 Good day, everyone. My name is Harris Lizzy Duckies. I am the chief executive designate of the World Organization of Family Doctors, Wonka, and I would like to welcome you all in this fifth webinar on COVID-19. The topic of the webinar today is primary healthcare for universal health coverage. Before we start, however, I would like just to mention how you, the attendees, can interact with us. So on the bottom of your screen on Zoom, you will see two buttons. The first one is the chat where you can exchange messages that can be seen also from our panelists. And the second one is the Q&A where you can put your questions, and our colleagues who are monitoring the discussions will convey key points to the panelists during the discussion today. Our session will be also live streamed on Facebook, and we will be posting the recording on our YouTube channel later on. So without further ado, I would like to introduce our chief executive officer, Dr. Garth Manning. Thank you, Harris. And a very warm welcome, everyone, to this, the latest in the series of Wonka webinars. Today, the topic is PHC-UHC. Wonka has always been clear that you can't have UHC, universal health coverage, without PHC, primary healthcare, most especially with sustainable development goals, listing UHC as one key goal under SDG3. So this will be an interesting discussion. COVID-19 has thrown up many challenges for family doctors, and this week's webinar will look at those challenges faced to date, and how we can plan for increased preparedness into the future. Today's webinar will be moderated by our President-elect, Dr. Anna Stavdahl, and with inputs from our Wonka WHO liaison, Vivi Martinez Bianchi. We're also especially delighted to welcome two of our senior friends and colleagues from WHO HQ in Geneva. Dr. Benton Mickelson is director in the Department of Non-Communicable Diseases, whilst Dr. Ed Kelly is director of Integrated Health Services. You're both very welcome, and we're really grateful to you for giving up your Sunday afternoon to take part. But before I hand over to Anna Stavdahl, I'd like first to hand over to our Wonka President, Dr. Donald Lee, for his opening remarks. Thank you, Garth. Good day, good morning, good afternoon, good evening. Welcome to the fifth Wonka webinar. In the midst of the massively increased workload for family doctors, I'm proud of the level of support and collegiality displayed within and across our member organizations and from region to region. Family doctors all around the world are disseminating scientific advice, clinical updates, reflective messages, and professional support through their social media links and connections. The Wonka webinar is a platform for all of you to share experiences, relay information, and to keep in touch with each other regularly, like family members urging courage, offering mutual support in these extraordinary times. Next week. The Astana Declaration of 2018 and the achievement of Sustainable Development Goals 3 are of utmost importance in the pursuit of universal health coverage for every person everywhere. Family doctors provide quality primary care to millions of people globally. We recognize that effective timely primary care delivery is not only about the doctors. We value working in professional and competent multidisciplinary primary care teams to reach ever greater numbers and population groups. Next. Wonka signed the MOU with WHO in 2019, strengthening our collaboration with WHO at the central level and through technical and policy collaboration, and also at regional level and at country level. Next please. Harris, next please. Our member organization work with WHO country and regional colleagues on a wide range of issues in which family doctors and GPs have specialist expertise, which includes planning, delivering, accrediting, and monitoring primary care programs, as well as the establishment of and curriculum development for family medicine programs at undergraduate and postgraduate levels. Our expertise also includes system development to support effective primary care, health security, health emergencies, mental health, measurement and classification of primary care, environment, workers health, and disaster risk reduction. Tonight, our webinar on primary health care for universal health coverage will focus on the main success factors and the areas of improvement in the primary health care response to COVID-19, as well as ways to increase preparedness for the near future and the next global health crisis. So with this, I'll hand back to Garth, who has made some introduction of our expert panelists already. Garth, please. Thank you, Donald. And without further ado, I will now pass the baton on to Anna Stavdall and her team of experts. So it's over to you, Anna. Other relationship between WHO and Wonka. The dialogue between our two organizations contributes to integration between public health and primary care in order to reach our common goal of health for all. First slide, please. We have a shared goal with different approaches, reflecting our different mandates. Public health is population-based. Programs are primarily vertical, targeting specific populations or strata for populations due to specific conditions, diseases, risks, or social determinants. Programs are usually time-limited. Where there's primary care is horizontal in this nature and is, in general, person-centered, continuous, and comprehensive, not disease-oriented, and services are not time-limited. We deal with the whole spectrum of age, gender, and medical issues. Knowledge of local context enables the primary care worker to actively use the personal relationship to tailor services to the person and the family. Primary care services are delivered in the community. And that is where public health and primary care should meet and merge to one, the community. Primary care workers hold a golden position to advocate for public health strategies, it being immunization, family planning, antenatal care, hygiene, and nutrition, and implicitly risk assessment with regards to MCDs. Working in the field with the unselected patient population also provides us with an excellent position for reporting back to public health planners on how strategies actually play out on the ground. The vertical programs have a higher success rate if harnessed and advocated by the healthcare workers who enjoy people's trust. A few questions from my practice the last couple of months might be illustrative. Next slide, please. Do you think the measures taken by the health authorities are sensible, doctor? Or how can I behave in a safe way if I need to see my own mother now? She lives alone and her current health is deeply dependent on my visits. Do you believe it's safe to send my total back to kindergarten now the restrictions are lifted? Suddenly it's not dangerous anymore. How come? And not least, is it safe to come to your clinic? I understand I'm holding multiple risks, my diabetes, hypertension, and heart failure add up. In its simplicity these are examples of how people at large relate to public health issues in the context of their own health and their everyday work and family. I would say that the current pandemic works as a magnifying loss. It makes it more obvious where the population-based measures and the person-centered services must be balanced against each other. In actual fact, we are one and the same. We can't succeed without each other. We need the population strategy and we need a workforce to take care of people with and without COVID-19 conditions. Next slide, please. To maximize the outcome of the different approaches, we need to find common ground, analyzing the present in order to plan for the future. Short-term for this pandemic and long-term for the next global health crisis. As already introduced to you, we are so fortunate to have three panelists who have prepared their response to two questions. The first one, aiming at taking stock of the current situation. The second, addressing how we can improve, how we can increase preparedness. We will start with the first question and it's a pleasure to welcome Dr. Ed Kelly, he is Director of the WHO Department of Integrated Health Services. I would say that you're also a WHO focal point for Wonka. It gives us real pleasure now to welcome you and the screen is all yours for your first three minutes intervention. Thank you so much and also Donald Garth Harris everybody and thank you for welcoming me here and WHO and it's a pleasure to be with Bento with whom I'm working very our team is working very closely these days and also people said it in the chat but also a big thank you on behalf of WHO at least to the world's in quotes that is at home family doctor for almost all of us particularly in an period of isolation mothers around the world so happy Mother's Day to everybody. So I'll quickly just lay out a few points next slide that lay the grammar for where we are and Dr. Tedros has really talked about how the best defense that any country has and this is before the outbreak this is during Ebola this was during other times as well is a strong frontline healthcare system strong primary healthcare program of strong primary healthcare workforce and the essential health services that deliver that. Next slide please. The obviously there's huge stress posed by the number of patients with COVID there's lack of supplies and equipment and burden on healthcare workers but all of those same things that are happening in sort of the delivery system that's focused on COVID right now it's the same healthcare workers it's the same emergency rooms and certainly it's the same primary care centers around the world that are and family doctors that are managing both COVID and non-COVID patients so the disruption to essential services in basically every country in the world whether they've got 100 cases or a thousand or 10,000 cases has been very similar really to balance the demands of responding to COVID with strategic planning and coordinated action. Next slide it would not be a WHO where are we introduction if I didn't give you at least some picture of the global epidemic curve we have you can see when the beginning of that curve as Donald knows well when we thought things were just really dire was when things were in China and look where we've come so clearly some nations have taken the lessons from the countries that have responded well and some are struggling to you could the cases jumped up overnight in the 24 hours and I expect a bit more we tend to get the US numbers delayed over the weekend so tomorrow I think will be another jump in numbers and another jump in deaths. Next slide please. This gives you a bit of a picture of how if this kind of curve a steep rise and then a tapering off happens in your ideal normal quote unquote situation you've got in the western Pacific that happened with China but then came back in other countries it happened you've got a different shape in emerald where you have a steep rise that's flattened but flattened deaths are flat in Paha we've got an Afro we've got a rise that are a little bit off but you can see shapes of the curve are slightly different so we need to understand this better and certainly there's a lesson about solidarity that I'll come back to. Next slide please. The role of primary care is quite clear that we have a 70 to 85 percent of cases managed outside the hospital and there's a whole host of activities that really need to be done in order to ensure that effective of primary care can be carried on during this time. Next slide please but you know for us in terms of where we are we felt at WHO that we weren't in some sort of new picture of primary care and a new sort of layout really the role in terms of primary care is really to integrate this into the overall response adapt the roles and responsibilities to better respond to COVID and maintain this delivery of essential services and these I won't go through all of the details here but certainly spend a bit of time to look at how these actions need to be customized in your own setting in your own country. Clearly the structures of health systems around the world are have their specificities but there's commonalities across all disease programs and all of the particular areas of work and for us this where we are is perhaps it's a new wrinkle on the path we were on but it is still the path of primary health care at the heart of universal health coverage and it's just that it's been put more under the microscope because of COVID. Next slide please. This highlights the trap path we were on before in terms of looking at how access and quality of essential services the problem of COVID again has shown a light on both of those issues that access even more difficult now to services chronic care as well as acute care and the quality of those services given the inability to access key essential medicines because of supply chain interruptions or having the adequate protective equipment brings in stark quality about with the Lancet Commission and with work with Wonka Estana and others. Next slide please. We have a number of resources that I'll spend a bit of time going through later in terms of where the next role next slide please and a host of complimentary pieces that are core guidance elements of health service delivery both for COVID confirmed cases as well as people with all of the host of regular quote unquote disease burden that we have to manage. We have a particular flag right now on long-term care and the role between home care, primary care, hospitals, resident facilities and emergency rooms about tackling that issue better. Next slide please. The that I think gives us a picture of where we are in terms of WHO's work to date with some guidance that for the first time ever has put the response to essential services and primary care in particular at the heart of the response it's not a different sort of set of people or different activity. One of the pillars the last pillar of WHO's work in in the response is ensuring essential health services at the primary care level. So I think we finally got that the big machine cranked up and it's just whether we can keep moving. So I'll pause there and we'll come back to the question on what we could have done better later and I'm back to you. Thank you Ed. We go straight over to Bente and I'm sure we will get back to you with questions and comments. Thank you for a comprehensive presentation. Next one up, Sassier Bente-Mittiesen, WHO director of NCD's department. Congratulations on your new post. A hearty welcome to this webinar. We're looking forward to your presentation. Thank you very much Anna and all Vonka colleagues. I am super intrigued by being invited to this very important webinar. So and also exciting sort of context for the webinar and I think you have already started to sort of give us a sense of a build back better. One thing is what we sort of experienced just now but how can we learn and I really enjoy that perspective. So if I can get the next slide please. So I think this audience knows more than anybody else any other work health force in the world that people are dying mostly from non-communicable diseases both without pandemic situations and of course as you mentioned earlier Anna the pandemic is kind of an amplifier. So during the COVID-19 pandemic we have seen and then has also spoken to this that people living with NCD are more vulnerable to become severely ill with the virus and also to die from a comorbidity with COVID-19 and many of people living with NCD are not receiving appropriate treatment during the COVID-19 pandemic. As you can see on the right hand side of the slide this is sort of the graph that you know from before that we have approximately 70% of the deaths in the world accounting for NCDs and also of course NCDs is the four diseases that make people die too young before the age of 70. So of course as in this amplifying perspective prevention early diagnosis screening and appropriate treatment of NCDs and very much at the primary health care level to be able to really achieve UHC fully concur with everything said so far must be the cornerstone of any global post COVID response. So there is a lot of material out there and we have all the official web pages and you will also find more on NCD. Next slide please. So what we need to do today is really to strengthen governance to be sure that we include NCD and mental health in national COVID-19 preparedness and response plans. As you know every country is now planning they are drafting their plans and through our contacts to the regions we are not so sure that it's really also taking this into account. So that is very important and I think from your public health perspective this is also something you Wonka members can try to influence on. Then there is a need as Ed has already spoken to to monitor their access to and the continued to essential health services for NCD and we will be able to publish a survey that is now in the countries because we had very few numbers globally we have a lot of numbers from Italy, China and from sub regions and so on. We also need to review the evidence on modern transmission pathogenesis and disease associations to determine implication for NCD and mental health services and programs but also the conditions. As you have seen just before the weekend Peter Piot who was one of the those who found the Ebola virus had himself now a coronavirus disease and I think just reading his personal journey reminds us that even if you survive COVID you have a tendency to have a more complicated entity after COVID. So this is important we did disaggregate the data and we need to really understand what is the situation for people living with NCD as a mental health and as you are very sort of eager to see we need to have very clear community service and guidance to be able to continue essential health and community services. We have raised also the need to have clarity terminology and this is especially coming out of our civil society working group that we work very closely with because there has been a tendency to call it pre-existing conditions and many of the people living with mental health and NCDs doesn't really associate them with this kind of terminology. You were asking also for examples of success and what we can see anecdotally is that those countries that really have community based primary healthcare systems like in Sri Lanka and in Kerala state in India they have been better able to respond to COVID-19 and NCDs and you see the flow chart on the right hand side and this is really sort of telling exactly what was said by the president of Wonka that we need to really look at the frontline workers and it is important that you continue your gatekeeper function but also that there is a differentiation between COVID and non-COVID so the continuation of health services can continue. So a primary healthcare continues to support early diagnosis screening and appropriate treatment and also as was said give accessible public health information both to the patients itself but also I think back to the planning, the sort of the governance, the sub-regional, the national government on what can be done to really improve the situation. So I will come back with what is the new opportunities in the next session. Thank you very much. Thank you, Vente. I mean we're on time, believe it or not, and with so much information on the table already. Before we start the discussion, it's time for our own Vivi Martinez Bianchi. She's been the WHO liaison person for the last three and a half years and you have prepared a key message in response to the first question as well. The screen and floor is yours, Vivi. Thank you, Anna. Thank you everybody for this opportunity. Family medicine success in the fight against COVID-19 relies in the adaptability and flexibility of family physicians. The comprehensive and broad training of family doctors has allowed them to serve in any aspect of the health system and adapt to where they are needed. From ambulatory care clinics to emergency rooms, inpatient care, labor and delivery and intensive care settings, the world has seen family doctors stepping up and practicing at many levels during this pandemic. A problem is that even though primary healthcare should be at the front line in the fight against COVID-19, many countries put all the emphasis on hospital-centered models, often relegating primary healthcare to the margins when primary healthcare should have been at the forefront of a pandemic response. Many health systems close the doors of primary healthcare practices and repurpose primary healthcare workers to wherever they thought they were needed. Others sent everyone home and canceled important work these front-line workers could have been doing. Our member organizations stepped up with informative webinars to inform and train doctors how to care and manage the problem. Family doctors knew and know that their patients wanted to hear from them and needed continuity of care and adapted rapidly to telehealth, addressing the health needs of their patients through video and telephone visits to prevent or mitigate the collateral damage of isolation and lack of access for mental health services and the management of NCDs. Family doctors entered airways in radios, tv and facebook live to inform their communities about how to prepare for the pandemic. Some started working with municipalities as advisors or with health departments organizing contact tracing. Next slide. Family doctors and their teams set up drive-through COVID screening tests and ambulatory acute care COVID clinics. They continued vaccinating children and adults and providing care for non-communicable and communicable diseases to those patients who needed to be seen in person. They created hospital and home programs like the one picture in Peru with teams monitoring the health status of patients with COVID at their homes and others providing care for the elderly in extended care homes. Lack of enough testing supply is a problem. Lack of PPE and even hand sanitizer in the health centers is a serious problem for healthcare teams in many countries of the world in low income, middle income and high income countries alike. This is causing severe burden of disease and death for healthcare workers and other essential personnel who are not being provided the essential equipment they need. We need this equipment also in primary healthcare settings. I do not want to see any more of my friends and colleagues die from a preventable problem if they have had access to PPE. The pandemic has uncovered deep inequities in access to services, inability of full families to shelter and isolate and get appropriate food and even water. Inequities linked to social determinants of general viability and poor health. The bigger successes are not in deploying family physicians into the hospitals to support intensivist internist and surgeons, even though we are able to do that. As coronavirus spreads, the biggest and universal successes come from investing in the frontline with well-resourced primary healthcare teams working at the community level. Thank you. Thank you. We will now go into discussion. Before we start the discussion, I will introduce the rest of the webinar team today. We have three monitors with us. Shabir Mosa, he is the African regional president. He is monitoring the chat channel. We have the regional president of the East Mediterranean region, Jinan Usta, monitoring the question and answer channel. And we have Anna known as Parata, the young doctor representative on our executive to monitor the Facebook channel. So they will now channel to me, input and questions. And Shabir, I would like you to now get ready in a short while to pose a question from your part. While I kick off the discussion with this question, and it goes to all three of you. Because to me, that's not only in the pandemic, but it seems to start a default reaction to challenges in healthcare or other places. It seems to be to reinvent the wheel. Eagerness to establish new services when faced with a threat, instead of looking at what already exists or what we have we know can function and we have to build. So instead of adapting the existing services to the current needs, we are eager to event new ones. And that is the huge advantage, of course, of primary care. To adapt services to local needs. How to make sure that experience from the frontline in the current situation is channeled back to public health level, to plan for a better utilization in the next round. Now in this pandemic and the next one. So who will start? I would like all three panelists to reflect on this. Are you are you ready? Yeah, maybe you're you want to start? That's fine. I think I have this in my what to do next slides, but I really think there is a need for recognition of what primary healthcare brings in regards to knowledge. As frontline workers, as people who are connected with the community, we can start seeing trends before they become the big numbers. In my experience, I have known of outbreaks in factories, in plants where many patients are being diagnosed with COVID-19 five to seven days before it becomes the news. So we are the years, we are the hearts, we are the people who are connecting with communities who are coming to tell us what's going out there. So we have an opportunity to be connected more with the decision makers and those who are talking about what are the practices and laws and policies that should be put in place. There is a disconnect that for future pandemics, for the present pandemic, we should be connected and and be listened to and and if not advocate for our organizations, our members to actually be connected with the public health sector in the region, in the country, and also be able to share our expertise. Over to me. Yeah. Yeah, sorry, I couldn't the audio broke up just as you were assigning it. So it's conveniently hoping someone else come to know. Yeah, I think this it's a very important question and I think one of many lines of discussion that have happened across countries in this outbreak has been, you know, whenever something like this happens and countries find themselves flat footed in and many places sort of all of a sudden making these realizations of big, big gaps in where they were spending energy and time. Obviously, there were there were thoughts around around kind of the essential public health functions and universal health coverage and primary health care. And I think we should as Wonka and Davuto as organizations that exist just to support both of those kind of worldviews of public health and preparedness, but also, you know, essential services and move towards universal coverage. But there will definitely be a push from those who are wanting to return us to the disease focus, sort of unique focus on preparedness and IHR as if it's a zero sum game. And I think we have to be very careful. There was a there's been several discussions in the media around all these highly touted universal health coverage systems in Europe. And look, they fell apart, they weren't able to deal with it. They've been making the wrong investment. And it's not about UHC. It's around something else. And I think that we have to be very loud and clear that this it's not that we spent too much focus on primary health care and UHC. It's that we haven't spent enough that is one of the key lessons that's come from this outbreak that that the front line was not ready with all the supplies it had. It should have had its disposal to take to take this on. The functions still need to be there. I think we can submit to that take home message. Music in our ears anyways. Venta, let me hear your views. I think I'll start with just here and now as I mentioned in my in my sort of intervention in the beginning is that you can do something just now. Try to influence on the national preparedness plans that are actually just going on just now. Because I think there is a need to immediately sort of come out with all of the experiences, even if it's not summarized, evaluated and so on. It's ongoing. So that's that's sort of number one. Number two for me is very high level politically, but it's extremely important. And for non-communicable diseases, which is really cross cutting and not very disease specific in its nature. We had a breakthrough, I would say in a UN General Assembly in 2018, where we for the first time got really good commitments from heads of state and government linking together emergency and non-communicable diseases. And I'm saying this because we all know it's a huge divide in the politically funding-wise between humanitarian and development. So actually, Anna's and mine home country is the first country ever that have put non-communicable diseases into their development strategy. And this is sort of very high level political things. But for Wonka, I think you can be very vocal on these that we need to continue to really bridge between humanitarian and development, between emergency and chronic diseases and chronic conditions. So these are very important. So then the last point maybe just now is that I think many countries are not planning evaluation or their immediate response. And I think it's extremely important that we have people from all levels and all parts of the healthcare system involved in these evaluations. It's a tendency that there's very few nurses and midwives and family doctors. It's very often focused on the very, very high end experts on virology and so on. So I think this is also an extremely important thing. Lastly, of course, I couldn't agree more. I think what we are prioritizing now in WHO for non-communicable diseases is exactly UHD for MCD at primary healthcare level. That will be our focus for the coming year. So this is also, of course, a preparedness in itself. Thank you. Thank you. This confirms that we have common goals. We share the goals. Shabir, are you ready for a question to our panelists? Yes. I just want to share this, that lots of the people in the chat are actually echoing that sentiment that it's very easy for primary care to be marginalized as Muslim says in PhD being marginalized. Hospitals, I think it's echoing what's been said earlier. I mean, the question that came up quite at the outset, it was a comment made by Huda about what's going to happen about financing. Where are we going in the future with financing? WHO has put out things like primary healthcare needs to continue and yet the governments are not quite following that. It's actually very likely that financing will shift the same way with all the high tech care around hospitals. Is there any plan by WHO to address this financing of healthcare in generally and particularly primary healthcare? I think that's an utterly important issue with the USU. We'll give them a short rest before you are responding to this. Yeah, I'll then to add to this, but I mean for WHO, our main guidance around sort of finances in regards to COVID, actually our main guidance overall is that there are some important adjustments that need to be made to make frontline care delivery and actually community and outreach care. I'll come do it in my second slide. But otherwise, the world should not suddenly twist on a new COVID access. We need to keep the funding flows going for all of the work that we have there. We need to keep immunization programs going. Many, many more children will die of measles than will offend entire set of deaths worldwide on COVID. But the financing shift on high tech care, there is some recognition that in some member states that they have, that there has been almost all member states still spend tons of money at a tertiary level and much less at primary care and almost nothing at sort of public health and preventive services, etc. But there is some recognition within that financing that's gone to tertiary care that it has been very inequitably delivered and that you have big rural sections of your country that have very poor access to secondary hospitals or any hospital access. And I think it's an opportunity for examining that, but I think it's an opportunity for examining the sort of the integrated delivery of care across the continuum and looking at serving populations and panel populations with the full set of needs. And I think that that's been the strong message on financing. The only shift that we have made is to ask that countries just do away with user fees at the point of care to encourage proper care seeking for COVID and for other diseases. Ben, anything to ask? Yes, I think again, you know, it's all coming back to governance. So, I mean, the reality seen from non-communicable diseases is that if we have been able to prevent those before we had a COVID pandemic, we would probably would be better off. And this again comes back to funding because we know that this sort of problem, but within national, within countries, but also, of course, in the whole overseas development assistance is that the world's biggest killer is not funded and domestic funding is not necessarily going into chronic disease. So, this is again, you were talking about amplifying. And I think I would like to use that again, because, you know, this situation exactly amplify what we know is ongoing in peacetime. And we see it even more in this time. So, that's sort of one comment. The second one is that we can see that many donors know reprofile. They want us to re-profile as well the work we do. And the good thing is that several donors are now coming up with new funding and so on. And again, coming back to governance, I think that's where we need to be having also NCD and mental health and communicable diseases as well in the preparedness plan so they can actually benefit from these funding streams as well in this very specific COVID time. So, these are the two things. So, it's all about governance. It's about understanding what is needed. And then it's also to be especially vigilant, I would say, in these times. And the best way is to be reflecting what we think is necessary in the national, but also sub-regional, sub-national preparedness plans. Over. Thank you. Good reflections are these. And we will now close this part because this points ahead, doesn't it? So, now we'll go to the second question. If we can have a slide. Harris, and here we go. How can we plan for increased preparedness for the coming months and this pandemic as well as the next global health crisis? We have already, of course, touched on this. But we will have another round of short presentations from our excellent panelists. And we will go back to you, Ed. You will kick off this round as well. So, I'm sure Harris will find your slides. And we are ready for another three minutes. Good. Well, thanks again. And I think, you know, this question of what we could have done better. Anyway, I guess a few of you have heard maybe somewhere in the news that there might be those questions floating out there for WHO and also for many countries. Actually, one of the speeches that I live in France over the border and one of the speeches that I have enjoyed recently, I thought it was one of his better speeches in his entire presidency was the first speech that President Macron made. And he fully acknowledged that he, his task force and the government have not been perfect in this very unprecedented global health crisis. And I think that's fully understandable. The issue is trying to move as quickly to address those gaps and transparency about what the gaps are and how they can be fixed. I think is important at global level, but it's very important that national, even more important than national and local levels. But for WHO, I'll just highlight a few things and flag setting it up maybe for some of the work also for Bentay that and we have a full set of slides that will make available. I think I hope Harris and others can speak to this afterwards, speak to this afterwards too about how those will be available. But basically WHO's focus has really been on, you know, in a number of areas. So first, the research and development. We brought a group together in January that looked at the, at starting quickly on vaccine work, but not just vaccines on therapeutics and diagnostics and then on some of the very important lessons learned in a few of the chats have come up about what are we learning about what countries are doing at primary care level that are innovative and to be emulated. And we have a team that's working on gathering that. We're very happy to connect afterwards for those of you who like to work with us and take part in that lessons learned approach. Helping countries prepare and respond obviously is part of WHO's core work for its emergencies program. And this point that Bentay raises about to be involved around response plans, I think is very important. I think one of the lessons we learned early on is that the response planning was very, how should we put it at global level, but certainly national level, most countries were very close hold government, very high level of the government reporting to the president and very little involvement of civil society, sort of medical associations and others. And I think it's really time to try and crack into that, find out who's on that dashboard, talk to them, try and set up meetings to give perspectives from the front line. Those people in almost every country are spending 24 seven time in meeting rooms and on phones, which is great, but they need the perspective of the frontline workers about where the gaps are. And we can't expect them to shift policy if we don't tell them where we're doing we need to do better, according to the global response is one of our jobs. And we have a partner platform and I just want to flag on the national plans and the international approach. Like I said earlier, there are eight pillars that are related to preparedness and response lab work on laboratories work on infection prevention work on essential supplies, etc. And the ninth pillar is ensuring essential services. So it is part of the response itself. And it's a fundable area. And there are three main documents out there that are guiding that global response. First is the WHO strategic preparedness and response plan SPRP. The next the second version of it has just been released. There's also the global humanitarian response plan, which is a focus on 20 plus some FCB from fragile conflict affected and vulnerable states and those focus on those states and vulnerable populations. And the third is the framework for addressing the socioeconomic impact of COVID and that guidance document was launched two weeks ago last Monday, the secretary general met with all resident coordinators in all countries to discuss that. And the main the one link between all three of them is ensuring essential health services. So the whole primary care agenda is really the link between these big pieces. Those are all funding opportunities. There was nearly seven billion put forward for addressing the humanitarian response. There's even more for the for the UN framework in terms of an ask. So that's a big opportunity at country level to make a difference on that. Obviously, we need to do more work on essential medical products and communicating about how people can protect themselves. I think it's quite clear that what we didn't spend enough time on with countries and all was the whole community mobilization and involvement of civil society and on ensuring that there's a big push now on getting supplies and diagnostic tests. The secretary general has made available the UN's entire supplies work, which is the world food program UNICEF. It is a multi multi billion operation with multiple 747 jets flying around the world bringing supplies that we thought only about COVID and not thought enough about the PPE, for instance, the colleague from Nigeria flagging that needs to be also made available. So our at WHO level, WR has a clear message now that when they're thinking about all the supplies they need, they need to think about also personal protective equipment for COVID, etc. So next slide or sort of wrap up here. I think it's just really to come back to this issue that we had talked about that, you know, here is I was heartwarming to see it in the earlier slides. The vision that we had coming out of Astana, it is sort of if we hadn't already been taken, we could have used now more primary health care now more than ever, right in this particular phase of the work on the virus. But it's quite clear that the big challenge that will now face countries as they're shifting the how they're managing these public health measures as they're trying to, I just spoke to through the UN disaster and risk reduction platform framework to set up small businesses, businesses reopening, that has to happen. But it we need to think now, not just of physical distancing and hand-washing and these kinds of things only, but in how many cases we have, we need to think about how able we are in different countries for the primary care system to function normally as cases will rise. And for sure, nobody's really talking about this, but cases will definitely rise. You saw the western specific numbers there. And I think it brings home a last message that I'll close with on that is that the part of primary health care, which is solidarity. It's only one country, but it's being played out in many other countries. Singapore, which has a very strong help, many on the call know it better than I have, but a very strong health care system had reacted very robustly in terms of managing the outbreak, has good testing capacity and managed it quite well, had a re-outbreak, a second big second wave because of migrant workers who are sort of outside the health care system outside of the regular testing capacity and are their vulnerable population. So this will happen in every single country that unless we also target the vulnerable and come together in solidarity within the spirit of primary health care, it'll be a very long time before each and every country controls this. Thanks. No, I lost my pointer here. Yeah, here I am. Okay, Benta, over to you. Thank you. And thank you Ed for giving you the really big, big picture. So seeing from NCDs and you may recall I guess the reason why Wonka asked NCDs to come is because we are probably the kind of diseases that occupy most of your time as family doctors. So we think that NCDs can act as a kind of a spare head to really build the bridge between the national COVID-19 response and utilize the best buys, the way that we can prevent NCDs in this situation. So building the bridge with the primary health care and UHC as the foundation. And as I briefly mentioned in my reply to one of the questions as well, we see that there is a missing piece actually. We don't have UHC benefit packages defined for NCDs and not specifically on primary health care level. And we can see that there is fatigue because we have, as I said, best buys. We know what to do. We have a toolbox that countries know of. But since it is not sufficiently both sort of been defined but also integrated at primary health care, this is something we really want to provide. And of course raising the priority given to continuity of care of health services. And I have to say that one of the really good things that has happened at least in WHO during COVID is that we now are working together regardless of program diseases conditions. And we are looking at what does it take to give continuity of health care services. We will come out, as Ed said, with guidance on this. And I think this will really be something that is appreciated by the family doctors because it's meant to be very practical. So on that practical level, it's important. But it's also important that we continue to push for these things through the international agendas, including in the UNGAs and the World Health Assembly. As you know, the member states will be discussing COVID in the virtual World Health Assembly 73. Somebody mentioned funding and fundraising and also being sure that we are funding these kind of health systems to take care of the broad amount of patients. So of course reprogramming is very important, but maybe calling for new international funding patterns and revisit, I would say, the Addis Erbeba accord coming out in 2015 before the SDGs were agreed where domestic funding and financing was at the forefront with the countries at the steering wheel. I think this again shows that there is a need for doing this. It's also a need for building new partnership for NCDs. So from the NCD community, we see positive development when it comes to private public partnerships. But there is also a concern that we have an undue influence from tobacco and alcohol industry trying to define themselves as essential products in this very difficult situation. So then, of course, there is also new opportunities to implement double-acial guidance on resuming health services and activities for health and well-being. And there is definitely an opportunity to develop systematic approaches for digital healthcare solutions. We see that this is now happening extremely rapidly in, I think, at all levels of healthcare system. But there is also a need to really look carefully into this. So we are not, by accident, I would say, increasing the inequity and sort of accentuating the social determinants of health. We need to involve the ministries of health in the revision of the social economic and new environment policies and further investment for health. My last slide is just to inform you that we have specific working groups at three levels of WHO, so very importantly, representatives from, especially from regions speaking on behalf of the countries. And we have defined the eight most important things that we need to focus on. So, of course, an advocacy strategy to really be sure that we are speaking clearly about non-communicable diseases and also try to mitigate for all the false information out there, mobilize action to include the NCDN national preparedness and response plans, and then reinforce all the preventive care. Because I think it was Anna or somebody talking about public health in sort of the mix of the pandemic. I think we must not forget all the preventive care and all that needs to go into health and well-being. And it's maybe even more important than ever to have strong voices for this. Then we need to identify key epidemiological and research questions and also to identify innovative solutions. So that's what we are doing. We also try to add NCD specificity to efforts to maintaining essential health services. And we need to mobilize action for access to medicines. We try to map out where the big pain points are. We know that, for example, access to insulin is a problem, but also access to palliative care. And we work together with the whole organization to see where is the biggest need to respond. And then there are still a lot of questions, as I think was flagged from earlier interventions, on very specific things on cardiovascular diseases, on diabetes, of course, on cancer, on access to cancer therapy and so on. And this is at the core of WHO as well as a normative health agency. So through this working group, we work very closely with the civil society working group under something called Global Platform for NCD. And even more, maybe or not more important, but as important is also to work with the EU and interagency task force with 26 different UN agencies that feed into the same sort of eight priority tasks. So I will collect all the sort of inputs from this meeting as well and try to reinforce the actions that we are now developing in the response of COVID. So thank you. Thank you, Bente. Thank you to Ed and Bente. I mean, a lot of words and concepts here. We are happy to hear about and to work with you on a lot to respond to as well. But Vivi, you have your message to the second question now before we go to a discussion on some of many of these points which have been raised. So please. Thank you. Thank you. Increased preparedness requires investment in primary health care and in community resources. The next crisis, the present crisis needs primary health care, family medicine organizations to be invited to decision making and disaster response centers. Funding to strengthen primary health care and an increase in the number of family doctors and other members of the healthcare team trained so that every country is ready to provide the universal health coverage that is needed in COVID and non-COVID times. Planning for primary health care to be able to meet the needs of each country and territory. We need to really assess what is needed on the ground at the front line to be able to meet the needs of the population. Primary health care needs to be counted in humanitarian aid and global health planning and budgeting. Without primary health care the outcomes of this and future pandemics and disaster will be worse. Health justice demands affordable and equitable access to health care including testing and treatment for COVID-19 as well as accommodations and support for more routine but equally life-threatening physical mental and behavioral health needs. We need to look at things with a health equity lens. Family physician led primary health care teams with empowered patients understanding what is going on. Breaking silos and providing innovation in data and technology with data integration. In other words health information exchange between hospitals, primary health care, labs, practices and health departments. We have to have a better coordination to understand what is going on. Which are the hotspots in the community and how do we work together to make things better. We need adequate PPE for protection and testing supplies at the primary health care level so we can take it into the community to understand the true prevalence of disease in the community if we want to save more lives. We need regional, national and international collaboration and taking away the political diatribe and discourse out of this serious situation. Next slide. Multi-sector collaboration. Primary health care collaborating with public health and community state stakeholders to enhance COVID and future responses. When united we are stronger. The front line has many of us working together with other essential personnel and other people that are making this this is the life of many of us and many of other partner organizations and essential people who belong to multiple cultures and groups. A community spreading disease such as COVID-19 needs a community health response. Something that family doctors are well prepared to do. We have to work together at this front line to be able to make a big difference. Thank you. Thank you Vivi. We will now have a second round of discussion and I will invite you an anonymous Paralta, a young doctor representative, to present us with a question from the Facebook channel or from you and if you can also think about who you will address this question to because we only have time for one reply to or comment to the question. So hello everyone. So this will be difficult to address the question just for one person. It's been quite active in the Facebook group but I would like maybe to pinpoint some key messages in terms of how eventually the WHO could encourage the development of partners in less developed countries because how to implement comprehensive primary care mostly in this setting in the less developed countries as was shown before that has a very high mortality also when it comes to access to healthcare or not adequate healthcare as well. Maybe just and then adding a point on the best resource documents and references to describe primary care practices mainly in this COVID situation is to how we could find them. I think the first part of the question. Repeat it please because WHO was called for here. First call, first serve. The first question. Okay so the first question would be how can WHO encourage development of partners to focus on implementing comprehensive primary care in less developed countries and maybe which are the best resource documents in this time of the changing COVID situation in terms of primary care practices if I would summarize it in these two points. Before I go ahead I've got a very similar take perhaps I can add that and then you can answer both. In fact it's a very similar kind of feedback that came from the chat group as well where people felt that there's this marginalization of primary healthcare as was said and I think you noticed that and responded with the document as reference which I would just mention is the COVID-19 operational guidance for maintaining essential services during outbreak. Thank you for that. I had a quick look at it and in fact I have been meaning to look through it. One of the paragraphs in the first in the introduction talks of many routine and elective services may be postponed and suspended in addition you know and it goes on to talk about that but it's become almost a reason for many governments to shut down services and you know almost a knee-jerk panic reaction. Richard Bottello asked the question is there not a possibility for us as WHO and Wonka to consider in the same line that I think Anna has just raised now for us to consider joint exercise in actually spelling out a much clearer process in preserving both in in in addressing COVID but also to establish stronger health systems rather than shutting down as is implicit in this document. Okay Ed so you are challenged here um it will get even worse because you have one one minute yes very and I'd be very pleased to yeah the thing is that you can pick the part which you want to respond to so yeah yeah yeah usually at WHO that means that you pick the easiest part but anyway I think uh with thanks to Shabir for framing it there I think I mean firstly the the the guidance in terms of what it says definitely so does not say don't seek care for essential services it does not say shut down essential service delivery as a matter of fact it says this is going to be a core part of your response you will not be able to sustain the response to COVID unless you keep essential services running but you know people have heard also the message around around the physical distancing and the stay at home measure and it's become sort of like mixed in people's mind that people say well thought they told me to stay at home but am I supposed to go if I need my services and so we are working right now and that's really a like a risk communication effort as well as being a technical programmatic management and and strategic management of health services so we're working more even this week on on stronger messages for say for instance malaria endemic countries it is not okay for someone to stay home with a mild fever for a while and see if they develop COVID symptoms you need to be able to seek and access care um and unfortunately many countries that are in that situation also don't have great telemedicine options and sort of promote compensation options so that it is an issue that we're trying to address more we have three key guidance documents around that Ben mentioned earlier first is this one that I that I reference and actually that's the page where all of them sit the first is this program you know quick programmatic high level guidance for countries on what you should the key actions to take in terms of ensuring essential services the second is one that just came out last week then jointly with um and I'll paste it in the chat with UNICEF and IFRC on ensuring this the effective delivery of community based and outreach services so that's that's another important very very important and it goes through very specific disease areas and the third is a guidance that we're coming with now which will be delivered in about a week and a half it goes through disease area by disease area and population by population with the very specific adjustments to make to ensure the continuity of those services but I think that this whole idea just to close that I really think we have an opportunity on primary health care if you look just at WHO it is the first time this third guidance I mentioned the first time since my actually ever but definitely since I've been there and I've been there a bit of time where we have brought every disease program HIV, TB, malaria, the NCDs, neglected tropical diseases and all the population programs together for one guidance and it's because they realize that in this context uh it's this essential services around primary care and and also essential you know tertiary care services as well that um occasionally that that need that need to be taken in a whole uh way when I worked in South Africa years ago uh we're launching some new guidance for quality standards on primary care and hospitals and the the head of the disease program work uh came I was there with the WTO and said these are great standards but my my disease program people don't see themselves in it they are definitely seeing themselves in primary care now and I think that we have to um it's the great unifier and I think we should approach uh try and approach it that way and keep everybody on board. Fantastic this this was this was not Pente you will you will maybe be the the recipient of the last question I will allow to run five minutes over time because we have a third monitor. Jinan are you there? Yeah hi everyone actually the question is for me. Yeah okay uh it is about uh if you have any success stories about the uh collaboration between private and public sector in overcoming ncds especially in covid times. That's for you it's tailored to you Bente. So thank you very much and I think that fits very well with the second question that Ed didn't really respond so much to either and it was a question about how do double HL partner with other partners in low and income countries in in low in income settings and I just want to mention this that um Dr. Tedros has been very proactive so he did a double HL investment case he is setting up a double HL foundation we have a framework for how to work with uh non-state actors including primary sorry private sector so I think sort of if you look at double HL now and compare with five years ago we are really sort of able to partner but so many different organizations and I have seen this coming around now after Dr. Tedros took office we have uh MOUs with FIFA with the international food and beverage industry and so on and so forth and of course we can see that in this time of covid we have a lot of offers from the private sector so I think it's mostly coming through in the supply chain sort of pharmaceutical products but of course through the collaboration with CEPI also on development of vaccines so it's especially in this area but we have also a question in our survey if also the private sector health and the healthcare providers also are sort of offering new kind of things we can also see that in the digital health area there is a lot of private sector engagement I'm sure that Ed could speak to this we haven't we have had to set up actually mechanisms which is a positive thing on innovations on apps that are under production and so on and so forth because there is a need for a clearinghouse and all these positive development also have to be very carefully paired as I said initially with the same vigilant when it's come to conflict of interest management so we are not sort of crossing any red lines with all the kind of industry that have a negative influence on people's health but I think all in all we can see that it's all hands on deck we saw all kind of partners want to really partner and we are ready I would say with WHO because we now have the frameworks in place thank you thank you thank you both there are many clues here for us to come back to together I will not go into to the details now summing up I will have a slide on the screen please Haris and I think I'm even more sure now than when we started this webinar that we can submit to Richard Horton editor-in-chief of the Lancet and also an expert of global health and let him sum up what we have I mean basically said the pandemic is an issue of global health security there is no global health security without individual security and what is individual security it means strong primary care strong primary care is an absolute prerequisite to defend us against this pandemic and future pandemics it is the first line of defense thank you so much especially to our guests to Vivi as well who have prepared presentations I am personally looking forward to to work with you in the years to to come on behalf and with Wonka colleagues I now hand over to Donald for your concluding remarks thank you thank you Anna and thank you panelists before I make my some concluding remarks like to do some advertising is that next Sunday we will be talking about rural practice but first of all note the time it's at 10 UTC instead of noontime so that's three hours earlier so please tune in next Sunday but at an earlier time next slide Haris next slide so the webinar will enable rural doctors to describe how they are preparing for protecting against and dealing with COVID the session will allow sharing of initiatives limitations and concerns and explore how rural health systems prepare for the future in the COVID era so please join us if you're interested and have time so next slide please thank you again panelists for offering so much information resources and discussions I would like to share some thoughts about the way forward from aspiration to reality three points I just want to make the first is we need to continue to develop congruent conceptualization of primary health care through policy so what does that mean inclusiveness everybody involved national policies there is always a concern of selective primary care where we are actually maybe focused on specific interventions on vertical disease programs instead of overall a concept so likewise indicators and measuring programs we need to look at it from this angle I think our panelists have shared a lot of insight into this a lot of discussion advocacy and also inclusiveness and I like you know some of the speakers always use all all all I I think that's very important likewise the second point is the capacity building a primary health care teams there's concerns of selective team members but we are a team as I said at the beginning it's a primary health care team and in the past there has been a lot of discussion whether community health workers are enough sufficient or maybe from Wonka we always just talk about family doctors but actually not so we believe in the team so again this capacity building should be the whole team and lastly which has been touched upon which I won't go into too much finance and resource allocation of course some of you may know but most would have forgotten there's something called 20 by 2015 advocated by Wonka earlier you know many years ago asking that health budgets of you know individual countries should devote 20 percent of the health budget to primary horizontal primary health care programs and now we're working on a paper with John the messineer of gone university 30 by 2030 so that's something that we will present so next slide so to conclude as ever we are the first in last out professional group serving our patients as best as we can so do the best you can for your patients you should stand proud of your contribution to tackling this world crisis next week no one knows what we will face in the weeks and months ahead but everyone knows enough to understand that COVID-19 will test our capacities to be kind and generous and to see beyond ourselves and our own interests our task now is to bring the best of who we are and what we do to a world that is more complex and more confused than any of us would like it to be so maybe we all proceed with wisdom and grace thank you very much God thank you thank you very much Donald and thank you to all the panelists we really really appreciate it a lot of very good feedback on the chat on the chat screen as Donald has said join us next week for an absorbing webinar on the rural issues in the time of COVID-19 it'll be led by Bruce Chater chair of our working party on rural practice with panelists from various parts of the globe and including Professor Michael Kidd former president of Wonka and now principal medical advisor and deputy chief medical officer for the Australian Department of Health and as Donald says that the webinar next week is at 100 GMT or UTC so please note the earlier time and I hope very much you'll join us again so thanks again to the panelists and but for now everybody you know have a good day and stay safe look forward to seeing you next week thanks a lot thank you very much thank you very much