The answer to pandemics? Strong public health systems

Covid-19 demands a rapid response, while investing in public health systems is as important as ever. International financial institutions like the World Bank therefore need to see these uncertain times as the prime opportunity to take measures aimed at social protection, strong public services, decent work, tax justice, and progressive financing of social sectors – thereby strengthening health systems. Because after all this, we cannot go back to business as usual.

Just like in the rest of the world, at Wemos we are captured by the terrible pandamic. We see impressive mitigation measures, and also encouraging acts of solidarity and assistance, which includes financial assistance. At the national level, many governments are mobilising resources to prevent and mitigate the disease and its social and economic impact.

Impressive offers of global financial assistance

At global level, we are witnessing an impressive stream of announcements regarding financial assistance in response to COVID-19. They range from grants, to loans, to potential insurance pay-outs and a call to halt debt collection from low-income countries. The involved amount varies. For instance, the potential maximum pay-out for the coronavirus from the insurance window of the World Bank’s Pandemic Emergency Financing Facility (PEF) is 196 million USD per event. The foundations organising the COVID-19 Solidarity Response Fund to support WHO’s work in fighting the pandemic raised over 235 million USD (by 25 March 2020). And the World Bank and International Finance Corporation (IFC) offered fast-track financing amounting to 14 billion USD to support medical (diagnostic) services and enterprises. Also, the International Monetary Fund (IMF) communicates how it can assist countries in multiple ways. It is scaling up its Catastrophe Containment and Relief Trust Fund to 1 billion USD and ready to use its full lending capacity or ‘firepower’ – about 1 trillion USD – to help countries.

However well-intentioned, not all these global responses are likely to be successful in softening the impact of the pandemic. The PEF for low- and lower-middle income countries, for instance, seems deliberately designed to fail. Its activation criteria are spelled out in such a tight way, protecting investors’ bonds, that funds will only be released very late in the game, if at all. The fund pools funding from capital and insurance markets to address cross-border outbreaks while using public money to mitigate risks. It is likely that the public money invested in this fund would have had a higher impact if invested directly in health systems strengthening activities to strengthen pandemic preparedness in these countries.

Lessons from the past

One of the painful lessons from the Ebola outbreaks is that a response to infectious disease outbreaks can only be effective when the country has a strong public health system, especially at the primary healthcare level. Strong public health systems are:

• staffed with sufficient well-equipped and trained health workers
• responsive to the needs of all communities and citizens
• accessible to all – thus free at point of service
• well-managed
• sufficiently, transparently and reliably funded

Allan Maleche (Director of the Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN))

Allan Maleche is the director of the Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN). Reflecting on the Covid-19 outbreak and the global financing initiatives, he emphasises that “definitely, investing in the public health system should be the way to go for all forms of diseases, because a strong public health system then means a better response, and to keep people healthy in general”. He adds that transparency is crucial: “For the funds to be used wisely [by governments], the funds must be made transparent to all stakeholders. So that they know what these funds are exactly going to be used for. Even though it is an urgent situation, that information should be made available.”

Yes, robust public finance structures are key in delivering the human right to health, in strengthening countries’ health systems, in reaching Universal Health Coverage (UHC) as well as in responding to infectious disease in a timely manner. That’s why the 2019 Political Declaration on UHC also calls to ’promote strong and resilient health systems, […] ensuring adequate pandemic preparedness and the prevention and detection of and response to any outbreak’.

World Bank: take the right, just and social measures

With this in mind, we have words of caution in response to the World Bank Group President Malpass’ statement (March 23rd) that “countries will need to implement structural reforms (…)”, after announcing the World Bank/IFC money made available for health care projects and programmes. Austerity measures, coupled with the consistent push for private finance and privatisation in healthcare, advised by the World Bank and other international financing institutions, have proven to be counterproductive in efforts to reach UHC and health for all. Therefore, instead, we call upon the World Bank to take reform measures aimed at social protection, strong public services and decent work. To support fiscal measures that countries are taking to finance social sectors progressively and to ease monetary policies. And, finally, to apply structural reforms that can deliver tax justice and halt illicit financial flows, so countries can expand their fiscal space for health, instead of being advised to restrict public spending.

The new normal

This is the time to concentrate and align global solidarity efforts towards pandemic relief by strengthening public health systems everywhere, to ensure countries are better prepared to cope with the current and future pandemics. Judging from recent articles we are not alone in this opinion. Ireland and Spain decided to go public for health for all.

We cannot go on with ‘business as usual’. Will COVID-19 later be known as the turning point after which coordinated investments in global public goods, quality public health care for all, and the universal human right to health are regarded as the new normal? We sure hope so.