Promoting Universal Health Coverage for an Aging Asia - Takehiko Nakao | Asian Development Bank

Promoting Universal Health Coverage for an Aging Asia - Takehiko Nakao

Speech | 4 May 2017

Opening remarks by ADB President Takehiko Nakao at the 50th Annual Meeting of the Board of Governors on 4 May 2017 in Yokohoma, Japan

Good morning. I am very glad to participate in this Host Country Event on promoting universal health coverage (UHC) for an aging Asia. 

ADB’s role in health sector

When ADB was established in 1966, Asia was poor and underdeveloped.  Fifty years later, the region has made remarkable progress in economic development and poverty reduction. However, Asia still faces various development challenges, including improved access to health services and efficient health systems. 

ADB has a long history of supporting the health sector. ADB first provided a loan in the health sector in 1978 for the Sha Tin Hospital Polyclinic in Hong Kong, China. From this initial health investment, ADB’s health sector projects have evolved—from clinic and hospital support to strengthening integrated health systems and achieving universal health coverage. In recent years, we have provided loans and technical assistance to strengthen health insurance systems in Lao PDR, Mongolia, Viet Nam and other countries; and to combat cross-border health issues such as HIV and malaria in the Greater Mekong Subregion. 

"ADB’s health sector projects have evolved—from clinic and hospital support to strengthening integrated health systems and achieving universal health coverage."

Challenges in an aging society and the importance of UHC

Goal 3 of the Sustainable Development Goals adopted in 2015 calls for good health and well-being for all ages. Health issues arising from aging is a critical challenge to us. Asia is experiencing a profound demographic shift not only in high-income countries but also in many middle- and low-income countries. In 2016, one in eight people in our region was aged 60 or above. By 2050, it will be one in four, although situation varies by country.  

In order to address the health challenges of an aging society, we must accelerate progress toward UHC, or Universal Health Coverage. UHC is fundamental to equity and fairness among people.  It is essential for sustainable growth. 

ADB efforts to promote UHC

ADB has been promoting UHC through loans and technical assistance. I would like to share the key principles of UHC when we design this.

First, Inclusiveness. UHC should ensure that no one is left behind in access to health services. Every person should have access to quality essential health care services without financial hardship. UHC is not enough if the quality of health service has a wide gap between segments of society.  UHC should address the rights and needs of all people in an equitable way, the young and old, the poor and rich, and urban and rural populations.  

Second, Integrated Care. Health care systems should be integrated from primary care, hospital care, to home care and community care. UHC should incorporate both preventive and treatment services, which promotes healthier lives and so-called healthy aging. Health care providers should have sufficient capacity and information to coordinate among different types of services. 

Third, Sustainability. UHC should include appropriate financial incentives to consumers and providers to contain increasing cost of health care. Governments must become strategic purchasers of medical services, medicine and equipments, and regulators of price and quality, supported by prudent public financial management and transparent governance systems. 

Fourth, Innovation. UHC should encourage innovative ideas and technologies. The examples are: (i) ICT to reach out to the elderly patients and people in remote areas; (ii) more innovative design of health and care facilities which are more convenient for patients and resilient to disaster risks; and (iii) robots to help the physical functioning of the elderly.  Recently, ADB has sponsored a seminar for usage of ICT in health. Currently, ADB is planning to provide a loan for the development of digital health systems in Tonga.

Fifth, Private Sector Participation. We should encourage collaboration with the private sector to help overcome challenges in an aging Asia. It will mobilize additional financing and management know-how to health sector.  

Last year, we approved a loan project in Yichang City of Hubei province in the PRC that employs public-private partnership approaches to scale up health and elderly care services.

Lastly, Multi-sectoral Approach. Health interventions should be complemented by non-health sectors.  We should enhance public transportation to support people access to health services.  Securing clean water and sanitation is the basis for good health.  Urban planning should incorporate age-friendly design. ADB urban health projects in India and Bangladesh aim to guarantee access to primary health care for poor populations in urban areas and promote a multisectoral approach including appropriate plans for transport and water. 

"ADB is now scaling up health sector operation with a focus on UHC. We will further strengthen policy dialogues, design and implement innovative projects, and disseminate knowledge."

Conclusion

ADB is now scaling up health sector operation with a focus on UHC.  In the health sector, we will further strengthen policy dialogues, design and implement innovative projects, and disseminate knowledge. In doing so, ADB will enhance our collaboration with various development partners, including the World Bank, the WHO, and bilateral organizations such as JICA.   

I hope this seminar sponsored by the Japanese government would provide an excellent opportunity to share knowledge and exchange views on Universal Health Coverage and other health issues for Asia and the Pacific.