How to strengthen health systems for UHC and equitable access to Covid19 tools:

Only 0.3% of COVID-19 vaccinations so far are in low-income countries, while 90% of countries report disruptions to health services due to the pandemic. There is therefore an acute need to invest in health systems to support the ongoing COVID-19 response – especially to promote equitable access to COVID-19 vaccines, tests and treatments – and to protect other essential health services and make progress towards universal health coverage (UHC).

To help identify and promote priorities for action, here are eight lessons from the UHC2030 Related Initiatives:

1. Leverage Primary Health Care for vaccine rollout and other essential health services

PHC plays a key role in ensuring access and continued provision of essential health services for all. PHC’s focus on people- and community-centered approaches is especially important to widen access to COVID-19 tools, including vaccines, and build trust and vaccine confidence.

The Primary Health Care Performance Initiative (PHCPI) has launched several resources on PHC in the COVID-19 response, including  ‘Improvement Strategies’ (developed with Ariadne Labs) that compile latest guidance and country experience on PHC and vaccine delivery, and COVID-19 key messages to help stakeholders communicate effectively about PHC-based vaccine efforts. PHCPI also hosts Allies Improving PHC, a diverse group of over 40 organizations committed to advancing PHC on the road to health for all – join us here.  

2. Prioritize Common Goods for Health

COVID-19 has reinforced the importance of investing in essential public health functions such as strengthening disease surveillance and improving planning & regulations for health emergencies. These are examples of Common Goods for Health, i.e. functions and services that markets do not sufficiently provide but which have major impacts on health.

The Health Systems Governance Collaborative (HSGC)’s “Building the Reset” initiative has highlighted how countries and the world can move forward from COVID-19 by investing in Common Goods for Health, prioritizing UHC, and promoting inclusive social development.

3. Support the health workforce: invest in and protect those who protect us all

The health workforce is of course crucial for vaccine rollout and all other health services. Protecting, training and empowering health workers, including equipping them to be trusted community role models on vaccination, is vital for all health system capacities. Some emergent lessons from the Global Health Workforce Network (GHWN) are here.

To build political commitment and collaborations to empower the health workforce, GHWN is promoting the Year of Health and Care Workers. Specialized GHWN ‘hubs’ are leading events and forums to share best practice. The Youth Hub is supporting young health and care workers and students to take an active role in pandemic response and recovery, and hosted a Building a Resilient and Adaptable Youth Health Workforce event. The Health Labour Market Hub is developing country case studies from Africa and Latin America to assess the effect of COVID-19 on health workers, and policy responses. The Gender Equity Hub shared in this blog some important evidence and actions needed to improve gender equity and promote leadership in the health workforce.

4. To get money where it is needed, align public financial management with health financing policies

COVID-19 has reinforced the urgency of adjusting and scaling up public financial management mechanisms that enable rapid release of funds towards health priorities. Countries increasingly face questions of not only “how much” but also “how to” channel necessary funds to widen access to COVID-19 tools.

The social health protection network Providing for Health (P4H) is gathering and promoting global and country evidence on health financing in the COVID-19 response – with insights here on PFM to support vaccine roll out. Other blogs cover health system preparedness and response to COVID 19, COVID-19’s impact on health financing and health service utilization in South Korea, and lessons from Uganda’s purchasing arrangements and voucher system.

5. Strengthen data and information systems to guide decision making

Technology and digital systems can help accelerate the flow and use of data and information at all levels of health systems and move us closer to getting the pandemic under control. For example, better data and information on demand and supply forecasting, monitoring of vaccination rollout, side effects will support informed decisions at all levels. Effective data monitoring systems are vitally important to track access to COVID-19 testing, treatment and vaccines.

Health Data Collaborative (HDC) is continuing to provide countries support to strengthen underlying health information systems in the COVID-19 context. Working closely with the SDG3 GAP, HDC has supported dialogue in Malawi and Nepal on how to better use data and digital efforts to effectively monitor the response to COVID-19. The HDC has stimulated country dialogues with Kenya, Tanzania, Uganda, Malawi, Nepal and Zambia over the last four months, to prioritize data and digital efforts within overall UHC country strategic plans plus leverage COVID-19 data assets with wider efforts towards equitable PHC.  

6. Support policymakers with practical guidance based on research and evidence

The Alliance for Health Policy and Systems Research is advocating for better use of evidence in decision-making, especially evidence that is co-produced with stakeholders including patients and the public, health professionals, health system managers, and policy-makers. 

Recognizing that the pandemic has also exacerbated existing inequities, the Alliance supported the EMRO Commission on Social Determinants of Health to publish its new report, Build back fairer: achieving health equity in the Eastern Mediterranean Region, which highlights the ways that countries in the region can “do something, do more and do better” – in other words they can introduce policies to tackle inequity, expand programmes that are helping and improve existing policies and programmes.

Health Systems Global (HSG) hosted the Sixth Global Symposium on Health Systems Research (HSR 2020) between November 2020 and March 2021, engaging 2,350 researchers, practitioners and policymakers from 125 countries. HSR2020 came at a crucial time for health systems worldwide. It provided a forum for critical and creative thinking and collaboration to address COVID-19, strengthen capacities and improve equity and access in the face of the pandemic, and build stronger and more resilient health systems. HSG, through its 1,700+ membership, continues to share evidence, learning and insights from the COVID-19 response in different national and thematic contexts, and through its Wakelet collection, is providing focused resources on COVID-19 and the implications for health policy and systems.  

7. Promote cross-country learning and information sharing

Much can be learned from how different countries have responded to the pandemic. Even countries considered to have “strong” health systems have faced significant challenges. It is important to analyse and identify prior investments and capacities that contributed to successful responses.

Depending on its health systems context, each country has a unique approach to promoting access to COVID-19 tools. It is valuable to learn about different countries’ experiences and methods. The Joint Learning Network (JLN) is helping countries share experience, including through its COVID-19 Network for Open Dialogue (NODE), and sharing learning on topics such as improving global health procurement, healthcare system integration, and the role of provider payment mechanisms in pandemic preparedness. Its synthesis of best practices in PHC financing brings together peer-to-peer learning from six countries, highlighting both contextual and unique approaches and common themes throughout the world. To find out more, join the JLN’s mailing list.

8. Respond to emerging countries priorities in an agile way

Now more than ever, all partners need to work in solidarity and coordinate their efforts to support governments in responding to COVID-19, providing essential health services and strengthening preparedness and resilience to future health emergencies.

From the beginning of the COVID-19 pandemic, the UHC Partnership, one of WHO’s largest platforms for international cooperation on UHC and primary health care (PHC), has been working with more than 115 countries across the 6 WHO regions to ensure that shifting priorities are addressed in an agile way. Flexibility in funding and technical assistance, combined with a bottom-up-approach, has enabled the timely delivery of WHO’s expertise on major pillars of health systems strengthening, noncommunicable diseases and health security where they are most needed. This also ensures that efforts are fully aligned with the COVID-19 response, that countries are supported to get back on track in achieving their UHC goals and continue to build equitable and more resilient health systems based on reinforced PHC. Country experiences and lessons learned are captured in this special series of stories from the field and videos on building stronger health systems and pushing for UHC in the COVID-19 context.

The UHC2030 Related Initiatives will continue to share lessons learned during the COVID-19 response and enhance common approaches for strengthening health systems that protect us all.

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Convened by UHC2030, the Related Initiatives are a group of global partnerships, alliances and networks that focus on strengthening comprehensive or specific areas of health systems towards UHC.  Find out about the UHC2030 Related Initiatives in this information pack.

See more contributions from the UHC2030 Related Initiatives blog series & news articles here

Photo: © WHO / Blink Media - Hannah Reyes Morales