Equitable Health System Resilience to Attain Universal Health Coverage

December 5, 2022

The COVID-19 pandemic exposed fragilities and weaknesses of health systems regardless of countries’ geography or wealth. An April 2021 World Health Organization National Pulse Survey assessed the continuity of essential health services during the pandemic in 135 countries. The survey revealed over 40% of all countries reported disruptions in availability of and access to quality services and 48% reported disruption in primary health care services. High-income and upper-middle income countries reported an average 22% and 39% disruption of health services respectively. Even moderate interruptions of health services delivery and utilization can result in worsened health outcomes. Nations must address systemic weaknesses so their health systems can absorb, adapt, anticipate, and transform when exposed to external threats. Such resilience will enable the systems to maintain their primary objectives and functions: healthy outcomes for all citizens.

A resilient system is the foundation for achieving the vision of Universal Health Coverage (UHC), which we celebrate on December 12, the 10th anniversary of the United Nations’ endorsement of healthcare for all. Ensuring resilience means adopting strengthening measures with an eye toward equity for marginalized groups without access to quality health care. They can unwittingly infect the rest of the population, undermining efforts to control pandemics. Including more people in the health system thus serves the goals of increasing resilience, increasing equity, and moving toward UHC.

For example, in responding to the double challenge of the COVID-19 pandemic and influx of Venezuelan migrants, equity and inclusion were hallmarks of the Colombian government efforts to support Venezuelan migrants’ access health services, an initiative U.S. Secretary of State Antony Blinken recognized during his visit to a Venezuelan migrant service center serving 644 migrants. “We are working side by side with Colombia in the spirit of the LA Declaration on Migration and Protection,” Blinken tweeted.

The government adopted participatory processes that engaged communities, especially women and migrants’ groups. The goals were to strengthen availability of migrant data, support the enrollment of 91,000 migrants in health insurance, and promote infection prevention, control measures, and surveillance strategies at 14 territorial entities. These inclusive interventions resulted in better access to health services, reduced the morbidity and mortality from COVID-19, lowered transmission, and strengthened system resilience for both Colombian and Venezuelan populations.

How can countries uphold UHC through equitable system resiliency?

Policymakers must look beyond health systems to achieve equity in resilience efforts, however. What’s needed is a whole of society approach that incorporates systems thinking and multisectoral strategies in the design, implementation, monitoring, and adaptation of interventions. These approaches will expand the role of marginalized populations, communities, civil society organizations, and the private sector as active players in decision making that shapes the health system.

Systems thinking addresses challenges as part of a wider dynamic system, incorporating the linkages, relationships, interactions and behaviors among the system elements and actors. One tactic is greater inclusion, which can lead to consideration of a country’s political, economic, societal, and cultural complexities that hinder achievement of UHC. Engaging all relevant players will promote diversity, bring different and innovative perspectives to the table, and identify non-obvious systemic barriers. It also will encourage feedback loops and strengthen continuous learning and adaptation.

In Ukraine, for example, to respond to the impact of the Russian invasion on access to health services, the Local Health System Sustainability Project helped the government strengthen telemedicine governance to advance equitable access to health services. Recognizing the contextual complexity, LHSS supported the establishment of an interagency working group that included telemedicine finance, technical, clinical, and patient stakeholders and connected them to facilitate their dialogue. This inclusive approach produced transparent and equitable decisions to create a more resilient system that enabled more people to have access to health services through telemedicine.

Governments must also use a multisectoral approach and avoid a narrow focus on to health issues since human health is intricately connected to a larger ecosystem. When humans encroach on animal habitats, for example, we risk spillover of novel and unpredictable diseases from animals. And air, land, and water pollution can aggravate health conditions, leaving people more vulnerable to pandemic outbreaks.

Tanzania’s National One Health Platform addressed broader threats comprehensively. The platform connected different ministries, institutions, technical working groups, and the disaster management council. This reinforced collaboration, coordination, and communications among the organizations during responses to public health emergencies.

Consider the rapid reaction to an Anthrax outbreak in 2016 in the northern Arusha region. The response included interviews with households and livestock keepers, sampling of decomposing wildlife carcasses, and laboratory testing. The multisectoral strategy enabled health system actors to recognize that the behavior and social characteristics of diverse groups put them at varying levels of risks in their exposure to animal and environmental threats. Identifying those inequities paved the way for interventions tailored to those most vulnerable. The investigation led to a recommendation to reduce human and livestock interaction without disrupting access to and availability of essential health services.

For decades Abt has designed tools and solutions that promote integrated, equitable, and sustainable results. As global organizations work to achieve UHC, we will continue to support their efforts. As more and more countries increase their health systems’ resilience and improve access to medical services, the world can move closer to quality healthcare for all.

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