Leveraging economies of scale and scope through multi-country pooled procurement enables countries to increase access to quality affordable essential medicines and supplies that meet priority health ...objectives as well as effectively respond to health emergencies. Strategic partnerships and tools can minimize supply chain disruptions and streamline procurement and deployment in health emergencies, thus mitigating stockouts and ensuring cost efficiencies across various therapeutic areas, including for public health programs at a time when countries may struggle to meet complex needs. As a means to better respond to health emergencies while maintaining priority public health programs, countries should optimize usage of pooled procurement mechanisms facilitated by multilateral technical cooperation and other regional mechanisms, such as the Pan American Health Organization's Strategic Fund. Because few analyses have assessed the role of such regional procurement mechanisms, this Health Policy paper evaluates the key areas of impact of the PAHO Strategic Fund and concludes with lessons learned to help prepare for future health crises while maintaining essential health services.
With large swathes of the world's population-majority clustered in low- and middle-income countries-still yet to receive the minimum of two doses of the COVID-19 vaccine; The need to address the ...failures of international solidarity to equitably distribute COVID-19 vaccines is now more urgent than ever to help curb the pandemic and prevent future variants. However, many high-income countries have adopted a "me first" approach, proceeding to offer COVID-19 booster doses to their entire populations, including those at least risk of severe illness, whilst the rest of the world is left unvaccinated or partially vaccinated with one dose for even their most vulnerable communities.
COVID-19 vaccine inequity places the health of the global population at risk and exacerbates socio-economic repercussions, especially in low- and middle-income countries. Initiatives launched to combat vaccine inequity such as the Fair Allocation Framework for the COVID-19 Vaccines (COVAX) have been unsuccessful as several governments, primarily from high-income countries, have scaled down their contributions to the initiative. Furthermore, COVAX has not seriously engaged with the Access to COVID-19 Tools (ACT) Health Systems Connector, as was originally intended, leading to crucial health systems components critical to vaccine delivery to be overlooked. Several strategies can be employed to help achieve the desired global immunization goals, such as Intellectual Property waivers, increased donations, and activation of new COVID-19 vaccine manufacturing hubs. In addition, continued advocacy for vaccine equity by all involved and affected stakeholders, as well as critical amendments to existing or upcoming legislation and funding mechanisms will help address the shortcomings of current inequitable vaccine distribution.
Global solidarity and collective action through pandemic governance mechanisms are urgently needed to ensure vaccine equity. These interventions are vital to rapidly mitigate ongoing health and humanitarian crises and ultimately curb the pandemic, sooner rather than later.
...over 90% of countries reported widespread backsliding of health services, and routine immunisations plummeted to their lowest point in three decades.1 This regression created a vicious cycle of ...vulnerability, especially for groups at high risk of disease. ...PHC should not be an afterthought—it must be core to pandemic prevention, preparedness, response, and recovery (PPR). ...establish community-driven contingency plans to deliver PHC at all stages of a crisis, ensuring health workers and essential health services remain accessible and affordable and can be used for catch-up care. ...leverage PHC as a coordination point for integrating PPR and universal health coverage.6 PHC can be the linchpin for equity in PPR. ...emergency response should not be made at the expense of routine service delivery; both are required to maintain functioning health systems.
To achieve global health security and universal health coverage, stakeholders must commit to integrated and actionable steps rather than vague end goals, write Katri Bertram and Arush Lal
...it is essential to assess the intersectional and gendered vulnerabilities in health emergencies. The lack of representation in agenda setting and decision-making matters because women face a ...triple burden in pandemics—high risk of exposure to nosocomial infections in their role as healthcare workers; lost opportunities due to school closures and increased unpaid family care; and heightened risk of ill health due to diverted resources and the cascading effects of pandemics.1 In the context of COVID-19, women and sexual minorities can also face a higher risk of Gender-Based Violence (GBV). Additionally, women constitute a majority of workers in the non-agricultural informal sector7—leaving them vulnerable to loss of livelihood and economic insecurity due to the disruptive ‘fearonomic effects’ of pandemics.8 The socioeconomic impact of disasters and crises is further exacerbated for women in minority and lower income groups.9 As mothers, women are more likely to be responsible for nearly 1.5 billion children who are out of school in times of widespread school disruptions—drastically impacting their ability to be financially independent.10 Epidemics further exacerbate other profound security, mental health and health risks in countries facing protracted conflicts with widespread gender inequality and general societal and economic disruption, due to weakened infrastructure and reduced access to health services. Measures to promote gender equity, and representation in decision-making at all levels such as those proposed in the ‘COVID 50/50 Five Asks for Gender-Responsive Health Security’ will strengthen both global and local COVID-19 efforts and ensure greater engagement of those who are most affected in planning of response and recovery.18 In addition, mainstreaming gender in data collection and policy instruments such as the Joint External Evaluations and greater inclusion of women—particularly women from LMICs—in decision-making at the global level and in public discourse will ensure that we reap the innovation and knowledge dividends through smarter and creative decision-making for an effective COVID-19 response and a resilient post-COVID-19 future (see figure 1).
The recent flood crisis in Pakistan has had significant impacts on the physical, mental and socioeconomic fabric of almost 33 million people. Floods in Pakistan are leading to a range of negative ...impacts on health and major disruptions to healthcare services. The lack of mental health and psychosocial support services (MHPSS) is a significant concern in rural areas of Pakistan in providing support to communities affected by floods. It is important for the government and mental health policymakers to work with academic coalitions and non-governmental organisations to replicate low-resource MHPSS models that will develop and advocate for effective, gender-sensitive mental healthcare throughout the country.
The COVID-19 pandemic highlights the implications of chronic underinvestment in health workforce development, particularly in resource-constrained health systems. Inadequate health workforce ...diversity, insufficient training and remuneration, and limited support and protection reduce health system capacity to equitably maintain health service delivery while meeting urgent health emergency demands. Applying the Health Worker Life Cycle Approach provides a useful conceptual framework that adapts a health labour market approach to outline key areas and recommendations for health workforce investment—building, managing and optimising—to systematically meet the needs of health workers and the systems they support. It also emphasises the importance of protecting the workforce as a cross-cutting investment, which is especially important in a health crisis like COVID-19. While the global pandemic has spurred intermittent health workforce investments required to immediately respond to COVID-19, applying this ‘lifecycle approach’ to guide policy implementation and financing interventions is critical to centering health workers as stewards of health systems, thus strengthening resilience to public health threats, sustainably responding to community needs and providing more equitable, patient-centred care.
The COVID-19 pandemic has placed enormous strain on countries around the world, exposing long-standing gaps in public health and exacerbating chronic inequities. Although research and analyses have ...attempted to draw important lessons on how to strengthen pandemic preparedness and response, few have examined the effect that fragmented governance for health has had on effectively mitigating the crisis. By assessing the ability of health systems to manage COVID-19 from the perspective of two key approaches to global health policy—global health security and universal health coverage—important lessons can be drawn for how to align varied priorities and objectives in strengthening health systems. This Health Policy paper compares three types of health systems (ie, with stronger investments in global health security, stronger investments in universal health coverage, and integrated investments in global health security and universal health coverage) in their response to the ongoing COVID-19 pandemic and synthesises four essential recommendations (ie, integration, financing, resilience, and equity) to reimagine governance, policies, and investments for better health towards a more sustainable future.
PDF
