Speech at the Government of Japan-World Bank Conference on Universal Health Coverage

在日本政府与世界银行全民健康覆盖大会上的讲话

World Bank Group President Jim Yong Kim

世界银行集团行长金墉

Tokyo, Japan

东京，日本

December 6, 2013

2013年12月6日

Thank you, Mr. Shibusawa, for that kind introduction, and for the excellent work of JCIE.

感谢Shibusawa先生的热情介绍，感谢JCIE的杰出工作。

I would like to extend my heartfelt thanks to Minister Aso, Professor Takemi, and the Government of Japan for hosting us, and for the continuing strong partnership between Japan and the World Bank Group.

我向麻生太郎副首相、Takemi教授以及作为东道主的日本政府表示衷心的感谢，并对日本与世界银行集团长期密切的合作表示感谢。

I also would like to thank all of the honorable ministers from Ethiopia, Ghana, Myanmar, Senegal, and Vietnam who are here with us today. Thank you for your time and for your commitment to universal health coverage.

我还想感谢今天在座的埃塞俄比亚、加纳、缅甸、塞内加尔和越南的各位部长阁下，感谢你们拨冗出席以及你们对全面健康覆盖的承诺。

It is very appropriate that we are meeting in Japan on the topic of universal health coverage. When it comes to universal health coverage, Japan has led the world by example.

我们在日本开会探讨全民健康覆盖问题是十分合适的。在全民健康覆盖的问题上，日本以身作则，领先世界。

Japan achieved universal health coverage 52 years ago in 1961—17 years before the global community gathered in Alma-Ata to call for “health for all” and “development in the spirit of social justice.” The Kishi and Ikeda reforms that led to universal coverage promoted social solidarity and helped unleash Japan’s rapid economic growth and shared prosperity.

日本在52年前、即1961年就实现了全民健康覆盖，是国际社会在阿拉木图聚会呼吁“人人享有保健”和“在社会公正精神下实现发展”的52年之前。岸信介和池田勇人推行的改革带来了全民健康覆盖，从而促进了社会团结，帮助日本释放出了高速经济增长和共享繁荣的潜力。

Japan is not only a leader in achieving universal health coverage for its own citizens, but Japan is also a leader in extending this commitment to universal health to poor people around the globe. Through its leadership of G8 summits and its various roles on the global stage, Japan has helped mobilize substantial global health and development assistance that has saved countless lives and advanced the health and well-being of millions.

日本不仅率先实现了本国公民的全民健康覆盖，而且也率先将全民健康覆盖的承诺扩大到全球各地的贫困民众。日本通过自身在八国集团峰会上的领导力及其在全球舞台上担任的各种角色，帮助调动了大量全球健康与发展援助，拯救了无数生命，推进了亿万人民的健康与福祉。

Today, there is a large and growing movement in developing countries to undertake the necessary comprehensive health reforms to achieve universal coverage. To reflect this reality, the goal of universal health coverage should be firmly embedded in the emerging post-2015 global development agenda.

如今，发展中国家已出现一场大规模的并且不断扩大的运动，推行必要的全面卫生改革以实现全民健康覆盖。为了反映这一现实，应将全民健康覆盖的目标牢牢地嵌入新的2015年后全球发展议程。

The quest for universal coverage is not only a demand for better health – it’s a demand for equity.

寻求全民健康覆盖，不仅是对改善健康的需求，也是对公平的需求。

At the World Bank Group, achieving universal health coverage and equity in health are central to reaching the global goals to end extreme poverty by 2030 and boost shared prosperity.

在世界银行集团，实现全民健康覆盖和卫生保健公平，对于实现到2030年消除极度贫困和促进共享繁荣的全球性目标十分重要。

My colleagues and I at the Bank Group are deeply committed to helping countries realize their aspirations for universal coverage. Our aims are clear:

我和我在世行集团的同事们都坚定地致力于帮助各国实现全民健康覆盖的愿望。我们的目标是明确的：

First, everyone should have access to affordable, quality health services. Our commitment is universal, but during the next 755 days until the MDG deadline in December 2015, we are putting a special focus on expanding access to vital services for poor women and children. We are helping the poorest countries scale up results-based financing programs that are already producing dramatic improvements in maternal and child health in countries from Afghanistan to Zimbabwe.

首先，人人都应享有负担得起的优质医疗保健服务。我们的承诺是具有普遍意义的，但是在今后直至2015年12月千年发展目标到期的755天里，我们亟待重视加强对贫困妇女儿童的基本服务提供，我们正在帮助最贫穷国家扩大成果导向型融资计划的规模，这些计划已在阿富汗、津巴布韦等国的孕产妇和儿童健康方面带来了显着改善。

Second, no one should be forced into poverty, or be kept in poverty, to pay for the health care they need. Every year an estimated 100 million people – that’s more than a quarter of a million people every day – face poverty as a result of out-of-pocket health care costs. So we must pay special attention to affordability for the poorest 40 percent of the population in every developing country.

第二，任何人都不应因支付所需医疗保健服务的费用而被迫陷入贫困或持续陷于贫穷。据估计每年约有1亿人——即每天超过25万人——由于自付医疗费用而面临贫困。因此，我们必须特别关注各发展中国家最贫穷的40％人口的支付能力。

Third, all countries must harness investments in other sectors beyond health that provide the essential foundations for a healthy society. Achieving universal health coverage requires solutions beyond the health sector – including targeted efforts in areas such as education, social protection, roads, transport, water and sanitation, public finance, and information technology.

第三，所有国家都必须充分利用超出卫生部门以外的其他部门的投资，为建设一个健康的社会奠定必要的基础。实现全民健康覆盖，需要有超越卫生部门的解决方案，包括在教育、社会保护、道路、交通、供水和卫生设施、公共财政和信息技术等领域做出有针对性的努力。

For example, we know that one of the most successful interventions to improve child health has involved putting money in the hands of poor mothers via conditional cash transfers. Air quality improvements, as well as tobacco taxation and road safety policies can play a critical role in turning the tide on the alarming increase in chronic conditions and injuries we see today in so many developing countries.

例如，我们知道，改善儿童健康的最成功的干预措施之一是通过有条件现金转移支付将钱交到贫困母亲的手中。改善空气质量以及烟草税和道路安全政策都可以在遏制许多发展中国家慢病和伤害急剧上升方面发挥重要的作用。

Helping countries advance universal health coverage is a strategic priority across the World Bank Group. Through our Bank loans and technical assistance, we are partnering with middle-income countries to design and implement tough health sector reforms and contain costs, while at the same time expanding and sustaining coverage.

帮助各国推进全民健康覆盖是整个世界银行集团的一个战略重点。我们通过世行贷款和技术援助，正在与中等收入国家合作设计和实施艰难的卫生部门改革和控制成本，与此同时扩大和保持覆盖面。

Through IDA, our fund for the poorest countries, we are supporting the next generation of countries to lay the foundations for universal health coverage. Japan’s continuing strong support for IDA in our current replenishment round will be critical if we are to scale up our efforts over the next three years.

我们还通过面向最贫困国家的基金国际开发协会，协助一批国家为全面健康覆盖奠定基础。日本继续对本轮国际开发协会增资给予强有力的支持，这对于我们在未来三年扩大我们的业务规模是至关重要的。

And through the International Finance Corporation, our private sector arm, we are helping both middle- and low-income countries harness the resources and innovation of the private sector, working in concert with the public sector. The private sector represents a large, and in many cases, growing share of the health care market in developing countries--so the private sector must be integrated into universal health coverage reform efforts.

我们也通过世行的私营部门窗口国际金融公司，帮助中等收入国家和低收入国家充分利用私营部门的资源与创新，与公共部门协同努力。私营部门在发展中国家的医疗保健市场中占有很大份额，而且在许多情况下其份额还在持续增长。因此，必须将私营部门结合到全民健康覆盖的改革努力之中。

While there is no single pathway for countries to achieve universal health coverage, all countries can learn from one another’s experiences as they chart and calibrate their own paths. Why, for example, are some countries able to achieve better maternal and child health outcomes than others with the same level of resources? How have some countries managed a rapid expansion in coverage? What are the best ways for governments to engage private sector partners while ensuring equity and quality?

虽然各国实现全民健康覆盖没有统一的路径，但各国在规划和调整自己的路径时可以相互学习交流经验。例如，为什么有些国家能以同等的资源取得更好的孕产妇和儿童健康结果？有些国家是如何做到快速扩大健康覆盖的？政府吸收私营部门伙伴参与同时又确保公平与质量的最佳途径是什么？

As a global health community, we need to document, evaluate, and share lessons across countries, to save lives, reduce spiraling health care costs, and demonstrate value for the money. That’s why at the World Bank Group we are placing a priority on what we are calling the science of delivery. We are gathering data and evidence on what works and what doesn’t. We are beginning to systematically capture this knowledge and then we will make sure that these lessons from experiences around the world can be applied to local situations.

作为一个全球健康社会，我们需要记录、评估和分享各国的经验，以挽救生命，降低不断攀升的医疗保健成本，并证明物有所值。这就是为什么我们世界银行集团重视我们称之为“交付的科学”，收集“可行”与“不可行”的数据和实证，我们已开始系统地捕获这种知识，然后确保从世界各国经验中获得的启示可以应用到本地情况下。

This is where our Japan-World Bank Group Partnership Program on universal health coverage and this conference play such an important role, yielding a wealth of practical lessons from country experiences.

这就是日本与世界银行集团全民健康覆盖合作计划以及此次大会的用武之地，从各国经验中产生大量丰富的实际经验启示。

Today, I am pleased to announce that with our Japanese partners we are releasing a synthesis of case study findings from 11 countries that have achieved, or are committed to achieving, universal health coverage.

今天，我很高兴地宣布，我们同日本合作伙伴共同发布了已经实现或者致力于实现全面健康覆盖的11个国家案例的综合研究成果。

These 11 countries are diverse – geographically, culturally, and economically. But all of these countries are demonstrating how these programs can improve the health and welfare of their citizens and promote inclusive and sustainable economic growth.

这11个国家在地理上、文化上和经济上千差万别。但所有这些国家都显示出这些计划如何能够改善国民的健康与福祉，并促进包容性和可持续的经济增长。

The good news is that many low- and middle-income countries are introducing fundamental reforms and achieving remarkable progress.

好消息是，许多低收入国家和中等收入国家正在出台根本性的改革，并取得了显著进展。

So what are the main lessons from these 11 countries? Here are five:

那么，这11个国家的重要经验启示是什么呢？一共有五条：

One, strong national and local political leadership and long-term commitment are required to achieve and sustain universal health coverage;

第一，强有力的国家和地方政治领导力和长期的承诺是实现和维持全民健康覆盖的必要条件；

Two, short-term wins are critical to secure public support for reforms as in the case of Turkey where hospitals were outlawed from retaining patients unable to pay for care;

第二，短期成功对于获得公众对改革的支持具有关键意义，比如土耳其对不让付不起医疗费的患者离开的医院予以取缔；

Three, economic growth, by itself, is insufficient to ensure equitable coverage—so countries must enact policies that redistribute resources and reduce disparities in access to affordable, quality care;

第三，经济增长本身不足以确保公平覆盖，所以各国必须颁布政策重新分配资源和缩小在获得可负担的优质医疗保健服务方面的差距；

Four, strengthening the quality and availability of health services depends not only on highly skilled professionals but also on community and mid-level workers who constitute the backbone of primary health care.

第四，加强卫生保健服务的质量与可获性不仅取决于技术高超的专业人员，还取决于构成初级卫生保健骨干力量的社区和中层工作者；

And finally, five, countries need to invest in a robust and resilient primary care system to improve access and manage health care costs.

第五，国家需要投资建立一个强大坚韧的初级卫生保健体系，以改善医疗保健服务获取和管理医疗卫生费用。

Not surprisingly, all of these cases also demonstrate that as countries move toward universal coverage, they will confront competing demands and continuing trade-offs. Countries face choices that can either enhance or erode coverage. The countries which have been most successful in expanding coverage have been in a mode of continuous learning – from what is happening both inside and outside their borders – and adapting their approaches based on the best available knowledge and evidence.

毫不奇怪，所有这些案例也表明，随着全民健康覆盖的进程，国家将会面临相互竞争的需求，需要不断做出权衡取舍。国家面临在增强或削弱健康覆盖两者之间做出抉择。在扩大健康覆盖方面最成功的国家始终处于一种不断学习的模式——借鉴国内外的发展经验，并根据可获得的最佳知识与实证不断调整他们的模式。

A promising message from these case studies is that even low-income countries with low levels of health coverage can still aim for universal health coverage. Countries can start by building their institutional capacity, learn from the experiences of other countries, and adapt innovative approaches that can catalyze the expansion of coverage.

从这些案例研究中产生的一个令人鼓舞的信息是，即使健康覆盖水平偏低的低收入国家仍可以全民健康覆盖为目标。国家可以从自身的机构能力建设出发，借鉴别国的经验，采取创新方式促进覆盖面的扩大。

These are the cross-cutting lessons. Now let’s take a closer look at a few of these countries:

这些都是跨领域的经验启示。现在我们来仔细看看其中几个国家的案例：

In Turkey, an economic crisis in the early 2000s prompted major government reforms and laid the groundwork for the 2003 Turkey Health Transformation Program. Turkey cleaned up government deficits and created leaner and more efficient state bureaucracies—and also opened doors for reform in the health sector by breaking old interest group politics. Outcomes are impressive: Today, more than 95 percent of the Turkish population is covered by formal health insurance. The Program now provides a high level of financial protection and equity while ensuring high and rising levels of patient satisfaction. Furthermore, infant mortality rates have declined from 28.5 per 1,000 live births in 2003 to 10.1 per 1,000 live births in 2010, and the maternal mortality ratio fell from 61 deaths per 100,000 live births in 2000 to 16.4 deaths per 100,000 live births in 2010. Turkey’s example proves that financial constraints—even a major financial crisis—can catalyze the expansion of coverage. The Bank Group has been pleased to partner with the Turkish government to support this effort.

在土耳其，21世纪初爆发的经济危机促使政府进行了重大改革，为2003年土耳其的卫生改革计划奠定了基础。土耳其清理了政府赤字，建立了更加精简高效的政府机构，同时也破除了老的利益集团政治，敞开了卫生部门的改革大门。其结果令人印象深刻：如今，正规医疗保险覆盖面达到土耳其人口的95 ％以上。该计划现在提供高水平的财政保障与公平，同时确保患者满意度高且不断上升。婴儿死亡率从2003年每千名活产儿死亡28.5名， 2010年下降到每千名活产儿死亡10.1名。孕产妇死亡率从2000年的每10万活产死亡61人，2010年下降到每10万活产死亡16.4人。土耳其的案例证明，财政拮据甚至重大的金融危机都可能促进健康覆盖面扩大。世行集团一直很高兴与土耳其政府合作支持这一努力。

Thailand has focused on strengthening its health workforce, with the Thai Network of Rural Doctors leading the push for reforms. In addition to increasing the number of doctors and nurses, the government raised basic salaries and introduced incentives to attract and retain health workers. As a result of the health workforce scale-up and other factors, popular utilization of essential health services has improved. Since the Universal Coverage Scheme was introduced there has been a declining trend in the incidence of catastrophic health expenditures, defined as out-of-pocket payments for health care exceeding 10 percent of total household consumption expenditure. The incidence dropped from 6.8 percent in 1996 to 2.8 percent in 2008 among the poorest people in the program. The impact on province-specific incidence of impoverishment has been even more impressive: in the poorest rural northeast region of Thailand, the number of impoverished households dropped from 3.4 percent in 1996 to less than 1.3 percent in 2006-2009.

泰国一直专注于加强卫生队伍建设，以泰国乡村医生网络为首推进改革。除了增加医护人员人数外，政府提高了基本工资，并推出优惠措施吸引和留住卫生工作者。由于卫生人力资源规模化及其他因素的影响，民众对基本卫生服务的使用率得到提高。自实行全民健康覆盖计划以来，灾难性卫生支出——即自付医疗费用超过家庭总消费支出的10％——的发生率呈下降趋势，在计划覆盖的最贫困人口中从1996年的6.8 ％到2008年降低到2.8％。对分省的致贫率的影响更为显著：在泰国最贫穷的东北农村地区，因病致贫的家庭比例从1996年的3.4％在2006-2009年期间下降到1.3％以下。

Ethiopia launched its Health Extension Program in 2003 to promote universal coverage of primary care. The program delivers 16 clearly defined packages of health services for free. At the center of the program is the network of health extension workers – all women, 10th grade high school graduates recruited from their communities, trained for one year and redeployed back into their communities. More than 35,000 health extension workers have been trained and deployed thus far, and their services are now in high demand from other sectors as well – such as adult literacy or sharing of sustainable agriculture techniques. The challenge is to continue to enhance the skills and performance of these frontline workers and to protect their time to ensure they can provide communities with the quality health services they need. The latest Ethiopia Demographic and Health Survey data show that between 2005 and 2010, child mortality fell from 123 per thousand to 88 per thousand, a 28 percent decline. Over the same time period, Ethiopia also reports impressive reductions in both stunting among children and anemia among women; and contraceptive use nearly doubled, contributing to a reduction in total fertility rate.

埃塞俄比亚在2003年推出健康推广计划以促进初级卫生保健服务的普遍覆盖。该计划免费提供16项明确规定的医疗服务包。该方案的核心是建立卫生保健推广工作者网络——均为女性，从社区招募的 10年级高中毕业生，经过一年培训，然后重新安置回到社区。截至目前共培训和安置卫生保健工作者35,000多人。现在其他部门对他们的服务需求也很大，比如成人扫盲或推广可持续农业技术。目前的挑战是如何继续提高这些一线工作者的技能和绩效，保障他们的时间，以确保能为社区提供所需要的优质医疗保健服务。最新埃塞俄比亚人口与健康调查数据显示， 从2005年至2010年期间，儿童死亡率下降了28％ 。在同一时段，埃塞俄比亚的儿童发育不良率和妇女贫血率也出现显著下降；避孕药具使用率增加了近一倍，导致总生育率呈现下降。

And in Peru, the government is leveraging its sovereign wealth funds to jumpstart ambitious reforms aimed at realizing universal health coverage. The Bank Group is partnering with the Ministry of Health to develop a national set of indicators that will allow them to measure, monitor, and evaluate the expansion of coverage, and take into account the epidemiological transition that the country is facing.

秘鲁政府正在利用主权财富基金推动以实现全民健康覆盖为目标的雄心勃勃的改革。世行集团正在与卫生部合作制定一套国家指标，用于衡量、监测和评价覆盖面扩大进度，也考虑到该国所面临的流行病学转型的情况。

These examples show that all countries face challenges implementing complex health systems reforms to achieve universal health coverage. That’s why we need global mechanisms through which countries can gain access to the latest experimental knowledge of what works and what doesn't, and why. We need to understand how successful examples can be taken from abroad and implemented locally. This points to the importance of having a joint learning platform and network in which policymakers, practitioners, and development partners can engage on the practical, how-to issues of universal coverage reforms, and put knowledge into practice with hands-on problem solving. The World Bank Group is moving toward a Global Practice as a platform for supporting countries in achieving these goals.

这些案例表明，各国都面临着落实复杂的卫生体系改革以实现全民健康覆盖的挑战。这就是为什么我们需要全球性的机制，籍此让各国能够获得关于可行和不可行方案的最新实验知识。我们需要了解如何借鉴国外的成功范例并在本国实施。这显示出拥有一个共同的学习平台和网络的重要性，让政策制定者、从业者和发展伙伴能够参与探讨全民健康覆盖改革的实际操作问题，提高动手解决问题的能力，将知识转化为实践。世界银行集团正在构建一个全球实践平台以支持各国实现这些目标。

This also underscores the vital importance of measurement. Although priorities, strategies, and implementation plans will differ from one country to another, all countries need to make their universal health coverage policies and programs accountable and measurable, so they can track progress and adjust as they go.

这也凸显出监测衡量的极端重要性。虽然各国的优先重点、战略和实施计划千差万别，但各国都需要让自身的全民健康覆盖政策和计划具有可问责性和可衡量性，这样才能跟踪进度和随时调整。

But in order for countries to continue learning from one another, and to benchmark progress, the world needs a measurement framework that can provide a common, and comparable, set of metrics.

但是，为了让各国不断相互学习和衡量进展，世界需要有一个可提供一套统一的、具有可比性的尺度的监测框架。

That’s why at this conference, the World Bank and WHO are releasing a joint framework for monitoring progress toward universal health coverage with two targets, one for financial protection and one for service delivery.

这就是为什么在此次大会上，世界银行和世卫组织将发布一个监测全面健康覆盖进展的统一框架，这个框架有两个目标，一个是财务风险保护目标，一个是服务提供目标。

For financial protection, the proposed target is by 2020 to reduce by half the number of people who are impoverished due to out-of-pocket health care expenses. By 2030, no one should fall into poverty because of out-of-pocket health care expenses. This is no small feat: this would mean moving from 100 million people impoverished every year now to 50 million by 2020 and then to zero by 2030.

对财务风险保护的建议目标是，到2030年将因自费支付医疗费用致贫的人数减少一半。到2030年，任何人都不会因自费支付医疗费用而致贫。这不是一个小数目：这意味着将因病致贫的人数从现在每年1亿人到2020年减少到每年5000万人，到2030年减少为零。

For service delivery, the proposed target is equally ambitious. Today, just 40 percent of the poor in developing countries have access to basic health services such as delivering babies in a safe environment and vaccinating children. We propose that by 2030 we will double that proportion to 80 percent coverage. In addition, by 2030, 80 percent of the poor will also have access to many other essential health services such as treatment for high blood pressure, diabetes, mental health and injuries.

对服务提供的建议目标也同样是雄心勃勃的。今天，在发展中国家只有40%的贫困人口能够获得基本卫生服务，比如在安全的环境中分娩和儿童免疫。我们建议到2030年将这个比例提高一倍，覆盖面达到80%。此外，到2030年，80%的贫困人口也要能获得很多其他基本卫生服务，比如高血压、糖尿病、心理健康和伤害的治疗。

In the next three months, WHO and the World Bank will consult with partners to work out the details of tracking these targets.

在今后三个月，世界卫生组织和世界银行将与各伙伴方磋商制定出跟踪目标进展的详细方案。

Yes, these targets are bold - but we need bold targets to close the gap on universal coverage. Simply put, targets drive action. Without the ambitious 3 by 5 target for HIV, I do not believe that today that we would have 10 million people and counting on antiretroviral treatment.

是的，这些目标很大胆，但我们需要有大胆的目标，才能缩小全民健康覆盖的差距。简而言之，目标推动行动。如果没有防控艾滋病的雄心勃勃的“三五”目标，我不相信我们今天会有1000万人获得抗逆转录病毒治疗。

So as we consult, let’s also commit to moving this forward. Let’s not make the perfect the enemy of the good. Countries’ futures -- and many people’s lives -- are at stake.

所以，在磋商的同时，我们也致力于向前推进。我们不要让完美与公益为敌。国家的未来，以及许多人的生命，危在旦夕。

In closing, I want to again recognize our hosts, the Government and people of Japan, for their continuing commitment to UHC.

在结束讲话之前，我想再次向我们的东道主日本政府和日本人民对全面健康覆盖的长期承诺表示赞赏。

We must do whatever we can so that every country in the world can benefit from the experience of Japan. Some 30 developing countries are implementing programs to achieve UHC, and many more are considering doing so.

我们必须竭尽全力使世界上每个国家都能从日本的经验中获益。目前有30个发展中国家正在实施全面健康覆盖的计划，还有很多国家也在考虑实施。

Like our Japanese partners, my colleagues and I at the World Bank Group stand ready to help developing countries advance on the path to universal health coverage. And while this will not be easy, the lessons and experiences we are sharing today show that it is possible for all countries to realize this goal.

和我们的日本合作伙伴一样，我们在世界银行集团的同事们和我本人随时准备协助发展中国家迈向全民健康覆盖之路。虽然这并非易事，但我们今天分享的经验启示表明，所有国家都有可能实现这一目标。

It has been 20 years since the landmark 1993 World Development Report, which led to a generation of investments that produced dramatic achievements in global health.

自1993年出版具有里程碑意义的《世界发展报告》已经过去了20年，这个报告带来了一代人的投资，在全球健康方面取得了显著成就。

It’s time to finish the job in this generation. Let us all leave Tokyo with a renewed commitment to ensure that everyone in the world will have access to affordable quality care so they may lead healthy, productive lives -- lives of dignity, equity and opportunities

现在我们这一代人完成这项工作的时候到了。让我们在离开东京时带着新的承诺，确保世界上人人都有机会获得可负担的优质卫生保健服务，使人人都过上健康的、富有成效的生活——拥有尊严、公平和机遇的生活。

Thank you very much.

谢谢各位。

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