An inclusive plan for healthcare systems to be built back better

The covid crisis is not over—far from it. We have many more months ahead. Global vaccine inequities continue to be a challenge, causing avoidable disease and death, and risking the emergence of new variants. If you are eligible, get vaccinated. Whatever one’s vaccination status, continue to take precautions: Wear a mask, wash hands and watch your distance. Avoid crowded places, close-contact settings, and confined or enclosed spaces. We must not let down our guard.

The pandemic will soon enter its third year. In addition to covid-19, the region faces a range of pressing threats, from emerging and re-emerging diseases to natural disasters and climate-related weather events. In 2021 alone, India, Indonesia and Timor-Leste have had to respond to floods. Indonesia and Nepal responded to earthquakes. In all countries of the region, the need of the hour is to strengthen capacities to prevent, prepare for, respond and recover from covid and other health emergencies, and to accelerate progress in all areas of health, towards our eight Flagship Priorities and health-related Sustainable Development Goals (SDGs).

We know what is required. Strong health systems that are primary health care (PHC)-oriented, and which leave no one behind, resulting in populations that are healthier, more productive and financially secure. Resilient health systems are the bedrock of emergency preparedness and response, and ensure that when acute events occur, essential health services can be maintained.

In ordinary times, a dollar spent on PHC-oriented health systems yields an average ‘return’ of at least nine to one and in lower-middle-income countries, that return can more than double, which in turn could accelerate progress on other SDG targets, like zero poverty, decent employment and gender equality. Consider that in September 2020, the Global Preparedness Monitoring Board, an independent group of global leaders, estimated that it would take the world 500 years to invest as much in preparedness—including on PHC-oriented health systems—as it was losing on account of covid-19.

Countries of the region unanimously agree that action to build back better essential health services cannot and must not wait. And they have a clear plan on how it should be done, as detailed in a declaration issued at the 74th Session of the WHO Regional Committee.

First, health leaders will mobilize leadership and accountability across sectors, with full recognition of the need for a health-in-all-policies approach that addresses social, economic and environmental determinants of health, and which empowers communities. Governance of the health sector in particular will be strengthened, including through greater oversight and engagement with the private sector and civil-society organizations.

Second, increased public investments in health that are allocated towards strengthened PHC services, enhanced human resources for health, and increased access to essential medical products. Since 2019, the WHO has advocated that all countries globally increase spending on PHC by at least 1% of gross domestic product.

Third, better integration of health emergency and disaster risk management strategies, as well as public health emergency preparedness and response capacities, with PHC services. Based on years of experience responding to health emergencies, countries of the region agree that to be effective, an emergency response must be embedded within affected communities and existing health structures, reducing response times, empowering local networks, and responding to on-the-ground needs as and when they arise.

Fourth, leveraging the potential of traditional systems of medicine, as well as key innovations in digital and disruptive health technology. We must draw on our past in a way that is safe, effective and well regulated. We must embrace our future in a way that is appropriate and sustainable, and which integrates technologies into existing systems.

Fifth, strengthening partnerships. Covid has shown that robust and reliable bilateral, multilateral and public–private partnerships are critical to emergency responses and to maintain essential health services. Such partnerships must continue to be strengthened, not only to anticipate and respond to emerging needs, but to feed into and support an overall vision that is cohesive, and which is aligned with our long-term targets and goals—our Flagship Priorities and SDGs.

We have before us a once-in-a-century opportunity to strengthen and transform health systems, accelerating a health and economic recovery that is more equitable, resilient and sustainable for all. The future belongs to the bold.

Poonam Khetrapal Singh is regional director, World Health Organization South-East Asia