many of the qualities that we would then talk about in the book. So the book has finally been published and we're very happy to release it and it's been written by over 100 contributors from different parts of the world over 25 countries and all voluntary contributors and as its predecessors we've divided into sections. So we have the first section dealing with the global political economic architecture and analyzing the implications for health of the current system. We have a section on health systems and how privatization and different dynamics happening and limiting access to decent health care for everybody. We have a section on the social determinants or determination of health with focus on aspects such as environment, ecosystem, but also war and conflicts and then we have a section that watches how global governance institutions exercise their often undue power shaping health opportunities for people. We think that this collective work speaks of our struggles and also speaks to our struggles so we really hope that it can in a way be a platform for people to know what health activists and activists for social justice are doing and so to basically recognize each other and also build alliances but also we hope that the analysis in the book can inform and strengthen our struggles for a healthier and more sustainable future. So the chapter I'm going to share a bit about is about the COVID-19 pandemic and health care privatization. And here our starting point was that we could already see so much evidence that's anecdotal evidence that the privatization of health systems had affected the preparedness of health care systems around the world and that was undermining the ability to timely and effectively control the pandemic and manage the health and social consequences but we wanted to gather more evidence to have more solid information that we could share and systematize. And in that process we also wanted to see how those process were also seeing the emergence of new trends of specific forms of roles that the private sector was taking in the health care sector. So we looked at different parts of the health care sector. We started looking at public health services and functions and both the privatization that before the pandemic and then the trends of privatization during the pandemic. And in this sector we really saw that over the last years 25 years or so the basic public health functions have been gradually eroded in high income countries, in middle income countries, in low income countries because the government was not prioritizing that area. It's not seen as an area that provides for resources. So it was kind of left for itself. So testing, tracing, data management, even communications functions were not covered adequately by the public sector. And as the pandemic came many of them were outsourced to the private profit corporations. Communication functions were not and were really left for no one to take care of them. And I think we've seen a lot of the implications of that when vaccines came around where people in communities felt they didn't have the information that they required. Lack of trust with the public health system made that you have hesitancy in, for instance, going for the public health advices that were there or so, for instance, for vaccines. But in other areas such as testing or contract tracing really it was outsourced to the private sector. Testing was mostly a private individual responsibility. If you want to get tested, you go yourself. It's not part of a public health strategy really. And that also means that the out-of-pocket payments are important or sometimes health insurance would cover it, but it's not part of a public health strategy in itself. In contract tracing, it was again very often contracted out to private providers or in partnership with private providers. And what this also allowed is to have an amount of data that needed to be analyzed and managed that was just falling into the hands of the private sector. And there were a few cases where that led to controversial situations and serious concerns, for instance, with the company Palantir that was working in the UK and in Greece and where the Greek government terminated the contract due to concerns on the privacy of the data that was collected and opposition that was raised. So these are new elements of this question of who holds the data and the amount of health data that is available. Those trends are really increased a lot during the pandemic. I will be presenting or speaking about the chapter 1B, which is on universal health coverage and the primary healthcare divide. And as we all know, I mean UHC or universal health coverage has become one of the major health strategies in the mainstream policy and health dialogue which is being pursued by global health actors and by countries. And it's discourses driven by organizations such as the World Health Organization and the World Bank and other global institutions. So the genesis of universal health coverage was already discussed in the previous global health watches. And the analysis in the previous reports basically highlighted the difference between what is meant by universal health coverage and the difference between that and comprehensive primary healthcare. And so just to remind ourselves when you talk about comprehensive primary healthcare as written and espoused in the Almata Declaration, it spoke about preventive, promotive, rehabilitative healthcare with a prominent role for community participation, community health workers and also a role for governments to be responsible to provide these services. In contrast, the UHC policy approach focuses simply on financial protection and argues explicitly for public but single-payer financing but not necessarily a public provisioning of health services. And so in a sense, the UHC discourse, especially the dominant UHC discourse seems to be favoring market based on neoliberal reforms. So the chapter basically tracks, traces the development, the policy developments within UHC during the period 2015 and 2020 and reflects on the implementation and driving the global health agenda. It also sort of touches on the pandemic because as we were finishing writing the chapter, we were into the pandemic and we also we've discussed what learnings or what priorities in terms of financing put the pandemic sort of bring forward. And then it is the chapter assesses in more detail how UHC as a concept is being implemented especially in lower and middle income countries and it does it in a critical approach in a critical manner because there is a problematic approach in the way UHC is implemented with a focus on purchasing of services from the private sector through health insurance schemes or other kinds of public-private partnerships in which the public, I mean the money is public but the provider is from the private sector. And then we go on and just to just to add that you know this chapter so the co-author I mean and the other contributors of the chapter was Remco van der Pas and also and we took from a lot of the documents of various networks which are involved within PHM and the health systems thematic circle. So we tracked some of the major developments for example the UN high level meeting on UHC that happened in 2009. We also highlight how within UHC policies the health workforce you know is not I mean is taken as given and the UHC policies basically focus on financing without at all looking at the way health systems need to be strengthened with you know the health workforce as a core you know component of that. So we find you know and we go on to give examples in terms of the implementation of UHC the universal health coverage model in strategic purchasing through publicly funded health insurance schemes in which we see that you know this new wave of insurance schemes under universal health coverage which is mainly being implemented in countries of the global south are very different from the way social protection or social solidarity has been visualized in you know high income countries. So in so this new wave of insurance schemes you know basically the rational is to reduce financial burden through efficiency quality competition between providers and you know giving a choice to people so really using a lot of the neoliberal language and concepts in order to promote these schemes and there is an explicit objective of favoring the private sector and the commercial health sector in the objectives of such schemes and it is also you know the implementation is supported by a lot of the global actors for instance the Gates Foundation philanthropic capitalists such as them and you know the World Bank, the ADB and many other you know such agencies which focus on developing capacities for strategic purchasing of services from the private sector and when we see especially I mean we give some examples of countries such as India, Indonesia, Philippines, Morocco, Kenya in which we find that you know the failure of such publicly funded health insurance schemes in low and middle income countries is mainly seen in the dominant model of purchasing clinical care from the for private sector and we find that and we discuss how private provisioning of healthcare really destroys any advantages of public financing of healthcare and how coverage in Asian countries especially we find there is coverage through insurance schemes which has been increasing however it does not result in financial protection, it does not you know result in equitable access to health services in fact there have been patterns of unnecessary you know surgeries such as hysterectomies and caesarean sections which have happened and which women have been subject to as you know because the private hospitals want to make money out of these insurance scheme and so insurance as a mode of financing and incentivizing hasn't really worked in the public sector and it has actually exacerbated the problems that people face in the for private sector and as a result of this funding going to private sector for instance in India the insurance the national health insurance scheme that we have more than 75% of that money goes to the for profit private sector and that means you know less and less money is available for investment into the public sector which in fact you know caters to the most valuable and marginalized communities it caters more to indigenous communities to families living in rural areas and other marginalized groups