All together – stronger health systems for UHC and health security

Now, more than ever, the global public health community must unite behind effective strategies for investing in common goods for health as the foundation for both universal health coverage (UHC) and health security.

This was the central message of a lively joint event, hosted by the UHC2030 Related Initiatives group of health systems networks and collaboratives and attended by over 150 participants on the opening day of the HSR2020 Symposium.

Despite substantial progress in health outcomes in the 21st century, countries everywhere face challenges to manage the COVID-19 pandemic while maintaining essential health services. Dr. Agnes Soucat, Director for Health Systems Governance and Financing at the World Health Organization (WHO) identified a profound global market failure in health. “Globalization has delivered on poverty reduction and wealth but it was a globalization of markets. It delivered on what markets can do, but it did not deliver on what governments should do.” Governments must therefore invest in common goods for health (CGH): shared population-based functions or interventions, such as disease surveillance and planning for health emergencies, that contribute to health and economic progress. [1]

“Covid19 is really the perfect example where externalities are at the core. Even neoliberal economists agree that we need collective action to invest in CGH, yet we don’t see that happening,” said Dr. Josep Figueras, Director of the European Observatory on Health Systems and Policies, who moderated the session.

Meeting participants identified three underlying causes of a lack of investment in CGH. First, a lack of political incentives and short-term thinking. Prevention is not visible, and “immediate” results are more attractive for investment. Second, lack of salience. Without a clearly defined problem of “potential future crises” there is not a perceived solution. Third, lack of collective identity. Collective action requires that we all think we are in the same boat, part of one community of global citizens.

Building on COVID-19 experience, speakers identified opportunities to promote collective action for five categories of CGH: policy and coordination; taxes and subsidies; regulation and legislation; information, analysis and communication; and population services.

Professor Soonman Kwon from the School of Public Health at the Seoul National University explained how policy and coordination combined with a strong health financing system helped South Korea manage COVID-19. This included a strong role for the Korean Centre For Disease Control, adaptation of policies that enabled contact tracing, reinforcing coordination between central and local government, and UHC policies that ensured access to testing and treatment services. These strategies were informed by the country’s previous experience with the MERS epidemic in 2015.

Similarly, Tolbert Nyenswah, Senior Research Associate, Johns Hopkins Bloomberg School of Public Health, discussed how, based on the country’s experience of Ebola, Liberia had invested in its national public health institute and coordination for health security. "The fact that we built emergency systems, invested in common goods for health and engaged with communities helped our response. When governments take collective action, it works," said Dr Nyenswah.

Regulations and laws can help address market failures. Reflecting on public-private collaboration on testing and treatment for COVID-19, Dr. Soucat noted that “inclusion of the private sector through regulations that promote incentives and integration is an essential step. It goes at the heart of having systems that are ready for tomorrow.” 

Strong systems for information, analysis and communication are key to get the right information to the right people at the right time. Professor Kwon explained how National Health Insurance data was used by pharmacies to allocate face masks and prevent shortages. Craig Burgess, Coordinator of the Health Data Collaborative secretariat at WHO, explained that data is a strategic asset for both UHC and health security and emphasized data governance and aligning data and digital tools to national processes.

Collective action on data can also promote trust and accountability to leave no one behind. “For stronger and more resilient health systems, governments should partner with the CSOs in collecting and sharing information amongst each other, as this will help accessing and analyzing information for the most vulnerable and difficult-to-reach communities, meeting their needs, strengthening trust and ultimately fulfilling UHC’s equity agenda,” said Dr. Khuất Thị Hải Oanh, Executive Director, Center for Supporting Community Development Initiatives in Vietnam.

Beth Tritter, Executive Director Primary Healthcare Performance Initiative, discussed investments in primary health care as the first line of defense – including investments in population services to prevent, detect and respond to infectious diseases and outbreaks. “PHC has been largely under-invested in. The answers to the challenges we are facing today are not new, they lay in commitments we made 40 years ago in the Astana Declaration. We need to create incentive structures at the country and global levels that rewards thinking and acting in an integrated manner,” she said.

The session ended on a note of optimism. COVID-19 can be a catalyst for the global public health community to rally together for both UHC and health security goals, based on principles of equity. Oanh Khuat highlighted that, “Covid19 has showed us that leaving no one behind is not only the right thing to do but also a critical thing to do.” Dr. Soucat agreed, concluding “Equity is at the heart of the CGH agenda. It promotes the most vulnerable as CGH are not divisible and not excludable. We need to promote a coherent health system built on engagement of citizens, with strong civil society voice. UHC2030 provides a strong multi stakeholder platform for bringing diverse voices and perspectives for the common goal of achieving UHC, sustaining momentum around UHC commitments, and promoting collective action.”

[1] Common Goods for Health (CGH) are population-based functions or interventions that require collective financing, either from the government or donors based on the following conditions: contribute to health and economic progress; there is a clear economic rationale for interventions based on market failures, with focus on (i) Public Goods (Non-Rival, Non Exclusionary) or (ii) large social externalities.

Resources

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Photo: WHO / Blink Media - Lisette Poole