Financing the commons: Now more than ever
By Alexandra Earle (1), Susan Sparkes (1), Grace Achungura (2), Joseph Kutzin (1), Awad Mataria (3), Tolbert Nyenswah (4), David Peters (4), Agnès Soucat (1) and Gavin Yamey (5)
A prescient call to action
No one could have predicted just how instantly relevant the Financing Common Goods for Health (CGH) agenda would become when it was launched as part of the United Nations General Assembly High-level Meeting on Universal Health Coverage in the fall of 2019. COVID-19 has shown us the necessity for prioritizing public financing for prevention, preparedness, and response, and has affirmed the financing-related blind spots in both global- and country-level agendas that were highlighted in the CGH special issue. Population-based functions that require public financing are essential for the COVID-19 response, as well as to protect against emerging and concurrent threats stemming from environmental degradation and chronic co-morbidities.
The Sixth Global Symposium on Health Systems Research (HSR2020) provided an opportunity for Dr Grace Achungura, Ms Alexandra Earle, Mr Joseph Kutzin, Dr Awad Mataria, Mr Tolbert Nyenswah, Dr David Peters, Dr Agnès Soucat, Dr Susan Sparkes, and Dr Gavin Yamey – all policymakers, policy advisors, practitioners, and academics who have been involved in building this agenda – to update financing priorities in light of the current crisis. This blog summarizes the key priorities discussed during the organized session titled ‘Financing the Commons: Now More than Ever‘, focusing on how to build more responsive and resilient health system so as to make sure we are not revisiting this same agenda come the next crisis.
Rebalance investments
The COVID-19 pandemic lays bare the critical need for investments into approaches that reduce future health risks, such as the Health Emergency and Disaster Risk Management (EDRM) approach, which tackles health emergencies across the continuum of prevention, preparedness, readiness, response, and recovery. We know that the cost of responding to COVID-19 far outweighs the initial investments needed in health EDRM, investments that could have greatly mitigated the vast social and economic damage the pandemic has caused. These investments require coordinated support of all sectors, levels of government, regulatory bodies, civil society, private sector, and communities. As we emerge from this crisis, we must evaluate how best to align the financing and actions that run through all responsible entities to ensure coherence and to create a system that is more responsive and resilient when emergencies strike.
Reduce fragmentation
The challenges presented by COVID-19 are not wholly new. In fact, there are many relevant lessons from the 2014 Ebola virus outbreak in West Africa. Fragmented and uncoordinated donor funds and financial flows made it difficult to pool resources and flexibly reallocate across budgets. Building from the lessons learned in 2014, many of the worst hit countries developed National Action Plans for Health Security (NAPHS), created National Public Health Institutes and Emergency Operation Centers, and increased integrated testing capacities of infectious diseases as a way to better streamline and integrate public health systems and processes. Once the COVID-19 pandemic began, these countries had a more agile system that treated the pandemic with a more immediate and coordinated response. The effort to align financing and to create a more cohesive investment in public health has helped to better prepare systems to confront the virus.
While a very different context, India is currently grappling with similar issues in its health system due to its highly decentralized system with 36 States and Union Territories, which contributes to fragmented, often inadequate, surveillance systems. COVID-19 has pushed the Indian Federal Government to develop plans to overhaul the country’s public health surveillance system and accelerate reforms on the information systems.
Sustainably finance global functions
In order to eradicate COVID-19, scientists agree that this will take the vaccination of all people worldwide. Realizing this collective benefit of COVID-19 vaccine distribution requires a shared commitment to vaccinations as a global public good. Implementing this vision requires collective financing mechanisms for equitable distribution so that these vaccines are not monopolized by high-income countries. Additionally, because global CGH suffer from cycles of emergency investment and then neglect once political pressures have lessened and the status quo is restored, we must also sustain this commitment of global action and investments beyond the COVID-19 pandemic.
For immediate attention, several institutions are already established within the global financing space, including COVID-19 Vaccines Global Access (COVAX), a global initiative aimed at equitable access to and distribution of COVID-19, and the Coalition for Epidemic Preparedness Innovations among others.
Incorporate climate-conscious policies and strategies into the budget
At the moment, much of fiscal policy is focused on the immediate response to the economic crisis of COVID-19; however, the ever critical climate crisis and environmental degradation have not disappeared. In fact, climate change is only increasing the social and economic issues exposed by COVID-19. Encouragingly, we can see increased political support in many countries to reexamine environmental considerations as part of their pathway to greener economic recovery. For instance, over half of OECD countries have adopted the green budgeting tool to identify what spending in their recovery plan is environmentally compatible. Some countries have offered environmental conditionality for recovery support to industries to promote the use of cleaner energy and technology. Additionally, impact assessments have been conducted across the world on both the positive and negative impact economic relief measures have had or will have on the environment (e.g. lack of international travel on air pollution, supply chain and distribution of COVAX).
A way forward
Policymakers, communities, and individuals are becoming increasingly aware of the consequences of underinvestment in CGH. This pandemic has shown that public financing can and should be mobilized to assertively intervene once people feel the consequences of an issue. As we look to the future, COVID-19 can be the tipping point for countries to come together to refocus priorities and investments towards these core population-based health functions as the foundation to prevent and combat future challenges that threaten all of our health and well-being. None of this is automatic. Rather, concerted action on the part of individuals and policymakers is required to demand and implement a new approach to health and economic systems.
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- Department of Health Systems Governance and Financing, World Health Organization
- World Health Organization Country Office, India
- Universal Health Coverage & Systems, WHO Eastern Mediterranean Regional Office
- Department of International Health, Johns Hopkins Bloomberg School of Public Health
- The Center for Policy Impact in Global Health, Duke University
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Image: By jiris