Global Health Governance & Health Systems Resilience

• The presentation is about global health governance and health systems resilience

Why Global Health Governance is Important

• Diseases do not respect national borders
• Global interconnectedness is increasing through trade, travel, and communication
• Global health inequities, such as life expectancy, demonstrate the need for governance
• In Central African Republic, life expectancy is 52.8 years
• In Singapore, life expectancy is 85.4 years

Funding

• In 2022, approximately $34 billion USD was allocated to health in low and middle-income countries (LMIC)
• The funds come from high-income countries through the Development Assistance Committee of OECD

International Health Regulations (IHR)

• Legally binding regulations were adopted by WHO in 1969
• They were revised in 2005
• They manage potential health risks that could cross borders

Historic Examples

• The presentation references some examples of diseases, as well as modern public health responses
• Plague from the Medieval ages to 1700
• The "Spanish Flu" Influenza 1918-19
• Smallpox
• SARS
• Bird Flu
• COVID-19

International agreements

• Global Health Governance should be steered by the Sustainable Development Goals (SDGs)
• SDG 3 has the goal of addressing maternal mortality, vaccinating people, and ending major diseases

Key Institutions

• Several institutions are important for global health governance
• WHO - World Health Organization
• UNAIDS – UN organisation against HIV/AIDS
• Unicef – United Nations International Children Emergency Fund
• UNFPA – United Nations Fund for Population Activities
• UNDP – United Nations Development Program
• The World Bank Group (IBRD, IDA, IFC, MIGA, ICSID) allocated $3.4 billion USD for Health, Nutrition and Population in 2019
• GAVI – The Vaccine Alliance
• GFATM – Global Fund on AIDS, Tuberculosis and Malaria
• BMGF – Bill and Melinda Gates Foundation
• Rockefeller Foundation
• Welcome Trust

Other Actors and Stakeholders

• Non-governmental Organisations (NGOs), such as:
  • Red Cross, ICRC
  • MSF
  • Faith-based organisations
• The Private Sector
  • Pharmaceutical industry
  • Manufacturing industry
  • Private providers in health care
• Civil Society
  • Civil Rights Movements
  • Patient organisations

Health Systems and Health Systems Resilience

• According to WHO, a health system consists of all organizations, people and actions whose primary interest is to promote, restore or maintain health
• This includes promotive, preventive, curative, palliative and rehabilitation activities

Why Health Systems are Important

• Health systems that can deliver services equitably and efficiently are critical for achieving improved health status according to the WHO
• The objectives of a health system from the WHO are:
  • To improve the health of the people they serve
  • To respond to people's expectations
  • To provide financial protection against the cost of ill health

Health System Transformations

• The following are health system transformations in the twentieth century (1900-2000)
• Founding of national health systems and extension of social insurance schemes
• There was a transition from "colonial” to national systems
• The Alma-Ata declaration (1978) declared Health for all, with a focus on primary health care and UHC
• From public to private (and Partnerships, PPP)
• Refocus on primary health care

The WHO Health Systems Framework (2007)

• The WHO has defined the elements of successful health systems and their goals
  • Leadership / governance
  • Health care financing
  • Health workforce
  • Medical products, technologies
  • Information and research
  • Service delivery
• These building blocks of health systems contribute to:
  • Access Coverage
  • Improved health (level and equity)
  • Responsiveness
  • Financial risk protection
  • Quality Safety
  • Improved efficiency

Leadership/Governance

• Government actors have a central role in the steering of the health system, since they have a public mandate
• Governance entails policy guidance to the whole health system
• This includes coordination of actors and regulation of different functions as well as accountability

Health Care Financing

• Several approaches exist to achieve this
• Out of pocket
• Public funding (taxes) – Beveridge model
• Social insurance fund (workers and employers pay) – Bismarck model
• National insurance funded by taxes
• Private insurance

Universal Health Coverage

• Universal health coverage (UHC) is present when everyone in a country has access to high-quality health services
• Everyone is protected from major health associated financial shocks via a tax-based financing system or a health insurance plan

Health Workforce

• SDG Target 3.c aims to substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States
• Health system staff are inadequately trained, poorly-paid and work in obsolete facilities with chronic shortages of equipment in low-income countries
• There is a resulting "brain drain” of talented but demoralized professionals to other countries or private practice

Access to Medicines

• Essential medicines are those that satisfy the priority health care needs of the population
• The 2030 agenda is focused on this with the following points:
  • 3.b. Medicines and vaccines: Support the research and development of vaccines and medicines for the communicable and noncommunicable diseases that primarily affect developing countries
• Provide access to affordable essential medicines and vaccines

Systems Thinking

• Systems are dynamic structures of interactions and synergies
• Every intervention, from the simplest to the most complex, has an effect on the overall system, and the overall system has an effect on every intervention
• Systems thinking can provide a way forward for operating more successfully and effectively in complex, real-world settings
• Systems thinking will increase the likelihood that health system strengthening investments and interventions will be effective

Resilience

• IPCC defines 'resilience' as the "capacity of a social-ecological system to cope with a hazardous event or disturbance, responding or reorganizing in ways that maintain its essential function, identity, and structure, while also maintaining the capacity for adaptation, learning and transformation."
• A health system is resilient when it has the capacity to absorb shocks, adapt to changing circumstances, and transform itself when necessary to continue delivering essential health services