Health Protection and Health Systems Strengthening for Universal Health Coverage and Global Security

Experts in Health Protection, Health Systems Strengthening (HSS), Universal Health Coverage (UHC) and Global Security came together at the Commonwealth Secretariat for a meeting aimed at identifying opportunities to build on the wider work on these agendas over the past year.

The meeting on the 18th August 2016 followed the recent Commonwealth Health Ministers Meeting (CHMM) in May 2016 on the theme of Health Security and Universal Health Coverage. The meeting in August also looked forward to next year’s agenda for Health Ministers on the theme of “Sustainable Financing of UHC as an Essential Component for Global Security Including the Reduction of All Forms of Violence”.

Attendees explored options for extending country capacity with the application of the Commonwealth’s Health Protection Policy Toolkit. This has been applied initially in Sierra Leone as part of the post-Ebola response.

The next steps of this programme will be to work with other countries to address a wider range of challenges including Climate Change, Antimicrobial Resistance (AMR), Malaria and Zika.

The meeting on the 18th had a number of objectives including:

  • Exploring the implications and contributions to wider global security for next year’s ministerial meeting
  • Coordination and collaboration for capacity building on health protection and health system strengthening with countries
  • Identifying actions to strengthen public health within health systems frameworks
  • Identifying additional supportive tools required
  • Identify next steps and develop a plan of action with partners

There were four sessions:

  1. Scene setting
  2. Ministerial mandate
  3. Building country capacity
  4. Taking forward action

1. Scene setting

David Nabarro spoke by video, setting out the scale and scope of the task at hand.

Rudiger Krech, Director, Health Systems and Innovation, World Health Organization spoke about the Global challenges for Health Security and the links between global health security and health systems.

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Dr Joanna Nurse, Head of the Health and Education Unit at the Commonwealth Secretariat, gave a scene setting presentation outlining the mandate for action, the challenges and opportunities. She introduced the Commonwealth Systems Framework for Healthy Policy (SFHP)Health Protection Policy Toolkit and the International Health Regulations (IHR) and then spoke about the need to scale up country capacity.

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Major Suzanne Odams, 77 Brigade, No4 Column, British Army, introduced a short selection of slides looking at definitions of ‘Global Security’ as well as ‘Global Health Security’.

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This first session showed that despite numerous global efforts and initiatives huge challenges remain. These challenges include; twenty-first century epidemics being tackled with twentieth century means, insufficient national capacity and systems, the need to increase coordination and promote better governance at both national and global level, the need for greater collaboration between the health and global security agendas, the need for greater preparation before emergencies to ensure well planned and adequate response during emergencies.

A number of gaps were identified including the need for better communication of health risks to Heads of Government (HoG), the need to balance between national sovereignty and global governance/collaboration, the need to recognise the political economy in health crises, importance of fostering coordination and coherence through using the systems approach of the Health Protection Policy Toolkit and the international mandate of the Joint External Evaluation Tool, the use of science in disaster mitigation, for instance as reflected in the Sendai Framework.

2. Ministerial mandate

In the second session Rob Yates, Project Director, UHC Policy Forum, Centre on Global Health Security at Chatham House, spoke about the challenges of Sustainable Financing of UHC.

The presentation noted that UHC is built on equity, provision of comprehensive services and financial protection. To be successful, the healthy and wealthy need to finance health for the poor and sick. Market driven private systems do not result in UHC. A successful UHC requires, firstly an efficient and equitable public health financing system via tax or social insurance and secondly, political commitment from Heads of Government and Ministries of Finance.

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Professor Virginia Murray and Tina Enderiks from Public Health England spoke about global security and preparedness, specifically mentioning the SENDAI framework for disaster risk reduction and experience with mass gatherings.

The Sendai Framework for Disaster Risk Reduction takes an all hazards approach to ensure resilience, recognises the role of health and the IHR in disaster risk reduction, includes the role of science and technology as a central component to disaster risk reduction.

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Professor Mark Bellis from Public Health Wales spoke about the role of health in preventing all forms of violence including lessons for countering extremist violence.

The presentation noted that violence prevention is key to articulating and communicating the role of health in countering violent extremism. That childhood experiences are significant determinants of mental health and that there is good evidence and experience to support the role of transferring and informing global security through countering violent extremism (CVE).

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The second session developed the following points and recommendations:

  • Mandatory public financing should replace private voluntary financing especially user fees
  • Highest level of political commitment is necessary for achieving UHC
  • The need to enhance the relevance of the Sendai framework to health audience as part of policy
  • The need to ensure coherence with the IHR
  • The need to enhance the relevance of health systems to violence prevention especially CVE
  • The need to explore cross sector approaches to violence prevention and other agendas

3. Building country capacity

Dr Sohel Saikat, Programme Officer for the Universal Health Coverage and Quality Unit at the World Health Organisation (WHO) spoke about the IHR and associated Joint External Evaluation (JEE) programme.

It was noted that to strengthen collaborative and complementary action for country capacity there is a need to; strengthen the links between health security and health systems, scale up work at the operational level, improve national and global coordination and collaboration to reduce overlap, ensure all countries whether developed or developing should have periodical evaluation of their health security system.

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Dr Quentin Sandifer, Executive Director of Public Health Services and Medical Director of Public Health Wales and Dr James Akabile, Health Systems Strengthening Specialist and Technical Lead with the Commonwealth Secretariat in Sierra Leone spoke about their work in Sierra Leone with the Commonwealth Health Protection Policy Toolkit.

The key challenges identified in Sierra Leone included; The history of conflict, the fragmented health systems, inadequate and underpaid workforce, multiple donors and lack of coordination, donor driven agenda and policies, difficulties with governance and reporting systems.

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Three key Action Points were developed in this session:

  1.  Emphasise operational linkage between health security and health systems
  2.  Strengthen institutional links between the Commonwealth Secretariat and the World Health Organisation
  3.  Conduct a joint country workshop using both tools (Health Protection Policy Toolkit and the Joint External Evaluation Tool (JEE)

4. Taking forward action

Outcomes from the meeting were organised under three themes:

I. Public Health, Health Systems and Sustainable Financing

Gaps/ Key Challenges:
• Low political commitment resulting in low financial investment in health
• Need for a comprehensive ‘OneHealth’ approach
• Donor driven health systems
• Need for efficient tracking system (e.g. updated National Health Accounts and Expenditure Analysis)
Joint External Evaluation and other tools not aligned through a health systems lens

Proposed Actions:
• Make a clear case for investment in health
• Genuine political and financial commitment from Heads of Government for UHC
• Maintain external assistance and increase country spending
• Establishing tracking systems for health financing
• Encourage south-south collaboration and sharing of best practices

II. Scaling up country capacity and Innovation

Gaps/ Key Challenges:
• Operationalising health security into health systems
• Human resource for health constraints
• Need for better governance in terms of coordination, legal basis and quality standards

Proposed actions:
• Advocacy to Heads of Government via partner networks
• Coordination via a framework for donor activity to assist in coordination
• Establish professional standards for health
• Facilitate partnership for the implementation of policy
• Mainstream health in ICT infrastructure agreements

III. Global security and violence prevention

Gaps/ Key Challenges:
• Silo approach to violence prevention and global security
• Limited collaboration among policy makers and stakeholders

Proposed actions:
• Make the link between health, education, criminal justice and the economy
• Inter-sectoral coordination and collaboration at all levels
• Horizon scanning to anticipate challenges