This week, WHO/Europe hosted a virtual high-level meeting with ministers of health and education from across the WHO European Region to highlight ways to minimize the impact of the COVID-19 pandemic on the schooling, health, well-being and education of young people.

In a statement, Dr Hans Henri P. Kluge, WHO Regional Director for Europe, said: “School closures and interventions such as distance learning may have a negative effect on children’s long-term educational outcomes. Children living with disabilities are further disadvantaged by school closures and inadequate distance learning measures to meet their needs. We owe it to the next generation, particularly those in vulnerable settings, to do everything we can to reduce vulnerabilities and to keep their in-person learning alive.

“The evidence is growing that targeting transmission in our communities will address the risk of transmission in schools. If proper and consistent measures are in place, schools do not pose a greater risk of infection for children, teachers and other staff than any other public place.”

Challenges and cooperation

The need for updated evidence for schools to operate safely was highlighted, as was the necessity of further enhancing the existing framework to support countries on schooling and COVID-19 with evidence sharing. In addition, the attendees explained the importance of evaluating responses to COVID-19 and how they impact the rights of children.

During the meeting, countries highlighted the methods they have employed to ensure that schools remain open as long as possible, while also recognizing the difficulties encountered during the pandemic.

In addition, the meeting heard from partners and collaborators on what they do and how they support countries. They also agreed on continued regional collaboration.

Hearing direct from young people

A group of youth advisors to the technical advisory group on schooling during COVID-19 (TAG), which was established earlier this year, were invited to contribute. The perspectives and participation of young people is vital to the topic of schools and COVID-19.

In their presentation, the youth advisors highlighted some findings from a survey shared with students from across the European Region. Feedback from young people included concerns about the immediate impact on their learning and well-being, as well as whether examinations and long-term plans, such as university, could be negatively affected.

Some students explained that they were feeling under pressure to complete work in a shorter time, while others said that in some cases, they lacked the ability to be properly educated at home; for example, if they have a poor internet connection or live in a vulnerable situation.

The meeting highlighted the importance of providing support to children and young people with disabilities or pre-existing health conditions.

Building on shared experiences

This week’s virtual discussion follows on from a meeting that took place in August of this year, highlighting the need for sharing evidence and country experiences on schooling during COVID-19. This resulted in the establishment of the TAG, which has been meeting to discuss the response to COVID-19 and schooling.

Education often has an impact on wider health in society. The closure of schools has led to concerns about some students being left behind, with many more facing mental health challenges as a result of the pandemic.

Leaving no one behind is central to the European Programme of Work, 2020–2025 – “United Action for Better Health”. Mental health, and the development of a coalition for mental health, is 1 of the 4 priorities influencing the work of WHO/Europe in the coming years.

As COVID-19 spread across Europe earlier this year, many countries moved quickly to address gaps in health coverage by extending entitlement to migrants, suspending the payment of health insurance contributions for low-income self-employed people, adding teleconsultations to the benefits package and offering free access to testing and treatment of the virus.

These actions demonstrate widespread acceptance of the need to ensure that everyone has access to health care and protection from out-of-pocket payments in a pandemic. On Universal Health Coverage (UHC) Day – 12 December 2020 – WHO releases new analyses that underline the importance of extending this principle to all needed health services on a permanent basis.

Financial protection and the Sustainable Development Goals (SDGs)

A new factsheet sets out how failure to address common gaps in health coverage before the pandemic was already undermining national and regional ability to meet targets to reduce poverty (SDG 1.1) and income inequality (SDG 10.1), and move towards UHC (SDG 3.8).

Two coverage gaps have even greater resonance now, in the context of COVID-19 and its economic impact.

First, countries that base entitlement to publicly financed health care on payment of health insurance contributions (rather than residence) find it hard to cover the entire population at the best of times, particularly if the informal economy is significant. This challenge grows in an economic crisis, as people lose jobs or suffer a drop in wages and can no longer afford to pay contributions.

Ensuring that everyone living in a country has health coverage is a precondition for UHC, not an optional extra.

Second, just being covered is not enough. User charges (co-payments) for covered services are a key source of financial hardship in health systems in Europe. Countries can reduce access barriers and alleviate financial hardship by exempting poor households and people with chronic conditions from co-payments. Redesigning co-payment policy allows the health system to target those most in need of protection.

Cyprus fixed its roof while the sun was shining

New WHO analysis of financial protection in Cyprus shows how health budget cuts and coverage restrictions introduced in the wake of the 2008 global financial crisis were associated with a rise in unmet need for health and dental care and a doubling in the number of households with catastrophic health spending. Before the economic crisis, Cyprus already had one of the largest gaps in population coverage because entitlement was linked to income and citizenship. This gap grew from 15% to 25% of the population during the years of the economic crisis, as new rules linked entitlement to payment of social security contributions.

Cyprus has recently redesigned its coverage policy. The new General Health System implemented in 2019 changed the basis for entitlement to residence, allowing all legal residents to be covered for the first time. It also reduced user charges, particularly for low-income people. As a result of removing many financial barriers to access, Cyprus was better prepared to meet the health and economic challenges of the pandemic.

The Republic of Moldova makes progress during the pandemic

Over 10% of the population in the Republic of Moldova lacks health coverage because entitlement is linked to payment of health insurance contributions and the informal sector is significant. Reforms introduced in the last ten years have led to greater use of health services and fewer people reporting unmet need due to cost, but better access to care has also increased people’s exposure to out-of-pocket payments – for example, through heavy co-payments for outpatient medicines and informal payments in hospital. New WHO analysis finds that poor households are at high risk of being uninsured, facing financial barriers to access and experiencing catastrophic health spending.

In working to control the pandemic, the Republic of Moldova has used reserve funds to guarantee free hospital treatment for everyone, regardless of health insurance status. As the longer-term economic disruption caused by COVID-19 becomes more evident, this short-term measure could be turned into a permanent feature. De-linking entitlement to all health services – not just hospital care – from payment of contributions would ensure people do not lose coverage when they need it most. Redesigning co-payment policy will also help to reduce financial hardship.

From crisis response to sustained progress towards UHC

UHC is one of the three priorities in the WHO European Programme of Work. “COVID-19 has caused enormous disruption and devastation, but it has shown us the importance of accessible and affordable health services. No one should be denied the fundamental right to health care,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe. “A commitment to universal health coverage is at the heart of our work at WHO/Europe. We need to mobilize the public and political will to make sure it remains a priority.”

Two policy responses to the pandemic stand out as candidates for permanent change in European health systems: breaking the link between entitlement to health care and payment of contributions, and exempting poor people and people with chronic conditions from co-payments. WHO/Europe will support the efforts of Member States to put universal health coverage at the core of recovery from COVID-19.