Multistakeholder Pledge: National Health System Inclusion

Key statistics

Since the affirmation of the GCR in 2018, individuals, private businesses, organisations and governments have made 96 pledges¹ to advance the health inclusion and mental health of refugees and host communities and work towards universal health coverage. Working towards the GRF 2023, an additional 235 pledges were made by multistakeholder partners on health inclusion and mental health and psychosocial support. Of those, 153 pledges were submitted related to inclusion in national health systems, including 102 directly linked to the multistakeholder pledge. Altogether 125 entities from across the world pledged their support, aiming to reach more than 36 million people². The largest number of the pledges were submitted by States, including 27 low- and middle-income refugee-hosting countries. 

The multistakeholder pledge benefits from commitments made from across the world to foster sustainable inclusion in strengthened national health systems. The largest number of pledges were received from Europe and the Americas (35 each). Pledges target all regions, including global pledges with organisation-wide commitments to foster inclusion.

Pledge analysis

Submitted pledges are categorized into three broad pledge thematic areas:

Law and Policy:

Law and policy pledges are the foundation for sustainable inclusion of refugees, other forcibly displaced and stateless people into national health systems, policies, and programmes, and enable equitable access to services at par with host communities. These commitments by refugee-hosting countries create an enabling environment and are frequently accompanied by concrete measures going beyond policy changes. Examples include pledges to provide equitable universal access to health services for all refugees through various means such as policy changes, (e.g., Governments of Brazil, Chile, Armenia, Morocco, Paraguay, Moldova) and inclusion in national health programmes and social health insurance schemes (e.g. Governments of Kenya, Thailand, Mauritania, Nigeria, Cameroon). Other pledges focus on the integration of parallel health services into governmental health service provision to enable effective inclusion (e.g. Governments of Chad, Uganda, Iraq), including as part of approaches to transform camps into settlements (e.g. Government of Ethiopia) as well as specific pledges for the inclusion of refugee healthcare workers into the national health workforce (e.g. Government of Slovakia).

Programmatic support:

Complementary to policy pledges, programmatic pledges enable the effective inclusion of refugees into national health systems and strengthen the national health system through technical, financial and material assistance to effectively deliver health and nutrition services for all refugees and host communities. Donor countries (e.g., Governments of Belgium, Denmark, Germany) and international organisations (e.g., Gavi, Global Fund, IOM, UNFPA, UNICEF, WHO and 27 UN country teams) pledged to enable effective inclusion into national health systems. An additional range of pledges from donor countries (e.g., Governments of Austria, Australia, Canada, Japan, Korea, Slovenia, Sweden, United States), and civil society organisations (e.g., International Medical Corps, Medical Women’s International Association, Society of North American Refugee Healthcare Providers and individual health care providers) aim to strengthen national health services as well as to enable complementary health services in support of refugees and host communities. Private sector partners and foundations (e.g., “la Caixa” Banking Foundation, Qatar foundation, Sony Group Corporation, UN Foundation) pledged more than 55 million USD⁵. This will play a vital role in advancing sustainable inclusion in health systems and social health protection schemes, alongside providing technical assistance to design and implement results-oriented projects in partnership with key stakeholders. Many pledges are closely linked to other multistakeholder pledges such as Fostering Mental Health and Psychosocial Wellbeing, Economic Inclusion and Social Protection, Climate Resilient Sustainable Human Settlements for Refugees and their Hosting Communities, as well as regional pledges such as Expanded Resilience, Enhanced Solutions for Rohingya Refugees, and are reflective of the multisectoral needs and the focus on comprehensive solutions.

Data and evidence:

More data and evidence are needed to promote effective evidence-based approaches, to support health systems planning and to monitor equitable access to health services. Pledges aim to strengthen national health systems by supporting collection of national data and indicators; supporting evidence generation through research and innovations in service delivery; and promoting international norms and standards and developing evidence-based tools and guidance to inform public health policy and practice (e.g. WHO). Moreover, the Johns Hopkins University led a joint pledge of 10 academic institutions (American University of Beirut, Columbia University, London School of Hygiene and Tropical Medicine, Queen Margaret University, University of Calgary, University of Geneva, University of Palermo, Upstate Medical University, and York University) aiming to extend their academic expertise to the field of refugee health through research, advocacy, and educational initiatives, including scholarships to refugees. Complementary, partners pledge to develop and disseminate global advocacy briefs, and other tools to advance access to inclusive health services (e.g. Women’s Refugee Commission).

Matching

• The Government of Germany commits to match three pledges made by the Governments of Ethiopia, Kenya and Mauritania to enhance refugee inclusion and support to promote access to public services such as health, WASH, education and others through various initiatives including urban settlement improvements, integrated services provision, and national social protection systems. 
• The Humanitarian International NGO Network (HINGO) pledges to match the Government of Uganda’s commitment to continue managing and integrating the infrastructure and services, including in health.
• The Government of Denmark together with the LEGO Foundation, Novo Nordisk Foundation and Grundfos Foundation has formed an alliance to respond to the protracted forced displacement situation in Turkana County, Kenya with a focus on strengthening integration of services for host communities and refugees within the programmatic areas of health, education, water and self-reliance. This alliance supports the pledge of the Government of Kenya on transforming camps to settlements and inclusion in national services.

Recap and next steps:

During the GRF, the multistakeholder pledges on National Health System Inclusion and Fostering Mental Health and Psychosocial Support were announced jointly on the first day by Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization and Ms. Louange Koffi, refugee nurse and youth advocate. Additionally, a high-level event “Achieving Health and Wellbeing For All” was held with high-level panellists from governments, refugees, international organisations, civil society and private sector.

Going forward, the Group of Friends of Health for Refugees and Host Communities intends to sustain the positive momentum demonstrated at the GRF and will continue to provide support and technical assistance to advance pledge implementation. The Group will capitalise on global and regional events and multilateral processes to advance inclusion in national health systems and galvanise additional support.

Footnotes

1. Until 30 June 2023
2. Refugees and host communities
3. Global pledges may also refer to those that have yet to determine a country focus or cover multiple regions.
4. Contributions are linked to more than one multi-stakeholder pledge