A new framework for performance analysis
How can we make international health cooperation more coherent, especially with regard to strengthening health systems, responding to the needs of communities, and ending preventable deaths? How can donor countries, specifically, contribute to making health systems resilient and equitable so that no one is left behind?
These questions were the focus of a lively dialogue convened on 13 December by UHC2030 and with the governments of Canada, France, Japan and the United Kingdom. The ongoing COVID-19 crisis has underscored the need for more equitable and resilient health systems that can protect everyone. We urgently need better-directed investment in the foundations of health systems, and a coherent approach based on primary health care that leaves no one behind.
Here are some key messages from the event:
1. COVID-19 reinforces the foundational principle that health is everyone’s business: we must step up international cooperation and solidarity to strengthen health systems
2. Health systems must put people and communities first
3. Focus must be on strengthening primary health care, including core public health functions
4. Strengthening the health workforce is a top health systems priority
5. Coordination and coherent support need to align with countries’ priorities, with focus on results, transparency and accountability
6. For long-term impact, there is a need to move from “support” to “strengthening”
Dr. Githinji Gitahi, Group CEO, Amref Health Africa, moderated the event. He emphasized the links between health security and UHC as twin goals of strengthening health systems. Although domestic public financing is central to achieving the SDGs, official development assistance (ODA) has an important role in helping to strengthen heath systems in low-income countries which face continued fiscal constraints. All countries must come together to ensure coherent action, in line with their UHC Political Declaration commitment. (1) He highlighted that the event will be part of an ongoing dialogue as UHC2030 constituencies identify their contributions to strengthening health systems and hoped that this dialogue will contribute to donors coalescing on key activities and levers to invest “more and better” in strengthening health systems. (2)
Two keynote speakers confirmed the need to step up international cooperation and solidarity to strengthen health systems to help countries reduce deaths from Covid-19 and other causes:
Hon Wendy Morton, Minister for Europe and Americas at the Foreign, Commonwealth & Development Office, United Kingdom, highlighted recent figures from 18 low-income countries that suggest there have been more than two maternal and child death for every official COVID-19 death. She said: “The tragedy is that if health systems had been stronger and more inclusive, many deaths could have been prevented.” She announced new government papers (3) that set out the UK’s contribution to stronger health systems and to cutting the toll of preventable maternal and child deaths.
Rt. Hon Helen Clark, Chair of PMNCH board, spoke about how under-investment in UHC and global health security, which left the world unprepared for a global health emergency such as COVID-19, reflects a failure of international cooperation and the world’s collective response. The disruption the pandemic has caused to health services and communities has set back hard-won gains for women’s, children’s, and adolescents’ health. “Learning from this tragic experience, all countries must strengthen their capacities to respond to emerging health threats. While many countries can fund the necessary investments from domestic resources, low-income countries do need solidarity funding.” she said. She added: “I remain optimistic that with a clear vision and a united approach, we can save millions of lives”.
The event also included several powerful testimonials from communities and civil society. Mumbi’s poem included a strong call to leaders to be about change, not just speak about it, providing a powerful reminder that this is about people, their choices and voices. Snehal, Blue Circle Diabetes Foundation (India), highlighted how a good health care system can improve quality of life if it includes the right to education and information alongside availability and accessibility to medical supplies. Naomi, White Ribbon Alliance (Kenya), explained how the “UHC for me” campaign enabled the UHC government scheme to better respond to community needs, prioritizing vulnerable and marginalized populations such as adolescent girls and people with disabilities.
The panel discussion highlighted how funders can look beyond supporting health services to meaningfully invest in strengthening systems:
Joshua Tabah, Director General for Global Health and Nutrition, Global Affairs (Canada) and Co-chair of GFF Investors Group, suggested that the global focus on vaccine deployment provides an opportunity to redouble efforts to reinforce health systems and essential public health functions with a core focus on developing lasting frontline capacity for primary care. This includes the need to pay attention to specific gender equity and rights considerations to help dismantle barriers to accessing services. He said: “This will only work when recipient countries at the national and sub-national community levels are at the center and when all key stakeholders are engaged in shaping those priorities”. He stressed that donors still have more to do to make sure that both bilateral and multilateral support align with country priorities and they need to be more explicit about their own priorities and requirements. He added: “We need to make sure that all stakeholders are on board, moving in one direction, to get system strengthening done right.”
Stéphanie Seydoux, Ambassador for Global Health (France) mentioned an important lesson learned from reviewing France’s global health strategy. For effective action, it is important to make a distinction between health systems strengthening, which aims at producing long term and sustainable improvements, as opposed to system support, which is about ensuring that health systems in the country continue to deliver services. She made a strong plea for country-driven coordination: “This is an absolute need that we are able to actually go by what national health strategies tell us to do as a donor community, what is in the plan of any given country, what is it that they want to do at their own national level.” She also mentioned greater investment in the health workforce as a catalyst because it brings “a triple dividend: better health care, greater gender equality as women make up 70% of the global health workforce, and contribution to economic growth through job creation.” In this context, she mentioned the Gender Equal Health and Care Workforce Initiative, which France is driving in collaboration with WHO and Women in Global Health (4).
Keiichi Hara, Deputy Director-General, Deputy Assistant Minister for Global Issues, Ministry of Foreign Affairs (Japan), emphasized that contributions to international efforts to overcome COVID-19 and make progress towards achieving UHC involves “developing vaccines and other tools, while ensuring equitable access to health systems, as well as improving health-related issues.” Japan will continue to play a lead role in international efforts to achieve UHC and to collaborate with relevant organizations. Coordination of stakeholders is critical and UHC2030 plays an important role by providing a platform to bring together the voices of multiple stakeholders. He added: “We also expect UHC2030 to contribute to reinforcing accountability across countries in promoting UHC.”
Dr Feng Zhao, Global Practice Manager, Health, Population and Nutrition, World Bank, spoke about the financial challenges low-income countries are facing as a result of both the health and economic shocks stemming from the COVID-19 pandemic. In such a context, allocations of ODA resources will be even more important due to recipient countries’ fiscal constraints. The approach going forward must integrate the health security and health systems strengthening agendas, focus on primary health care, and include ways to address fiscal space constraints through, for instance, additional health taxes and investment in human capital. He said: “The most cost-effective way is to really prevent a pandemic from happening and then contain it while you are still in the early phase.“
- For donor countries to honor their UHC Political Declaration commitment means “to provide adequate, predictable, evidence-based and sustainable finance, while improving their effectiveness, to support national efforts in achieving universal health coverage, in accordance with national contexts and priorities.”
- UHC2030 is facilitating a multi-stakeholder push in support of stronger health systems. Its paper “Leave no one’s health behind: Action on resilient and equitable health systems, for UHC & health security goals“ summarizes a shared health systems narrative and priority actions. This event provides a platform for donor countries, as part of an ongoing dialogue with a wide range of stakeholders, to showcase what it takes to invest in equitable and resilient health systems and make it happen. More here
- UK Foreign, Commonwealth and Development Office’2 position paper: Health Systems Strengthening for Global Health Security and Universal Health Coverage
- Gender Equal Health and Care Workforce Initiative