"Health systems strengthening" is defined as a process to improve and expand the structural foundation, such as administration and finance, human resources, facilities, materials and equipment, that provides both public health and medical services to people in need. Health systems strengthening is essential to achieve UHC, which aims both at preventing financial catastrophe due to medical costs and at addressing geographic, financial, and sociocultural barriers to essential health services.
Together with the Japanese government, JICA has contributed to advocating UHC in global health and development through many international conferences and events. Eventually, achieving UHC was explicitly incorporated into the SDGs. In fiscal 2015, JICA participated in side events at the United Nations General Assembly in September and the World Bank Annual Meeting in October. It also co-organized the International Conference on Universal Health Coverage in the New Development Era: Toward Building Resilient and Sustainable Health Systems, in Tokyo, with the government ministries and agencies concerned. At the conference, JICA stressed the importance of achieving UHC and set out its future strategies for the high-level participants. In addition, JICA worked with the World Bank and WHO to provide training for people in Frenchspeaking countries and mutual training designed to build the capacity of experts from these three organizations.
To steadily deliver on internationally agreed goals, JICA also put effort into bilateral assistance to Kenya and other countries. It is now formulating a comprehensive UHC program for Senegal like the one for Kenya. In Cambodia and Viet Nam, JICA conducted studies with a view to supporting social health protection programs. In Latin America and the Caribbean, JICA continued to support the strengthening of community health systems that build on primary health care. It also organized an international forum in Paraguay to share the knowledge and experience of JICA and other organizations.
Approximately 99% of the 300,000 pregnant women who die during pregnancy or childbirth and the 5.9 million children who die before reaching their fifth birthday every year live in developing countries. This fact indicates that the health and wellbeing of pregnant women and young children is the most serious issue in developing countries.
In fiscal year 2011, JICA prepared a thematic guideline for maternal and child health and has been extending its cooperation to many countries for strengthening health systems that make a comprehensive "continuum of care for maternal and child health" more widespread and sustainable. JICA's measures include: reinforcing administrative and management capacity of health ministries for the extension of mother and child health services; building capabilities of local health authorities; strengthening capabilities of midwives and other health service providers; empowering the community and raising their awareness; and strengthening the coordination among health centers and primary and referral health facilities.
JICA also puts emphasis on contributing to achieving UHC through expansion of maternal and child health services. JICA assists developing countries in introducing a Maternal and Child Health (MCH) Handbook as a tool for promoting the comprehensive continuum of care for MCH. International efforts have been made for mutual learning about this tool. In September 2015, for example, the International Conference on MCH Handbook was held in Cameroon, attended by many people involved in JICA's technical cooperation projects, Japan Overseas Cooperation Volunteers (JOCVs), and other counterparts.
Moreover, since malnutrition among pregnant women and infants has a serious impact on their health condition, emphasis is placed on cross-sectoral nutrition improvement measures that involve sectors other than health, including agriculture, education, and water and sanitation. A case in point is the Scaling-Up Nutrition (SUN) Movement, a global multi-actor initiative designed to deliver effective measures. JICA participates in the SUN Donor Network and promotes nutrition improvement activities. In fiscal 2015, JICA continued to provide issue-specific training on improvement of maternal and child nutrition for the SUN member countries and country-specific training for Ghana, both of which were initiated in fiscal 2014. At the same time, JICA launched a capacity building training program for Japanese personnel.
As the Ebola outbreak in West Africa in 2014 gradually subsided, the international community shifted its focus of assistance to recovery assistance. It also learned the lesson that the failure to observe the International Health Regulations (IHRs) and weak health systems had accelerated and prolonged the epidemic. Based on this lesson, the international community recognized the need to build the capacity to observe IHRs, through such means as strengthening laboratory systems and surveillance and training human resources, and establishing resilient health systems through such capacity building.
For its part, JICA conducted a range of activities aimed at strengthening health systems in an integrated and sustained manner. They included technical cooperation designed to build vaccine manufacturing capacity and strengthen routine immunizations; loans for procurement of vaccines, including polio vaccine; the development of rapid diagnosis kits and early warning systems; and improvement in surveillance and laboratory capacities. JICA also contributed to infectious disease control in different regions by working with the regional hub laboratories that JICA has long been supporting, which include the School of Veterinary Medicine at the University of Zambia, the National Institute of Hygiene and Epidemiology in Viet Nam and the Noguchi Memorial Institute for Medical Research in Ghana.
Private-sector technologies, including effective vaccines and medicines and rapid diagnostics, are essential for infectious disease control. JICA has launched projects that involve these technologies in controlling tuberculosis.