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    What has COVID 19 taught us?


    Jurisdictions globally may need to inculcate effective habits of balanced future heath governance.

    By Surjith Karthikeyan

    Global economy is currently witnessing the weaker waves of COVID 19 and the key lesson from this long pandemic is indeed the requirement of new perceptive on “framing health policy and addressing global health challenges”. Health Policy tool kit of Countries should be comprehensive and at the same time succinct incorporating inter-alia, environment, technology, education, trade, migration, international cooperation and related sectors. A sound domestic health policy will have positive externalities on the global health, its good governance and vice versa, the best example being the success stories of countries like India which has a played key role in preventing global spread of communicable diseases like COVID-19 through vaccine supply across the globe. In addition to effective national policies and robust health systems, an effective national response must also draw upon local knowledge in line with international best practices of health care.

    Health issues need thrust and decisive implementation follow up. Accessibility and affordability by poor to essential technologies and medicines for medical diagnosis and treatment is the key area of concern. Ample capacity of motivated and well-trained health workers to meet patients’ services needs are also imperative. Global health institutional framework and governance need to be strengthened inter-alia by promotion of health research and application of research evidence in health policy formulation. World Health Organisation (WHO) may need to further strengthen and streamline global health
    architecture by working in close coordination with global health funding agencies, to avoid duplication and fragmentation. Accountability and transparency, coupled with information and evidence with global participation and effectiveness is the need of the hour.

    Global Health Policy should be supported by data and evidence for problem solving. Transparent reporting of health issues needs prime focus, considering the wide ramifications it has on global economy, especially with regard to communicable diseases. The share of health spending needs to be increased especially in developing Countries like India. Analysing WHO data helps us realize that Countries spending more on health care are better off in terms of resistance to both communicable and non-communicable diseases. Also, in most low and lower middle-income countries, out of pocket expenses remain high as a share of total health expenditure which ultimately results in financial catastrophe and impoverishment. As per IMF and WHO estimates even in countries where the ration of out-of-pocket expenses per total health expenditure has fallen, out of pocket expenses per capita has increased. Thus, there is need for avoiding increasing out of pocket expenses.

    The trends in health spending by jurisdictions across the world may lead us to interesting conclusions. In 2015, while high income and upper middle-income countries contributed 90% of the health funding globally, the contribution of lower middle- and low-income countries is hardly 10%. This assumes a challenge due to the fact that 50% of the world population and nearly 60% of the disease burden is contributed by the lower middle- and low-income countries (Institute for Health Metrics and Evaluation). However, there are news of global group of developing countries like BRICS contributing to reshaping global health and development. From 2005 to 2010, Russia’s assistance to global health each year grew by 36.1%, Brazil’s by 20.4 %, India’s by 10.8%, China’s by 23.9% and South Africa’s by 8%. On the other hand, the USA’s spending grew by 1.6%, the UK by 3% and Japan’s by 0.3%.

    The developing Countries like India need to focus on Universal health coverage (UHC) as a major health system goal, and as the foundation to achieve the goals of Sustainable development. “Ayushman Bharat” an UHC Policy recently announced by Indian Government which has essentially incorporated ‘digital health strategy’ best suits its health vision, needs, availability of resources and key values with appropriate use of digital technologies. This may bridge the digital divide and ensure health inclusion domestically as also globally.

    Developing Countries had dramatically achieved reduction of global poverty in all its forms, the humanity’s most urgent issue. However, more than 700 million people still subsist on extremely low incomes, and every year, around five million children under the age of five still die of diseases that could often have been prevented or cured with inexpensive treatments. This necessitates policies that effectively address poverty as also child health at the same time, as cited as an example to the experimental approach to alleviating global poverty, highlighted in the 2019 Nobel Prize in Economics. In view of
    the above, African and poor Asian Countries need to effectively think on these lines to improve global health.

    In health system, there is need for reduction in fragmentation especially in management structures, fund flows and pools. There is also need to limit public spending on ineffective interventions and reinforce use of treatment protocols and promote
    appropriate preventive actions. Balance spending on infrastructure and medicines and supplies coupled with influencing appropriate use of different levels of health system is the need of the hour. There is also need to improve transparency and accountability and to think about current incentives of inefficiency and new incentives of efficiency. The effective habits of future heath governance should essentially incorporate trans-sectoral and integrated view with inclusivity and at the same time embracing diversity. The roles, substantive norms & values should be defined backed by accountability and transparency, information & evidence and may harness information and communication technology. There is also need to promote research on governance ie; towards evidence and informed governance with a balancing act. The balancing act is required between national and global governance, formal and informal mechanisms, market forces and social justice/equity, specific diseases and systems strengthening, participation and effectiveness, ideas or theories and implementation and finally between learning from past successes/failures and the need for innovation on future governance.

    (Surjith Karthikeyan serves as Deputy Secretary, Government of India. Views expressed are personal)

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