Financing health systems to strengthen preparedness for future shocks

How can countries mobilize adequate resources for both the immediate response to COVID-19 and longer-term health system strengthening? This was the key question at a Voluntary National Review Lab on 13 July held during the UN High-Level Political Forum. The event, “Financing health systems to strengthen preparedness for future shocks” was organised by UN DESA Financing for Sustainable Development Office which invited several UHC2030 partners to participate.

COVID-19 has potential to cause three waves of morbidity and mortality: the first is due to the virus itself, the second due to the inability of health systems to provide ongoing essential health services, and the third is linked to the socioeconomic impact. For reducing the human toll of all of these, fulfilling the commitments made in the Political Declaration on Universal Health Coverage adopted by heads of state and government at the UN High Level Meeting in September 2019 is essential.

The pandemic has revealed the fragility of our public health systems and underscored the need to strengthen them. Countries must reprioritize their public spending patterns so as to optimize budgetary allocations on common goods for health and essential services. Increased public health spending, including on testing, tracing, and treatment capacities, can help ease the health impact of COVID-19, and have a multiplier effect on the economy.

This health emergency also serves as a strong reminder that access to quality and affordable healthcare is a fundamental human right. In this context, there is growing momentum for the provision of universal health coverage (UHC) as a means of providing effective health crisis management and ensuring health security, especially for vulnerable populations. According to the World Health Organization, countries must increase primary healthcare (PHC) spending by at least 1% of their GDP to close coverage gaps and meet the health targets agreed under the SDGs.

However, the current environment of declining investments, rising debt risks and protectionism is further constraining government capacities to fund essential public services such as healthcare. Countries need to explore all available financing options in order to respond to and recover from the pandemic.

Agnes Soucat, Director of Health Systems Governance and Financing, World Health Organisation said, "During ‪COVID-19 the use of services is already declining and economic hardships may reverse poverty gains. It is important to invest in the step zero of ‪UHC, which is 'common goods for health'. COVID-19 has shown that the private sector is able to respond quickly to demand but the market cannot deliver some goods and services. Population-based services, funded by taxes, require collective action. In this time of reduced fiscal space, many public 'common goods' interventions do not cost much and can achieve a lot."

Feng Zhao, Practice Manager, HNP, Global Engagement, World Bank Group said, "How do we best invest in the new version of resilient health systems to address health shocks? The question is not to invest in Intensive Care Units and hospitals to mitigate the impact but more to invest in health systems that are multi-sectoral and focused on ‪PHC. We have a lot to do in the efficiency agenda to strengthen the ‪PHC system, and reimagine it by integrating public health in this system "

Haruka Sakamoto, Department of Global Health Policy, University of Tokyo said, “In Japan, public health centres have played a central role in ‪COVID-19 management. Public finance has covered all costs for testing and treatment. Japan’s universality has resulted in early detection, isolation and treatment of COVID-19 patients. Equity is an essential value for the health care system. How do we secure equitable access for all? We need to assess core values in order to invest in health systems that work for everyone.”

Emmanuel Odame, Director of Policy Planning, Monitoring and Evaluation at the Ministry of Health, Ghana said, " We should look at the design of our systems and environment. How do we get new leaders to make sure we navigate a new path? This is the time to make sure we get things right. You cannot have health insurance reform without having service delivery reform. Individual reforms cannot happen on their own. Now we are also thinking about common goods for health along our objectives for the health sector. "

Trevor Gunn, Vice President, International Relations at Medtronic said, "Private Public Partnerships are for the long-term, and both partners need to strengthen their own internal systems significantly. Companies need to go from just producing things to cooperating and solving problems that society faces. The public and private sector can together build resilient health care systems. Practical issues can be hard to deal with, such as physical and human infrastructure, but we have to work in partnership to find solutions."

Emilia Saiz, Secretary General of the United Cities and Local Governments, and member of the UHC Movement Political Advisory Panel said, “There is a lot of benefit in good private public partnerships but governance is critical. Common goods need to remain common goods. A higher level of management is needed by the public authorities who are elected by the people to manage common goods. Our systems are not thought out for health and well-being. We need to collaborate and engage citizens. We must invest more in foresight to identify where situations can emerge."

Navid Hanif, Director, Financing for Sustainable Development Office, UNDESA, who moderated the event, made three key points drawing on the discussion. “Firstly, four out of five citizens believe that all systems are not working for everyone. Systemic change is needed. Secondly, solidarity is not altruism, it is self-interest. Collective action and global engagement are essential if we want to humanity to make progress. Thirdly, all sectors are willing to come together to finance the health sector. It requires effort from all parts of society. We cannot afford to leave anyone behind. It requires foresight, risk management, sharing plans and execution for results.”

Photo: © WHO / Blink Media - Gilliane Soupe