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Half the world lacks access to essential health services

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At least half of the world’s population cannot obtain essential health services, according to a new report from the World Bank and the World Health Organization. And each year, large numbers of households are being pushed into poverty because they must pay for health care out of their own pockets.

Currently, 800 million people spend at least 10 percent of their household budgets on health expenses for themselves, a sick child or other family member. For almost 100 million people these expenses are high enough to push them into extreme poverty, forcing them to survive on just $1.90 or less a day. The findings, released today in Tracking Universal Health Coverage: 2017 Global Monitoring Report, have been simultaneously published in Lancet Global Health.

“It is completely unacceptable that half the world still lacks coverage for the most essential health services,” said Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “And it is unnecessary. A solution exists: universal health coverage (UHC) allows everyone to obtain the health services they need, when and where they need them, without facing financial hardship.”

“The report makes clear that if we are serious – not just about better health outcomes, but also about ending poverty – we must urgently scale up our efforts on universal health coverage,” said World Bank Group President Dr. Jim Yong Kim. “Investments in health, and more generally investments in people, are critical to build human capital and enable sustainable and inclusive economic growth. But the system is broken: we need a fundamental shift in the way we mobilize resources for health and human capital, especially at the country level. We are working on many fronts to help countries spend more and more effectively on people, and increase their progress towards universal health coverage.”  

There is some good news: The report shows that the 21st century has seen an increase in the number of people able to obtain some key health services, such as immunization and family planning, as well as antiretroviral treatment for HIV and insecticide-treated bed nets to prevent malaria. In addition, fewer people are now being tipped into extreme poverty than at the turn of the century.

Progress, however, is very uneven.

There are wide gaps in the availability of services in Sub-Saharan Africa and Southern Asia. In other regions, basic health care services such as family planning and infant immunization are becoming more available, but lack of financial protection means increasing financial distress for families as they pay for these services out of their own pockets. This is even a challenge in more affluent regions such as Eastern Asia, Latin America and Europe, where a growing number of people are spending at least 10 percent of their household budgets on out-of-pocket health expenses. Inequalities in health services are seen not just between, but also within countries: national averages can mask low levels of health service coverage in disadvantaged population groups. For example, only 17 percent of mothers and children in the poorest fifth of households in low- and lower-middle income countries received at least six of seven basic maternal and child health interventions, compared to 74 percent for the wealthiest fifth of households.

The report is a key point of discussion at the global Universal Health Coverage Forum 2017, currently taking place in Tokyo, Japan. Convened by the Government of Japan, a leading supporter of UHC domestically and globally, the Forum is cosponsored by the Japan International Cooperation Agency (JICA), UHC2030, the leading global movement advocating for UHC, UNICEF, the World Bank, and WHO. Japanese Prime Minister Shinzo Abe, UN Secretary-General Antonio Guterres, World Bank President Kim, WHO Director-General Tedros and UNICEF Executive Director Anthony Lake will all be in attendance, in addition to heads of state and ministers from over 30 countries.

“Past experiences taught us that designing a robust health financing mechanism that protects each individual vulnerable person from financial hardship, as well as developing health care facilities and a workforce including doctors to provide necessary health services wherever people live, are critically important in achieving ‘health for all,’” said Mr. Katsunobu Kato, Minister of Health, Labour and Welfare, Japan. “I firmly believe that these early-stage investments for UHC by the whole government were an important enabling factor in Japan’s rapid economic development later on.”

The Forum is the culmination of events in over 100 countries, which began on Dec. 12—Universal Health Coverage Day—to highlight the growing global momentum on UHC. It seeks to showcase the strong high-level political commitment to UHC at global and country levels, highlight the experiences of countries that have been pathfinders on UHC progress, and add to the knowledge base on how to strengthen health systems and effectively promote UHC. In advance of the Forum, the UN General Assembly officially proclaimed 12 December as International Universal Health Coverage Day to raise awareness of the need for strong and resilient health systems that leave no one behind. 

The main high-level sessions of the Forum take place tomorrow, Dec. 14, and will also feature an all-day “innovation showcase,” highlighting innovations driving progress in health systems around the world, and a celebratory public event in the evening. A commitment to action, called the Tokyo Declaration on Universal Health Coverage, will be released during the Forum’s closing ceremony. 

“Without health care, how can children reach their full potential? And without a healthy, productive population, how can societies realize their aspirations?” said UNICEF Executive Director Anthony Lake. “Universal health coverage can help level the playing field for children today, in turn helping them break intergenerational cycles of poverty and poor health tomorrow.”

Building on the G7 Ise-Shima Summit and the TICAD VI in 2016, both of which stress the need for UHC, the Forum in Tokyo is seen as a milestone for accelerating progress towards the target of UHC by 2030, a key part of the Sustainable Development Goals. Countries will then gear up for the next global moment: a high-level meeting of the UN General Assembly on UHC in 2019.

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New Social Compact

Remote Learning during the pandemic: Lessons from today, principles for tomorrow 

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Education systems around the world reacted to COVID-19 by closing schools and rolling out remote learning options for their students as an emergency response.  New World Bank analysis of early evidence reveals that while remote learning has not been equally effective everywhere, hybrid learning is here to stay.

Going forward, for remote learning to deliver on its potential, the analysis shows the need to ensure strong alignment between three complementary components: effective teaching, suitable technology, and engaged learners.

“Hybrid learning – which combines in-person and remote learning – is here to stay. The challenge will be the art of combining technology and the human factor to make hybrid learning a tool to expand access to quality education for all,” emphasized Jaime Saavedra, World Bank Global Director for Education.  “Information technology is only a complement, not a substitute, for the conventional teaching process – particularly among preschool and elementary school students. The importance of teachers, and the recognition of education as essentially a human interaction endeavor, is now even clearer.”

The twin reports, Remote Learning During the Global School Lockdown: Multi-Country Lessons and Remote Learning During COVID-19: Lessons from Today, Principles for Tomorrow, stress that three components are critical for remote learning to be effective:

  • Prioritizing effective teachers: a teacher with high subject content knowledge, skills to use technology, and appropriate pedagogical tools and support is more likely to be effective at remote instruction.
  • Adopting suitable technology: availability of technology is a necessary but not sufficient condition for effective remote learning.
  • Ensuring learners are engaged: for students to be engaged, contextual factors such as the home environment, family support, and motivation for learning must be well aligned.

The reports found that many countries struggled to ensure take-up and some even found themselves in a remote learning paradox: choosing a distance learning approach unsuited to the access and capabilities of a majority of their teachers and students.

“Emerging evidence on the effectiveness of remote learning during COVID-19 is mixed at best,” said Cristóbal Cobo, World Bank Senior Education and Technology Specialist, and co-author of the two reports. “Some countries provided online digital learning solutions, although a majority of students lacked digital devices or connectivity, thus resulting in uneven participation, which further exacerbated existing inequalities. Other factors leading to low student take-up are unconducive home environments; challenges in maintaining children’s engagement, especially that of younger children; and low digital literacy of students, teachers, and/or parents.”

“While pre-pandemic access to technology and capabilities to use it differed widely within and across countries, limited parental engagement and support for children from poor families has generally hindered their ability to benefit from remote learning,” stressed Saavedra.

Despite these challenges with remote learning, this can be an unprecedented opportunity to leverage its potential to reimagine learning and to build back more effective and equitable education systems. Hybrid learning is part of the solution for the future to make the education process more effective and resilient. 

The reports offer the following five principles to guide country efforts going forward:

Ensure remote learning is fit-for-purpose. Countries should choose modes of remote learning that are suitable to the access and utilization of technology among both teachers and students, including digital skills, and that teachers have opportunities to develop the technical and pedagogical competencies needed for effective remote teaching. 

Use technology to enhance the effectiveness of teachers. Teacher professional development should develop the skills and support needed to be an effective teacher in a remote setting.

Establish meaningful two-way interactions. Using the most appropriate technology for the local context, it is imperative to enable opportunities for students and teachers to interact with each other with suitable adaptations to the delivery of the curriculum.

Engage and support parents as partners in the teaching and learning process. It is imperative that parents (families) are engaged and supported to help students access remote learning and to ensure both continuity of learning and protect children’s socioemotional well-being.

Rally all actors to cooperate around learning. Cooperation across all levels of government; as well as partnerships between the public and private sector, and between groups of teachers and school principals; is vital to the effectiveness of remote learning and to ensure that the system continues to adapt, learn, and improve in an ever-changing remote learning landscape.

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Youth embody ‘spirit’ of 21st century more than parents

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Even in the face of the COVID-19 pandemic, climate change and other global challenges, children and youth are nearly 50 per cent more likely than older people to believe that the world is becoming a better place, according to the results of a landmark intergenerational poll published on Thursday. 

The international survey was conducted by the UN Children’s Fund (UNICEF) and Gallup, the global analytics and advice firm, and has been released ahead of World Children’s Day on 20 November. 

The Changing Childhood Project is the first poll of its kind to ask multiple generations for their views on the world and what it is like to be a child today.  

Part of the solution 

Henrietta Fore, the UNICEF Executive Director, said that despite numerous reasons to be pessimistic, children and young people refuse to see the world through the bleak lens of adults. 

“Compared to older generations, the world’s young people remain hopeful, much more globally minded, and determined to make the world a better place,” she added.  

“Today’s young people have concerns for the future but see themselves as part of the solution”. 

More than 21,000 people in 21 countries participated in the survey, which was conducted across two age cohorts – 15-24 years old, and age 40 and up – and during the COVID-19 pandemic. 

Hopeful, not naïve 

Nationally representative surveys were undertaken in countries across all regions – Africa, Asia, Europe, and North and South America – and income levels.  

 The findings revealed young people are also more likely to believe childhood has improved, and that healthcare, education and physical safety are better today when compared with their parents’ generation. 

However, despite their optimism, youth are far from naïve.  The poll showed they want to see action to address the climate emergency.  At the same time, they are skeptical about the information they consume on social media, and struggle with feelings of depression and anxiety.  

This generation is also more likely to see themselves as global citizens, and they are more willing to embrace international cooperation to combat threats such as the pandemic. 

Aware of risks 

The survey also found children and young people are generally more trusting of national governments, scientists and international news media as sources of accurate information.  

They are also aware of the problems the world is facing, with nearly 80 per cent seeing serious risks for children online, such as exposure to violent or sexually explicit content, or being bullied. 

Young people want faster progress in the fight against discrimination, more cooperation among countries, and for decision-makers to listen to them. 

Nearly three-quarters of those surveyed who are aware of climate change believe Governments should take significant action to address it.  The share rises to 83 per cent in low- and lower-middle countries, where climate impacts are set to be greatest. 

21st century citizens 

In practically every country, large majorities of youth said their countries would be safer from COVID-19 and other threats if Governments would work together, rather than on their own. 

They have also demonstrated stronger support for LGBTQ+ (lesbian, gay, bisexual, transgender and queer) rights, with young women at the forefront for equality. 

The survey also revealed a strong alignment between the two generations, including on the issues of climate, education, global collaboration, though some of the deepest divides occurred around optimism, global mindedness and recognition of historical progress.   

“While this research paints a nuanced view of the generational divide, a clear picture emerges: Children and young people embody the spirit of the 21st century far more readily than their parents,” said Ms. Fore.  

“As UNICEF prepares to mark its 75th anniversary next month, and ahead of World Children’s Day, it is critical we listen to young people directly about their well-being and how their lives are changing”.

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Seva, a book that is here to heal the world

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It was early in February this year that I visited the Golden Temple in Amritsar. Walking outside the beautiful golden studded Gurudwara, I couldn’t help but feel awe at the langar that was being served. Prepared for lakhs of devotees everyday. Imagine a kitchen that is equipped to feed around one lakh people everyday, what goes on in the minds of people working at the Golden Temple tirelessly to feed one lakh devotees? There is really only one value behind their actions – Seva. Seva literally translates to helping others and seems simple at the outset. But to understand it deeply, you need to read Jasreen Mayal Khanna’s Seva published earlier this year.

Seva – Sikh secrets on how to be good in the real world by Jasreen Mayal Khanna is a book that is here to heal the world. It is a much needed book during the current times and promotes the values of helping others while outlining basic things that we often forget to do – say thank you daily, embrace joy, work harder than you pray, practice equality at home, help someone everyday, be brave, learn to laugh at yourself and live in Chardi Kala. While other points might seem easy and direct, the last one, Chardi Kala might not be obviously understandable to many outside the Sikh Community. What is Chardi Kala? It is the mental state of eternal optimism and joy. The Sikh Community is popularly known across the world for helping others and Jasreen Mayal Khanna explains more about the Sikh practice of Seva, serving others.

For a few, doing Seva comes naturally because it has been taught to them since childhood. This is especially valid for people from the Sikh Community who, as Khanna tells us in her book, are taught to contribute towards community service from a very young age. For some, they need to ingrain Seva in their life to lead a more balanced and happy life. We often forget that the individual and the community are woven into a beautifully intricate fabric that relies on each other. We are only reminded of how interconnected we are to each other during times of crisis. The COVID 19 pandemic has been a great reminder about how we need each other to survive. Friends, family and complete strangers helping out each other during times of the pandemic has been revolutionarily eye opening. The truth is that we should not need a pandemic to make us realise how interconnected we are. Books like Seva are an ode to that fabric of interconnectedness that is often forgotten in the world today. With ancient Sikh secrets and promoted values of happiness, the book heals readers in ways more than one. You quite literally need to read this book to lead a more balanced life.

While many Indians have been reading books like Ikigai talking about Japanese secrets to life, books like Seva hit far closer to home for Indians. Reading the book is also a testament to secularism since you can understand more about a community that you possibly interact with daily. Moreover, the book also gives you the opportunity to understand more about the values of the community that you can easily pick things from. Seva is not just a read for Indians, but deserves to be popularised across the world. The book will hit the UK market in May 2022.

“I had my first baby in the first wave of Covid. Through the pandemic, I kept seeing examples of Sikhs who were risking their own lives to help absolute strangers. And while I was very proud, I was not overly surprised because doing seva is second nature to Sikhs. I knew that this is a story that the world needs to hear, that my son Azad needs to hear. I wrote Seva because it is, in a way, the solution to the problems of modern life. Read it to believe it. “, Khanna says rightly. She is quite right about this, you need to read it to believe it.

I hope you can enjoy the book with some traditional Sikh Panjiri, the most delicious sweet made from wheat flour and dried nuts.

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