 Gretings, everyone, and welcome to this session on the economics of women's health. And thank you to the WEF for making this a mainstream session at the World Economic Forum. It's held, of course, in the context of the WEF's Women's Health Initiative, and that initiative was launched with the aim of obviously contributing to the health and well-being of the world's 3.9 billion women and girls. Now, it seems that we cannot state too often the case for investment in the health of women and girls. All the evidence tells us that obviously not only is it a good thing in its own right for women and girls, but it contributes to the overall economic performance of countries, families, that healthier women are part of more successful, more educated, more productive societies, that families with improved reproductive and maternal health are families which can report higher earnings in the longer run, that every dollar we spend on family planning services, and Nathalia, no doubt, would talk more about this, because it just has so many return benefits in many ways for health and economies. So, all up, it's a good thing, but why isn't there more of it than the question that immediately follows, and I guess those are some of the issues we want to explore with our panel today. Let's also acknowledge what an appalling setback COVID has been for the health and well-being of women and girls, particularly in loss of access during lockdowns in many countries to reproductive and sexual health services, but also the many millions of girls that we're told will never go back to school after the lockdowns because of impoverishment of families, the domestic violence that came from it, the list is long. So we've got setbacks and we've got big challenges with the sustainable development goals and gender equality. So, if we find wisdom of our panel today, we can go away with some insights and ideas as to how things can be speeded along. So, wonderful panel. I have right next to me the Minister of Women and Child Development of India. Next to the Minister is Kevin Ali, Chief Executive Officer and Member of the Board of Organon. Then, next to Kevin, Nathalia Karnem of the UN Population Fund, Executive Director. And way along the end, almost out of sight, but definitely not out of mind, is Mark Sisman, Chief Executive Officer of the Bill and Melinda Gates Foundation and let's acknowledge what tremendous support as the Gates Foundation has been of investing in women and girls. So, Minister, can we start with you? We need to have high-level political engagement in order to create a healthier, gender equitable and child-centred world. Tell us from your perspective why you think investing in women and girl child development should be such a priority. I think that if we lead from example and expressions of many a policy interventions in India with respect to health per se, there are a few takeaways from that experience. One of the largest and one of the most expansive healthcare programmes in India is currently under way called the Ayushman Bharat Yojana, which covers 100 million families from marginalised communities, from low-income group communities. They encompass close to services in 26,000 hospitals across the country where the government gives free support for medical support in over 1,300 diseases and at the same time, what it does is that it is transferable with a migration of people from one region to another geography. What it also does is, as it covers the huge expanse of the healthcare needs of those who are marginalised, it also brings to fore many achievements which have a societal impact or which have an impact with regards to some cultural narratives. I'll give you a very small example. People believed that in Indian society issues such as breast cancer, cancer of the cervix are not issues that will be popularly spoken of because women would be not as aggressive about their healthcare needs or for that matter in this segment not get the adequate support that they so desire. One of the outcomes of the health programme called Ayushman Bharat is that in the past one-one-and-a-half years there were over 130 million Indian women because of the support of this very programme have reached out to medical facilities across the country, gotten themselves scans for cancer of the cervix and cancer of the breast. After scanning, if they are in need of a medical intervention, have received that support from these medical institutions. Now this is a number which is unheard of especially in a segment of medication where people feel that they cannot be so culturally exposed. Which means that another interesting insight it throws up is that when women are enabled in terms of access and fiscal support there is not a single healthcare need that they will not address themselves. The other aspect which becomes a huge burden in terms of the financial aspects of any family unit is when you spend on pharmacology. And the Prime Minister was extremely keen to ensure that there is an available infrastructure in every district and every bloc of India which makes sure that any medicine that you need be it for cardiovascular diseases be it for diabetes be it even a stent it is available at prices which are affordable. Now that means when you enable a family to save on pharmacy needs that is an added plus to the family's income. Now in that matrix there is a special disposition for 40 female health related products. Let me give you a small example never in the history of my country from the ramparts of the Red Fort on Independence Day has any Prime Minister spoken of the availability of a sanitary pad for one rupee. That a male Prime Minister and with all my respects to the gender that I am speaking of could give India our first menstrual hygiene administrative protocol. So when we talk about how to put the gender agenda at the forefront of healthcare do we only take the refuge of let's say an insurance based programme like Ayushman Bharat? No. Where is the legislative need or gap that needs to be filled to complement our efforts for justice? For four decades in my country there was a bill pending legislative support which basically pronounced support through administration and medical communities for medical termination of pregnancy at 24 weeks. That it passed both houses of parliament without a whimper from any man or any political entity speaks volume about the maturity of the Indian populace and polity of sexual needs for women. That we have now enhanced maternity benefit for working women to up to 26 weeks is also something that we celebrate as women in my country. Apart from that I think that there is a conscious effort on behalf of the government to ensure that the whole life cycle needs of a woman's health is looked after by every government entity. For example, I lead the gender ministry in India. We run the world's largest nutrition program in the world. The Prime Minister started a flagship program which is an amalgam of 18 ministries in the government of India. It's never happened before. And we through our technology engagement service the needs and nutritional delivery at the doorsteps for 120 million Indian women and children below the age of six. It is a collaboration between citizens and government and it is a collaboration which has done us well especially in the pandemic. Ms Locke, with your permission given the time constraints, let me just expand beyond the relevance of let's say Aishman Bharat. Many a times we define health needs as the immediate health needs of a woman that needs to be addressed. There are evolutions in health needs especially given our labour markets especially given women in distress. So the Prime Minister led the establishment of emergency and crisis centres for women particularly in every district of my country. There are 703 such emergency crisis centres which are currently functional which were opened for business even during the global lockdown where we finance additionally 35 women's helplines and we have combined in our federal structure helped close to 220 million women in distress given them medical psychological and police help so that they can transition from challenges towards solutions. So if we look at the needs of women not only from let's say issues of cardiovascular diseases menstrual health but even mental health that is a huge prospect where we can see enhanced partnerships between the private sector and those who are policy makers. When you invest in the health of a woman you invest in the health of community because she is not singular to keeping or restraining that benefit to herself. When you empower her financially she tends to spend more on health and education. So let's look at health care from both perspectives not only from the infrastructural engagement but also when we fiscally empower women in other segments of society we give them more purchasing power in the health sector. Well thank you very much for putting all of those issues on the table and there's clearly very important elements of universal health coverage that you've talked about and also universal basic social protection as well and great to see the attention to the silent killers like breast cancer and cervical cancer and also the cause of menstrual hygiene which as we know is the lack of it keeps so many girls out of continuing with their schooling which is disastrous. So thank you so much for those insights. Kevin let's come to you as chief executive officer and member of the Organon Board gender equity and women's health are intrinsically entwined in the success of societies but we've seen women's health isn't always prioritised from your perspective why has progress been a bit slow and just make any comment you'd like to make about how you see this changing. Well thank you for the question. I would tell you that we could spend quite a bit of time just discussing that very topic and I'll try to be concise from the point of view of the biopharmaceutical sector which I am a leader of one of those companies in Organon. Look the sustainable development goals in terms of things like reduction and maternal mortality over the last 17 years it's the average of about 3 percentage points a year reduction when SDG you know basically says that it should be about 6 percent when we look at unintended pregnancy rates globally there about 50 percent 50 percent 5 out of every 10 pregnancies were unintended and so we all know that for many girls and many women that could basically lead them astray from being able to have their own development their own opportunities in life in terms of education opportunities to go after. Postpartum hemorrhage a woman dies every 3 minutes somewhere in the world from the complication of delivery which shouldn't be the case preterm labor there's about a million children a year that are born in a preterm labor state and the complications and the mortality and the morbidity associated with preterm labor not enough innovation has really actually been generated and focused on some of the things in terms of maternal care in terms of reproductive health for example unintended pregnancies in terms of a number of areas even I'll throw out fertility one would think that IVF therapies should be something that can solve some of the fertility needs around the world but when you look today even at the Asian Pacific countries and the Asian Pacific rim you need 2.1 in terms of per family in terms of reproducing the population in Korea it's .7 by the end of the century Korea will be half the size as it is today you can see some of the issues you read in the Wall Street Journal Natalia and I talked about this that China is actually about 1.5 China is having a population issue so all of that tells you that there's needed investment in the opportunities to bring innovation in that space and that's where the idea of organon was kind of born actually be a company that has many businesses but the direction of travel is really about investment in women's health to increase the investment in innovation if I give you a sobering statistic of the 37 products that were approved by the FDA last year only 3 were essentially targeting those conditions unique to women so there's much more that needs to be there now here's the good news the good news is there are green shoots of innovation across the world ranging from kind of the fast emerging area of femtech all the way to therapeutic advances as well we ourselves at organon have actually since the year and a half we've been live since we rang the bell at the New York Stock Exchange we've done 8 deals 2 in the medical device space 1 to solve the issues of postpartum hemorrhage 1 to solve the issue of some of the issues around any invasive hysterectomies all the way to new mechanisms of action for endometriosis preterm labour, polycystic ovary syndrome those are areas we're investing in because investment is the key now the reason there hasn't been investment over the years is very simple our industry the pharmaceutical industry is usually not gender focused they're agnostic of that they actually focus on the innovation in the R&D space whoever it actually supports but we feel their opportunities at organon to really invest in women's health not only reproductive health not only maternal health but in gynaecological conditions as well because the industry needs to see yes we believe this is a noble cause but is it a viable sustainable commercial enterprise and if commercially there are more and more innovations and more and more return on that investment then it will serve as almost a magnet it will magnetize the industry to start investing more in areas of women's health both distinctly women's health as well as those conditions uniquely or disproportionately actually impacting women everything from celiac disease to chronic cough to migraine to osteoporosis more needs to be done in the space that's the bottom line of innovation I think organon is being one that actually rings the bell that you can have a noble cause and sustainable viable commercial enterprise that ultimately can feed itself so it ultimately can go forward because any time we think of women's health as some sort of corporate social responsibility it will go up and it will go down depending on the time that we're in but if it's a viable commercial enterprise then it will be there for the long term Thank you Kevin Ryan, do you see green shoots? Are we going to overcome the barriers? I see green shoots precisely because women are no longer taking a backseat and as half the world's population the demands on the political system and I think we've had beautiful examples of transformation when women's needs are prioritized as well as the understanding that women themselves are stepping up to lead on these issues I think the examples that Kevin just put on the table for organon in terms of the wealth of possibility monetary wealth but also wealth in terms of health is wealth so from my perspective looking at certain barriers of why are women's needs not prioritized brings us back to this issue of making the case that evidence is not always enough so the transformation of the understanding of especially an adolescent girl of her human rights of her self-worth of her right to exist in a digital space of her right to not only lead but to consume products that are good for her and for her mental health these are the green shoots that not just the private sector but us as United Nations as public sector as regular citizens as fathers who support daughters we all have to embrace so it is disturbing that as we look across the spectrum of lack of priority COVID-19 told us everything we need to know about a health workforce that's almost three quarters female and midwives that UNFPA support were scrambling for raincoats of PPE-like barriers to be able to treat people in distress as has been alluded to the life cycle of women from pre-natal where nutrition is crucial and important all the way to older age and in a world of 8 billion many of us are aging but many women are voting with their feet when it comes to the size of their family I advocate of course for family planning and we've seen the wisdom by return of almost $10 for every dollar you invest in family planning and maternal health so the monetary case can be made but you also need to make the case for at a time when there is so much heterogeneity and different experiences in countries there are still 300 million women who want to access family planning that are knocking on the door of a clinic and nobody is there for universal health care as one of the key examples of sustainable development the woman who wants to limit her family size has to be catered to as well as the woman who is stigmatized because of infertility or frankly who is choosing not to have a first or second child because she can figure out the economics of trying to get a kid through school and college and the shoes and the books and everything else and that is the mission critical my last point is on geographic disparity and minister you alluded to this where you live you could be at the top of a hill in an island location your human right to health exists so looking at geography and innovation and some of the tech solutions that we can use to overcome those sound barriers but also just simple primary health care this is what is going to make a difference but listening to the voices of women who are saying this is what we need, this is what we want and we're not going to wait 100 years for the wage situation to equalize et cetera that's going to be the accelerator that we need thank you Natalia and of course in those years of waiting you're referring to it's the wefts own global gender gap the report which the figures for the year before the pandemic said 136 years to full gender equality then we have the horror year of 2020 reported on the 2021 report which said 136 years because that's how much things have regressed for women and then the latest one based on the 2021 data says 132 years so we're impatient aren't we we don't think that's an appropriate time to wait for full equality but the investments in this kind of area part of what's going to make the difference and that leads me to come to Mark Susan and say Mark from the perspective of the Gates Foundation what do you think of the most critical global health investments to be made now for women and girls so well thank you and thanks to the panel for already raising so many of the critical issues and actually where Helen started it remains as paradox even here we are at sort of Davos who's global prosperity at large where we know there is no single investment or set of investments beyond investing in the health education and agency of girls and women that has a better social and economic payoff full stop that's an uncontested fact but yet as a community whether it's from the Davos agendas to the foundation to the time frame of 132 vs 136 years it's as a world we are not remotely close to where we could or should be and so that does pull you into where and how are the investments that couldn't should be prioritized and shifted and at the Gates Foundation we've actually been to our own sort of learning where we've always prioritized health and women's health from our foundation in 2000 we've learned ourselves that we actually haven't always gone around it in a way that appropriately both listens to the needs of stakeholders brings in the communities targets particular opportunities need and you want to look at it across the spectrum so at one level one of the sets of investments exactly what the minister was just talking about in India and India has been a model in many ways of some of the things from the development of tools like development collectors that are able to collect the right agency that get you health and financial and economic and we think that is an incredibly important tool that can and should be spread in other parts of the world whether it's that linkage in on nutrition that we talked about because nutrition is such a critical enabler for both healthy pregnancies healthy birth prevention of morbidity and then providing those opportunities for later schools and access and more broadly the kind of medical interventions we talked about and this is how we've evolved our own thinking so for example there's both into the core research and development let's take an area where we are prioritising significant investment right now is there are treatments for anemia but investment in anemia which actually is one of the most fundamental challenges facing women and particularly women in pregnancy and the related effect now far, far short of what could and should be done so we are trying to pick areas like that where we think there are promising new interventions and new science that can be as priorities similarly in the area of nutrition the better understanding of the microbiome which there are lots of companies that are doing expanded research in to figure out how to do better weight loss but our research can focus specifically in what elements of treating the microbiome can actually be important in the antinatal and postnatal period for women and children and can you have again some transformative lessons we actually think the potential there is huge and so that's the kind of example of scientific areas where a foundation like ours can prioritize and target research and development is not naturally going there from private companies or others even though arguably it could or should be but we think could have a disproportionate effect but it's not just the development of the products it's also then the distribution pricing and access as Natalia was talking about some of that a sense of need say in family planning is how can you spread a different array of family planning products to make sure that women have full availability of choice there we've had partnerships including with UNFPA where you take some existing products which we know are of increasing popularity such as injectable contraceptives and what we would work with was a couple of private sector companies who didn't think there were markets in low and low and middle income countries and so we would arrange some deals in this case there will volume guarantees saying we think there is a market so if you have the price of your product we will guarantee as the Gates Foundation to make up if you don't actually make a profit at that price and reach your market they made a profit, they met their market twice as many women got access to the product as they would there are also ways in which you can produce or distribute the treatment or prioritize the treatment of new interventions we mentioned cervical cancer the HPV vaccine is a critical vaccine that has been developed and rolled out across much of the world and it's trying to, it's well short of what's needed is a major priority of Gavi providing you products including product research from some Indian and other companies around it at the Gates Foundation we were able to provide and do some research as a public good which showed the efficacy of a single dose of HPV is as much as the current thing of multiple doses that basically allows you to vaccinate twice as many children for the same amount of, again it's a study that anybody could or should have done potentially but it's an area where when you step in the gap in the public good that allows you to actually reach many more women so it's that combination of trying to identify both the key areas of research and development then the access of the products and then last but not least and maybe this can come back to that with the rest of the panel is that how do you then arrange the delivery of it through the public health systems through systems like India's significant networks and the Ayushman Barat Program through other tools because that's that last mile it actually has to reach the women and children that need to get access Yes and indeed a role of foundations I think to look for those niches which aren't being picked up necessarily by others and show what can and can be done so thank you for those insights. I'd like to bring out our audience in we've got a full room and the hands are going up already and we'll be gender equal and what we take so then you're first and you're next please introduce yourselves and maybe you want to wait for the microphone maybe stand up so people can see you as well Hello everyone I'm Sangu Delhi from Ghana and I'm a healthcare entrepreneur I run a tech-forward healthcare system with 65 hospitals and clinics across Africa and we have 7 million patients and we do this issue of women's health in particular on the African continent we're about 1.3 billion today we're about 15-60% of global population yet we're responsible for 25% of the global disease burden we only have 3% of global healthcare workers and 1% of global healthcare expenditure yet if you look at demographic projections by 2051 and 4 people globally will be African and the rest of the world's youth globally are going to be in Africa in fact more people are going to enter the workforce in Africa that year than the rest of the world combined so literally over the next 2 decades and change we expect over a billion babies to be born in Africa yet if we look at what's happening with our doctor to patient ratio and the chronic shortages that are starting to happen in the west every single day and the challenge I have in my hospitals are doctors and nurses being poached to go overseas yet we're the continent that needs these resources the most so pragmatically speaking what can we do to ensure that the continent that is going to be the world's future and is going to produce the future workforce will be able to have the right infrastructure and the right personnel for the future Natali, can I give you a go at that point well you've absolutely succinctly gotten to the heart of the matter which is equity and also the question of the future of the global world because Africa in a sense leads in the disease burden but also the innovation, the imagination and those young people who have to be equipped also come from Africa and Asia too will be part of the burgeoning population increase but the rights and choices of an individual girl but also of the nurse the doctor etc being buttressed at home makes so much more sense than trying to export them and or play the catch up so the wisdom of the African Minister of Finance health system universal health coverage system of building a workforce for example midwives who were trying to double the availability of midwifery looking at primary care but also making it more attractive for the workforce and many of them the preponderance of them being female is part of the solutions orientation that our panel represents today and I think that solution is coming from private sector actors who are the bulwark of the health system in Africa like everywhere else so the donated contraception that UNFPA provides is all very well and good but women are paying for services so thank you for the question and I think that really well summarizes the urgency of the types of innovation and social policy that we tried to put on the table Kristina so thank you can you hear me? I'm Kristina Lloyd and I'm the global leader of the fairings reproductive medicine maternal health portfolio and first of all I would like to thank all of you here and I'm really happy that fairing is a part of co-shamping this forums flagship this initiative which we're really proud of being here and I also would like to thank for joining us here and together and then you and UNFPA and Howard School of Public Health so that's fantastic so we are here in this coalition to try to work together and I think we are sitting here and everything we say should nobody say no we don't need that why don't we turn everything upside down we have to create a common narrative and this is also what we are doing and we are also creating a white paper based on data investments cases and we are trying to build business models that everyone can understand so and I would also like to say that listening to everyone here I'm going to call this an obstetrician myself I've actually been saving life during my days and then I was in healthcare with good equipment, medicine and everything so I do understand this is the purpose this is also what we as actually competitors are working together and this is the beauty of it I think so my question is back to the narrative that how can we do that to even more create this clarity of why it is a smart thing to invest in women's and girls health it's not about cost we are not talking about cost of healthcare we are talking about investment in healthcare this morning the same thing again so can you please tell me what could the narrative what could the story be to ministers of health and head of states and CEOs and so on so we can create a common narrative because we all have our stories and I'm so impressed listening to what you are doing so once again how can we create that and what could this question be and what can we ask them to do well I'm going to throw that question to the Minister of Women and Child Development of India because listening to you Minister I think there have been some very compelling arguments which have loosened the purse strings of the important things I think it's not about loosening the purse strings it is about spending what is in the purse mindfully there are two or three things that I would like to hear flag one is do we look at healthcare very myopically can there be a bigger narrative around women's health let me give you another Indian example the Prime Minister in 2014 when he took office spoke again very unusually about a very unglamorous subject which was can we build toilets for women now when he said that he spoke not only from a perspective of sanitation healthcare he spoke about it from an education point of view as Helen has said that there are many girls who drop out they are part of the menstrual cycle age in one year we built toilets in every government school in the country we curtailed dropouts however on a larger scale the government built 110 million individual household toilets now people would presume that there is a health benefit to it in 2013 there was a world bank report that because of lack of sanitation services there is a negative burden of 6% on Indian GDP so while he was addressing a gender justice issue he ended up addressing an economic issue but also a Lord Norda issue because there were reports out there in public that 40% of sexual violence took place when women went out to defecate so when we look at issues of women's health or women's dignity or justice there is a multiply effect when you try and reach one solution now apart from losing up the purse strings it is about partnerships so Mark is very eloquently spoken about what the Gates Foundation has done but what is significant about what he said is that they help fund the confidence that is needed to transition from failure to success to say that injectables will find a wider market till such time a partnership evolves from let's say a foundation like the Gates Foundation supporting industry impacting policy makers I think we need more and more players who will bridge that gap so apart from only looking at an initiative of women's health from the myopia of possible infrastructure or the myopia of only policy making it is us on this panel who are a part of the solution no individual entity in governance or the capital market or corporate infrastructure can be the answer alone I also feel that another myopia that we are inflicted by is when we talk about women's health we speak about women from a constituency of consumption how many of us are very focused on health innovators who are women who do frontier breakthrough work on research but do not know how to convert those innovations into enterprise because there are many entrepreneurial ventures innovations which are cost effective given the diversity of geographies which are culturally easier to ingest by many a countries when they evolve very organically from communities how much of our concentration from a health care perspective is even on those innovations lastly from a talent point of view I gentleman speak about the African challenge how do you address that challenge from an academic perspective we in India under the prime minister's leadership now have institutionalized health care education in every district of the country not only doctors paramedics, nursing communities those who are indulging in telemedicine it is a huge ecosystem that needs to evolve and find successive support across segments of policy making governance, civil society and corporates so if we start looking at the system as a whole we are addressing it as a coalition Mark spoke about in India a coalition of women who are entrepreneurial in nature 80 million of them they manage credit only within that segment of close to 30 to billion dollars every year they are available in every village in India they scale up and scale up on the supply chain from a crafts perspective agro processing perspective agents of change when it comes to health and when it comes to academics for women so how do we find new resources for communication with regards to women's health and lastly speaking as a mother of two kids what we do as women irrespective of our financial background we tend to put ourselves last when it comes to our pharmacological needs and diagnostic needs no matter who you are no matter where you are you do this as a woman your diagnostics needs are the last refuge in your healthcare framework so can we have more education and conversation around the diagnostic needs and the pharmacological needs because currently most of the conversation is about what do you do when you are in trouble how much are we investing or how much are we strategising with regards to preventive healthcare when it comes to women and young girls can I ask do we have Cynthia McCaffrey in the room yes Cynthia from UNICEF now take your questions Cynthia my name is Cynthia McCaffrey I work at UNICEF India and I actually have worked I feel like for four of you on stage because I've been at UNICEF for a long time so UNDP, Gates, UNFPA and now in India I work for the minister so so we're a partner but we're very proud to help implement the incredible very tangible initiatives that as you talked about Anjumandi frontline workers for example getting people trained my question is picking up on this point about women are beneficiaries but how to make them more of the shareholders and the decision makers around healthcare so that they're the real players when it comes to building this global health ecosystem let's start with Mark down the far end I can still see you it's a great set of questions and that is the fundamental issue there's no one set of interventions it's a whole scale of interventions from the models and examples that you do dress and bring in at a policy level with finance ministers and prime ministers who often don't have the same kind of leadership that the minister was talking about India need to be educated as to why and how this is so critically important and you can link in those economic issues it's about proving the products and the models so that you can show that that's true whether you're at a district level whether you're for the communities themselves for mothers to know if you're investing in this in the nutrition for your children or whatever it might be you're going to get these outcomes and then you've got the tools and things available for them but it's also about I started with that sense of a women's sense of agency and purpose and we know that that is still such a fundamental barrier for a whole range of those going well beyond healthcare but to take one example you refer to that by putting all of our health areas together our maternal child health areas into a wider gender equality team and we know that we've been doing this for a couple of years linking it to our women's economic empowerment it's allowed us for example to do work which we've been meaning to do for a while but they're not being completely silo-wised for adolescent girls and young women where you say for the agency for prevention for example we know that the highest incidence for HIV incidence remains 16 to 24 year old young girls and women particularly in sub-Saharan Africa it's not simply about schools it's a set of behaviors agencies understanding the motivation understanding the roots by which they might be able to access that kind of healthcare and that's true because it's that same group needing to access family planning products it's the same group we want to make sure staying in school and being educated it's the same group we want to be sure are perhaps joining some of those self-help groups as they come in more rural areas it's the same group who we hope are getting a ladder in a bank account for the agency and so on and so I think there's a short-term set of interventions around the specific things but there's also just a long-term connective tissue of building those connections and understanding that starts with basically providing power and agency to the women and girls themselves because that's the best way of demanding those outcomes and results time is always against us and we could get so much more from the panel and from the audience which we really don't have time for but I think we've had a wonderful mix of the practical examples from the Minister of what can be done Kevin loved your sort of can do, there's opportunities to innovate in this area UNFPA and Nathalia are always out there advocating making the case and actually delivering in real time to so many and Mark gates out there looking for the neglected areas and how to support women and girls in this area so some great takeaways I'm going to call on Shyam who's head of the health care practice here at the weft for his concluding comments Thank you Helen and as you said we are out of time so I'm going to be very quick here first of all thank you for moderating such an excellent panel discussion and we're so glad to hear from you Minister Irani from Kevin, CEO of Arganan from Nathalia UNFPA from Mark Suzman CEO of Foundation so you can see Gates Foundation so you can see you have the public sector private sector, United Nations and the charity for philanthropic organization here so bringing all this together listening to you that excites me that tells me that we are thinking about women's health we are going to do something about it this is an exciting time one thing I would like to just bring it to your attention especially to you Minister Irani and we were discussing this earlier today in a health care policy session we had two health ministers we had the health minister from Germany we had the health minister from India and we had a few finance ministers we had the ex prime minister of UK Tony Blair there in that session and it was very clear that now we are investing in health care we are talking about especially the finance ministers they were talking about health care as investment and not as a cost so this is really good to hear I want to hear the same thing for women's health that it is an investment and like our ex secretary general Kofi Annan UN Secretary General said investing in women is reducing poverty so that is very important and it's happening now so on the G20 side I know India is holding residency for G20 for this year we have been talking to Ministry of Health and Welfare I think it would be great for us all of us to lobby to highlight women's health as one of the health has ended up for G20 so that would be my request to you done and with that I know we are out of time so I would like to thank everyone for their support thank you