Beyond COVID-19 (coronavirus): What will be the new normal for health systems and universal health coverage?

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A COVID-19 testing center in Madagascar © Henitsoa Rafalia / World Bank
A COVID-19 testing center in Madagascar © Henitsoa Rafalia/World Bank

The COVID-19 (coronavirus) pandemic has substantial health, social, and economic impacts in all countries, rich and poor. It is a sharp reminder that everyone, everywhere should have access to quality and affordable health services. We will be living with COVID-19 and its consequences for a long time to come.

Health systems now face the dual challenge of responding to the outbreak and maintaining essential services. COVID-19 has reignited a debate from previous health emergencies: how to make health systems sufficiently resilient to manage shocks in ways that protect everyone, especially the most vulnerable?  Where do we need to start thinking differently, and what can we do differently, to be better prepared for emergencies and make progress towards univeral health coverage (UHC)? What is the new normal for health systems and UHC?

The UHC movement has focused on ensuring that health services are accessible and affordable for all. However, achieving UHC also depends on disease prevention, health promotion and emergency preparedness. The measurement of health service coverage, which is the focus of the Sustainable Development Goals indicator 3.8.1, includes International Health Regulations core capacities to detect, assess and report public health events.

COVID-19 demands that we think about UHC as protecting everyone. It calls for a renewed and urgent focus on specific public health actions as the first step towards UHC. This includes special attention to common goods for health – things like disease surveillance, laboratories and diagnosis, health information systems, communications about changing behaviors, engagement of communities and building public trust in the health system. These will largely not be provided by markets, hence they require public financing and collective action. Relative neglect of these areas has left communities more vulnerable to epidemics and other shocks.

As emphasized by the World Health Assembly last month, COVID-19 is a global crisis requiring sustained international solidarity and action. UHC2030 – the global movement to strengthen health systems for universal coverage – has an important role to play in bringing partners together on a joint vision for resilient health systems and priority actions.

UHC2030’s new discussion paper on UHC and emergencies examines the implications of COVID-19 for health systems and highlights key areas where we can take joint action. Its main conclusions are:

1. The new normal for UHC includes greater emphasis on common goods for health

COVID-19 reinforces previous experience that strong health systems based on primary health care are the foundation for health security and UHC.  National policies to promote UHC have sometimes neglected prevention, promotion and emergency preparedness. There’s a strong case to position these public health actions as the first step towards UHC, and a core responsibility of governments.

2. Invest more and better in health – for both health and economic reasons

Countries are facing economic recessions because of the crisis. But the pandemic gives compelling reasons to prioritize health investments now: the costs are small compared with the economic costs of not acting. Health financing policies should prioritize public financing for health and remove financial barriers to services.

3. Seize the moment: opportunities for change can benefit both health security and UHC

The pandemic has shown that the choice is not between health security and UHC: strong health systems, grounded in primary health care, are needed for both. The crisis reinforces the need for global cooperation on priorities including addressing health workforce shortages and ensuring equitable access to new diagnostics , medicines and vaccines. If retained, positive innovations developed during the pandemic – in service delivery models, information technologies, product development, financing, governance, and ways of working – will contribute to progress on both health security and UHC.

4. Local and global movements for shared health goals

Governments need to work closely with local communities as part of the solution to the pandemic; this is also a key lesson from the Ebola crisis in 2014-15. For populations to be better protected in future, governments must create space for communities to participate actively in shaping more equitable health systems.  Strong civil society voices have a vital role in demanding health systems that protect everyone.

These conclusions, and the proposed action agenda that the discussion paper sets forth, are important. Faced by COVID-19, we must all be united in strengthening health systems, especially primary health care, both to respond to emergencies effectively and to reach the whole population, leaving no one behind.    

Read the UHC2030 discussion paper – Living with COVID-19: Time to get our act together on health emergencies and UHC

Watch the recording of the UHC2030 discussion paper launch event

Authors

Agnès Soucat

Director for Health Systems Governance and Financing, World Health Organization

Francesca Colombo

Head of the Health Division, Organisation for Economic Co-operation and Development (OECD)

Join the Conversation

Edward Banka Gariba
July 07, 2020

Thank you very much Agnes, Francesca and Feng for this important discussion paper. I think the discussion and priority areas highlighted are very crucial to achieving universal health coverage. I have established a policy think-tank, non-governmental organization in Uganda called African Centre For Health Reform (ACHR). The ideas discussed in this paper are aligned with the African Centre for Health Reform (ACHR)’s vision “to create a one world where universal health coverage and access to quality healthcare and health services for all is achieved.” It is also aligned with ACHR’s mission “to promote universal health coverage, improve access to healthcare and services, strengthen health systems and improve the health of individuals and populations, via research, capacity building, programming, advocacy and knowledge translation.”

I agreed with you on the last priority area for action: Local and global movements for shared health goals. I am looking for partnership to implement research, programming, capacity building on strengthening public health security, pandemic and emergency preparedness and response, advocacy and knowledge translation on UHC in Uganda and other countries in Africa.
Please can I send you my grant application on AFRICAN CENTRE FOR HEALTH REFORM CAPACITY BUILDING PROJECT (ACHR – CAP). UNIVERSAL HEALTH COVERAGE (UHC) AND ACCESS TO QUALITY HEALTHCARE SERVICES (AQHS) MANAGEMENT PROJECT ?

Thank you in advance for considering. I look forward to hearing from you.

Kind regards,
Edward Banka Gariba, PhD
Executive Director
African Centre for Health Reform
Kampala, Uganda

July 08, 2020

Thank you for your interest. You/ACHR are very welcome to join UHC2030’s Civil Society Engagement Mechanism, a vibrant CSO community that engages with multiple stakeholders to promote progress towards UHC. You can learn more and sign up here: https://csemonline.net/ Other than small grants for specific UHC Day events, UHC2030 is not a funding body.

Dr.Abubakar Said
July 07, 2020

I am glad to join this platform.

Dr Ola AlAhdab
July 07, 2020

Thanks for your need and press about Covid 19

Jeff Tshabalala
July 07, 2020

The difference between SARS, Ebola and HIV is its global reach. For instance, with Ebola and HIV the conversation about weak health systems in the affected regions took centre stage. Interestingly, COVID-19 is pushing us back to the same default conversation. As with with Ebola and HIV the conversation was disease centric. From the lessons learnt from HIV planning, programming and financing the value of integrated systems driven thinking in the design and delivery of resilient and sustainable systems for health became apparent. It imperative that national governments, civil society organizations and global health financing systems build on this rather go back disease centricity. The danger of this happening is real.

Ann Kele
July 07, 2020

The UHC seems very promising for all of us, especially those who are interested in international relations. However I have discovered a week point what is the vulnerability. Anybody can become vulnerable left without access to care or has no right to self protection. Closing healthcare institutions for the patients or to oblige healtcare workers to work without the necessary protective equipments are good examples. The business has started to think and act. The online services have been booming and many of them have become the winners of the pandemic for a short period of time. What about the other participants of the economy ? They have become vulnerable and dependeng on the state Budget.

Dr.Musa Ajlouni
July 07, 2020

Greetings from Amman, Jordan

As a health systems specialist, it is a previllege for me to share with distngushed colleagues from all ountries the latest developments, research, success stories and discussions related to health systems. Special thanks for the World Bank and its dedicated staff for hosting and managing this blog.