The Resilient Health Systems discourse at the 68th World Health Assembly

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Dr. Remco van de Pas

The 68th World Health Assembly, the annual gathering in Geneva of the 194 member states that govern the World Health Organization, finished earlier this week. . The theme of this year was ‘building resilient health systems’. This is not surprising given the impact of the Ebola epidemic in Western Africa and the ensuing debate on the role of the World Health Organization in (mis-)managing the early stages of the epidemic, and, relatedly, on the need to strengthen both WHO and health systems in relation to future outbreaks of (re-) emerging infectious diseases.

Margaret Chan, the director General of the World Health Organization, was (as always) crystal clear in her opening speech at the World Health Assembly:

Countries need well-functioning health systems that can withstand shocks, whether these are caused by a changing climate, a runaway virus, or an overload of patients with non-communicable diseases”

and

UHC serves the health goal (Proposed Sustainable Development Goal no.3) as well as a unifying concept, a platform for the integrated delivery of health services, and one of the most powerful social equalizers among all policy options”.

In the wake of the Ebola epidemic, the WHA agreed upon establishing a global emergency health workforce to respond rapidly to adverse health events and the creation of a USD$100 million emergency contingency fund to facilitate the WHO’s rapid response. Moreover, all agreed that countries, including those in West Africa affected by Ebola over the last year, should develop (and be supported to develop) a resilient health system.

Perhaps one should mention that due to this year’s WHA focus on Global Health Security (which also included amongst others Anti-Microbial Resistance (AMR) and the International Health Regulations (IHR)), there was less space to discuss international policies and progress made on the path towards Universal Health Coverage (UHC). Yes, UHC was discussed as part of health in the Sustainable Development Agenda and during a side event organized by the Civil society network Action for Global Health, but all in all political attention for UHC seems to have decreased a bit, at least when it comes to rhetorics.

According to WHO and the Rockefeller foundation, that shouldn’t necessarily be a problem, though. Strengthening health systems in order to make them more resilient and policies for Universal Health Coverage are framed as a two-pronged approach that enhance and build on each other. In a recent conceptual article in the Lancet by Kruk et al (on what a resilient health system entails), synergies are described as follows:

This approach is most feasible where universal health coverage (UHC) is in place, which is why UHC is an essential resilience measure. Universal health coverage promotes broad-based provision of health services, and protects vulnerable families from financial hardship and helps to ensure health-seeking behaviour during normal times.”

David Heymann and colleagues, in another article on UHC and global health security, make the case that health security must be framed in a wider approach of human security and argue for a ‘Bismarckian’ approach that links national security to collective state action to ensure health and social security of individual workers.

The main question for me after attending this WHA is whether this integrated and supposedly complementary approach of resilient health systems and UHC will indeed materialize at the national level. This depends of course on the political decisions made by countries, and on available resources and policy space. In addition, like it or not, but the aim of a resilient health system; “to protect human life and produce good health outcomes for all during a crisis and its aftermath” is different from the universal, rights-based and equity oriented approach of UHC, with financial risk protection and quality health services as the main objectives.

A discourse analysis of the two concepts (resilient health systems and UHC), including the role, political economy, framing, policies and implementation by the different (international) actors seems much warranted in LMIC settings, including in the context of Uganda’s national health policy, comparing also with other countries. Obviously, the global governance of these issues at the international level is also a relevant research topic.

Dr. Remco van de Pas, is a Researcher in the Department of Public Health, Institute of Tropical Medicine (ITM), Antwerp

Follow him on @Rvandepas

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