Reimagining governance, policies, and investments for global health COVID-19 shows just how fragmented and underfunded health systems are worldwide. It’s time for a radically reimagined approach to governance for global health. Gostin and Friedman have argued that “robust national health systems, a 21st century WHO, a strong IHR with state compliance, and sustainable human and financial resources would transform the global health system”. Drawing from further recommendations in the annual reports of the Global Preparedness Monitoring Board, essential public health functions (ie, core capacities for GHS and IHRs) should be properly funded and integrated into national health systems that are rooted in UHC to ensure inclusive and continuous health services before, during, and after outbreaks. The framework of UHC, building on key commitments in the UN political declaration of the High-Level Meeting on Universal Health Coverage, should expand to include multisectoral, multistakeholder, and comprehensive activities at all levels of governance to control outbreaks while maintaining routine health services and addressing social determinants of health.
Further benefits of such a system include diverse decision making, increased public demand for health-care services to facilitate early disease detection, reduced risk of poverty, locally accessible health services, and enhanced trust, which is crucial to collaboration and public compliance with state-led interventions.
Incorporating the vision of the Healthier Societies for Healthy Populations Group (ie, to evolve our societies to enable people to stay healthy) in COVID-19 contexts ensures that the social determinants of health are reflected in accompanying economic and welfare policies, thus further enhancing response strategies.48 Notably, despite being initially praised for its effective COVID-19 response, Singapore has since seen a spike in cases originating from pre-existing overcrowded dormitories housing migrant workers. This spike emphasises the costly consequences of overlooking marginalised communities, signalling that, without careful consideration of socioeconomic measures to support groups that are susceptible to disease and vulnerable to the disproportionate effects of socioeconomic inequity, clusters of outbreaks might be inevitable. Furthermore, the US practice of tying health coverage to employment has left many people especially vulnerable as unemployment rates escalate due to the pandemic.
In recognition of the importance of social approaches in tackling infectious diseases, some US states have thus extended coverage to homeless and migrant communities and deemed psychosocial facilities and women’s shelters as COVID-19 essential services. Although breaking the cycle of panic and neglect, which is necessary for sustained GHS, might be unlikely, re-envisioning UHC as the foundation for solidarity and action, including for health security and healthy societies, offers a necessary path forward in the world after COVID-19. A system with programmes for social protection, cost-effective PHC, inclusive leadership, and adequate public financing can guarantee quality services for all, especially in fragile contexts where poverty, overcrowded housing, and inadequate resources make communities most susceptible. In the recovery from COVID-19, economic fallout and public fear might push countries to favour isolationist approaches to health, favouring privatised health care and quick fixes to provide the illusion of health security. Donors and advocates should be wary of overly securitised or neoliberal solutions that have long restricted both GHS and UHC, instead backing truly universal, publicly financed, and country-owned health systems that promote health equity and upstream determinants of health to leave no-one behind.
This expanded implementation of GHS capacities that are embedded and delivered through UHC can be developed along four core recommendations: integration, financing, resilience, and equity. Integration: build robust GHS capacities into comprehensive UHC systems Because national systems “lack interconnectivity”, decision makers and health experts struggle to work across the resulting “self-protecting silos” of health specialties, which are sometimes purposefully kept distinct to prioritise one area of the health system over another.5Subsequently, poor communication and collaboration across institutions and national health systems means that unifying GHS and UHC policies at all levels of governance is a monumental challenge.
However, analyses offer important insights on where synergies might be possible. Both GHS and UHC mitigate risk, obligate states to realise a human right to health, can be supported through efforts to strengthen health systems, and overlap in their focus on health workforce, access to medicines, and financing or financial risk protection.5 It is well understood that the skills and infrastructure needed for the two systems are mutually reinforcing; an opportunity exists to re-examine obvious areas, such as fortifying the national surge capacity of the health workforce as a connection between prevention and health-care delivery or integrating emergency health information systems with routine surveillance networks and other national databases.
Notably, countries with a poor track record of UHC, such as the USA and Ireland, have begun implementing UHC-style policies for outbreak response, including leveraging federal funds to provide COVID-19 testing that is universally free. These actions also suggest that the crisis might offer an opportunity to embrace reforms for UHC as a foundation for health systems that are unified and sufficiently publicly funded. This opportunity reflects the WHO conceptual framework that portrays a cyclical relationship between quality UHC and GHS, with the pattern appearing to hold true during the ongoing COVID-19 response across low-income, middle-income, and high-income countries.
Source : Lancet.