Healthcare budgets, ideally, should reflect the level of priority governments give the health needs of citizens. Inadequate government budgets and public expenditure on health results in weak health systems with poor health indices such as high maternal, child and infant mortality, high burden of communicable and non-communicable diseases, and inadequate preparedness for outbreaks and epidemics.
Every year, governments identify key health areas that form a part of their annual work/operating plans and budgets. While this practice helps to plan for existing, and possibly, anticipated needs, this practice has reduced Low- and Middle-Income Countries (LMICs) to budgeting for “routine domestic needs” with less consideration for the inclusion of health security as a tier of public health that deserves attention. Emergency preparedness and national coordinating institutions (NCIs) for emergency preparedness and response are “orphaned” when it comes to budgeting and resource allocation.
In recent times there have been epidemics in LMICs with responses showing less than adequate preparedness to address such situations. The Zika and Ebola crises at different times and locations is a quick reminder that preparedness by countries is of the essence. Because of this, the recently published World Bank’s first Pandemic Preparedness Financing Status Update harped on multisectoral engagement when mobilizing and allocating resources; it highlighted the need to encourage decision-makers to make global health security a priority.
With the recent Ebola and current experience of the COVID-19 crises, governments’ responses should go beyond an immediate vertical response, to include building resilient systems and creating frameworks that make funds and resources available for future outbreaks.
Lessons abound in many countries, however, not all are easily transferable across nations. Common denominators that have influenced the operational outcomes in countries’ global security preparedness and response have been diverse. A report from the Oxford Academic article shows how early investment in Research & Development (R&D) following the 2014-2015 Ebola crisis yielded success with successful vaccine trials.
In the same vein, a case study by Global Delivery Initiative shows that prevention of viral transmission, development of test kits, tracing, treatment & testing were part of the multi-dimensional approach adopted by South Korea to achieve its current win against the ongoing pandemic.
Lessons from these countries’ management of the COVID crisis show that a methodical response premised upon lessons from past experiences and purposeful investment could provide a significant level of readiness for similar events in the future.
Health systems experts need to take a stand on guiding multi-level governance teams on the importance of investing in health security at different levels of healthcare provision. Conversations on countries’ improvement plans that respond to the World Bank’s JEE reports should be scaled up.
This approach is to ensure that, if and when future epidemics or pandemics arise, the coordination of plans may be central. Still, the burden of implementing the response plans should remain decentralized, to save time and lives. Lastly, the current pandemic serves as a wake-up call for governments to respond to experts’ recommendations that propose institutionalizing investments in health security at all levels of governance.
Dr Ezinne Peters
Principal Technical Officer, HSCL