With COVID-19 leading to setbacks in health gains, the WHO released a position paper on building health systems resilience towards UHC and health security during COVID-19 and beyond to reinforce national and global commitment to make countries better prepared and health systems resilient against all forms of public health threats for sustained progress towards Universal Health Care and health security.
The WHO in the paper says that the commitment required an integrated approach to building and rebuilding health systems that serve the needs of the population, before, during and after public health emergencies. It encompasses capacities for
- essential public health functions that improve, promote, protect and restore the health of all people;
- building strong primary health care as a foundation for bringing health services closer to communities;
- all-hazards emergency risk management that strengthens the ability of countries to prevent and tackle health emergencies, and can surge to meet the additional health security demands imposed by health emergencies;
- engaging the whole-of-society so that all sectors work together towards a common goal of health for all.
The WHO says that the world has not learned from previous epidemics, and overreliance on reacting to events as they occur, rather than on prevention and preparedness, has meant that countries were caught unprepared for a pandemic of this speed and scale.
WHO Director-General Dr Tedros Adhanom Ghebreyesus said; “we cannot build a safer world from the top down; we must build from the ground up. Preparing for, preventing, detecting and responding rapidly to epidemics starts with strong primary health care and public health systems, skilled health workers, and communities empowered and enabled to take charge of their own health. That must be the focus of our attention, and our investment.”
The WHO has come up with seven recommendations in the position paper for medium and long term, positioning health within the wider discussions on socioeconomic recovery and transformation.
1. Leverage the current response to strengthen both pandemic preparedness and health systems:
- results from intra-action and after-action reviews and multisectoral reviews to inform sustained investment in health system strengthening
- identifying and mapping existing resources and weaknesses in capacities to determine priority needs
- updating country preparedness and response plans and socioeconomic recovery plans; embedding policies and planning for emergency management within wider efforts to strengthen health system
- ensuring wider stakeholder participation in intra-action and after-action reviews underpinning One Health approach.
2. Invest in essential public health functions including those needed for all-hazards emergency risk management
- increasing investment to address critical gaps in EPHF; conducting EPHF and IHR capacity assessments as part of multisectoral reviews of health system and public health capacity
- strengthening health and public health professionals’ competencies in the EPHF and their role in emergency management
- Conducting policy dialogue to promote the embedding of EPHF in administrative structures.
3. Build strong Primary Health Care foundation
- ensuring strong political commitment and leadership to place PHC at the heart of efforts to attain UHC, health security and the United Nations Sustainable Development Goals
- implementing health services planning and organization modalities that promote quality, people-centred primary care and the EPHF at their core
- ensuring adequate and sustainable quality, competency levels and distribution of a committed and multidisciplinary PHC workforce
- ensuring that health system financing arrangements that prioritize essential services and PHC appropriately
- investing in safe, secure, accessible and sustainable PHC facilities that provide high-quality services
4. Invest in institutionalized mechanisms for whole-of-society engagement
- reviewing existing mechanisms for the whole-of-society engagements
- developing institutional and legislative instruments to mobilize whole-of-government and whole-of-society resources
- advocating, mainstreaming and monitoring whole-of-society approaches in emergency preparedness, response, essential health services and recovery efforts
- developing health workforce capacity for engagement with and empowerment of the population
- adapting policies and planning with monitoring and accountability, underpinned by national legislation, to mandate the role of and support for local governments
- supporting global mechanisms to ensure equitable access to products in limited supply
5. Create and promote enabling environments for research, innovation and learning
- enabling regulatory environments
- maintaining and adapting innovative models implemented during the pandemic encompassing infodemics
- providing regulatory support to facilitate inter-country and intra-country information management, data-sharing and coordination
- promoting research, innovation and learning in all-hazards emergency risk management and health system resilience.
6. Increase domestic and global investment in health system foundations and all-hazards emergency risk management
- identifying existing capacities to determine the needs for long-term health system strengthening to maintain essential health and social services including non-communicable diseases and mental health and health emergency preparedness
- creating legislation and policy frameworks to increase and sustain the fundamental requirements for health systems and emergency preparedness
- prioritizing investment and financing for public health and health security with consideration for countries under protracted instability and fragile systems and governance, based on identified capacity gaps and lessons learned
- leveraging investment in non-health sectors to support the strengthening of public health capacity.
7. Address pre-existing inequities and the disproportionate impact of COVID-19 on marginalized and vulnerable populations
- guaranteeing access to safe and high-quality health care by mobilizing additional public funds and safeguarding and extending coverage of health protection and health care provision mechanisms
- ensuring engagement, participation and considerations of vulnerable socioeconomic groups
- supporting financial protection for vulnerable populations by pursuing social protection policies to ensure income security
- monitoring inequities in health and access to health care to inform policies, planning and investment; and, in fragility, conflict and violence (FCV) settings, exploring common concerns, challenges and opportunities to strengthen the FCV triple nexus