scholarly journals Health systems in the SDG era: consolidating and building on the gains

Author(s):  
Gunjan Taneja ◽  
Rajeev Gera ◽  
Dinesh Agarwal ◽  
Michael Favin ◽  
Satish Saroshe ◽  
...  

Global health today stands at cross-roads, with unanticipated problems challenging the unprecedented progress achieved over the last two decades. To achieve the targets established for the sustainable development goal 3 of “ensuring healthy lives and promote well-being for all at all ages”, significant resources and comprehensive health systems must play a critical and integral role. World Health Organization’s (WHO) framework for action on “Strengthening Health Systems to Improve Health Outcomes” has well identified the challenges of global health.  The Global Strategy for Women's, Children's and Adolescents' Health 2015-2030 states that for women’s and children’s health investments in high-impact health interventions for RMNCH at a cost of US$5 per person per year up to 2035 in 74 high-burden countries, could yield up to nine times that value in economic and social benefits. As global health marches towards achieving universal health coverage (UHC), innovative health financing schemes and health system design will be the major determinants of equity and efficiency in resource allocation and health care delivery. Because we are now in a critical phase, it is imperative that the initial years of the SDGs receive utmost thrust from all relevant stakeholders across countries to initiate and maintain a sustained momentum for achieving the targets. The primary priority for the health-related targets’ therefore’ necessitates the need for formulation of robust, responsive and resilient health systems strategies by all the major policy makers and concerned stakeholders.

Author(s):  
Andres Garchitorena ◽  
Megan B. Murray ◽  
Bethany Hedt-Gauthier ◽  
Paul E. Farmer ◽  
Matthew H. Bonds

Randomized control trials (RCTs) are considered to be the gold standard for impact evaluation in international development and they are associated with a new era of evidence-based global health policies. However, there are inherent challenges in using RCTs to answer some of the most important questions in global health: why, if solutions are known, affordable at scale, and supported by existing evidence, do hundreds of millions of people lack access to essential health services? A lack of clarity on appropriate research methods for strengthening health systems has corresponded to a lack of investment in more complex and adaptive systems of integrated care delivery. This chapter reviews the use of RCTs in global health, highlighting major contributions, and addressing some pressing priorities in implementation research at a time when the Sustainable Development Goals emphasize the importance of sector-wide approaches, such as integrated primary care and universal health coverage.


2020 ◽  
Vol 128 (4) ◽  
pp. 474-479
Author(s):  
Marino J González R

Introduction: Tracking out-of-pocket (OOP) health expenditure is a very useful reference for knowing the progress of countries in the goal of universal health coverage (UHC) in 2030. The World Health Organization (WHO) has developed the Global Health Expenditure Database (GHED) to facilitate analysis of health financing in countries or regions. The paper explores the use of GHED in the analysis of OOP health expenditure in the specialized literature. Objective: To perform a systematic review of the studies in which GHED is used to analyze OOP health expenditure in countries or groups of countries. Methods: The systematic review followed the guidelines of the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA). The database used was PubMed. All publications that were available on PubMed by July 30, 2020, were identified. Results: Twenty-five papers were identified. The use of the GHED to analyze OOP health expenditure was reported in five studies, one country study, and four studies with regional comparisons. The included studies cover the period 1995-2016. Discussion: The use of the GHED for the analysis of the evolution of OOP health expenditure in countries or regions is not very widespread in the specialized literature. The GHED has proven to be a very useful instrument for international comparison, although the fact that there are differences with national reports (public expenditure reviews) makes it advisable to combine both sources of information in the analysis of country- specific health policies. Conclusion: The systematic use of the GHED can be useful to improve the quality of information and estimates, such as country-specific expenditure analyses. To this end, it is particularly important to characterize the levels of OOP health expenditure and to incorporate policy monitoring into the analyses.


2018 ◽  
Author(s):  
Michael Miller ◽  
Aaron Reeves ◽  
Veronica Toffolutti

In this paper, we argue that particular institutional arrangements partly explain the large and persistent differences in health systems and health outcomes observed in former colonies. Drawing on data from the World Health Organization for 62 countries, covering the period 2000–2014, we explore whether economic (risk of expropriation) and health (complete cause of death registries) institutions explain mortality rates and access to healthcare. To identify this relationship, we use settler mortality and the distance of the capital from the nearest major port – factors associated with institutional arrangements – to explain cross-national variation in health outcomes and the universality of health systems. We find that inclusive institutions arrangements – that protect and acknowledge the rights of citizens – are associated with better health outcomes (e.g. lower infant mortality and lower maternal mortality) as well as with better health systems (e.g. more skilled birth attendance and greater immunization). Inclusive institutions not only foster economic growth but improve health and well-being too.


2021 ◽  
pp. 759-770
Author(s):  
Fiona Fleck

This chapter provides an overview of progress made in public health during the first two decades of the twenty-first century and charts the way forward to further improvements. It introduces the World Health Organization’s (WHO) current 5-year strategy, explains how this strategy is aligned with the 2030 Agenda for Sustainable Development, and how impact will be measured at the national level. Based on the Sustainable Development Goals, the WHO has set its triple billion targets to achieve by 2023. These are: one billion more people benefitting from universal health coverage; one billion more people better protected from health emergencies; and one billion more people enjoying better health and well-being. Components of each of these goals are described here, and the chapter concludes with the cross-cutting areas of monitoring and evaluation, and data and innovation that are vital to achieving measurable health impact in every country, regardless of income level.


2018 ◽  
Vol 3 (Suppl 1) ◽  
pp. e000597 ◽  
Author(s):  
Rüdiger Krech ◽  
Ilona Kickbusch ◽  
Christian Franz ◽  
Nadya Wells

The world faces multiple health financing challenges as the global health burden evolves. Countries have set an ambitious health policy agenda for the next 15 years with prioritisation of universal health coverage under the Sustainable Development Goals. The scale of investment needed for equitable access to health services means global health is one of the key economic opportunities for decades to come. New financing partnerships with the private sector are vital. The aim of this study is to unlock additional financing sources, acknowledging the imperative to link financial returns to the providers of capital, and create profitable, sustainable financing structures. This paper outlines the global health investment opportunity exploring intersections of financial and health sector interests, and the role investment in health can play in economic development. Considering increasing demand for impact investments, the paper explores responsible financing initiatives and expansion of the global movement for sustainable capital markets. Adding an explicit health component (H) to the Environmental, Social and Governance (ESG) investment criteria, creating the ESG+H initiative, could serve as catalyst for the inclusion of health criteria into mainstream financial actors’ business practices and investment objectives. The conclusion finds that health considerations directly impact profitability of the firm and therefore should be incorporated into financial analysis. Positive assessment of health impact, at a broad societal or environmental level, as well as for a firm’s employees can become a value enhancing competitive advantage. An ESG+H framework could incorporate this into mainstream financial decision-making and into scalable investment products.


2021 ◽  
Vol 23 (1) ◽  
pp. 143-154
Author(s):  
Palitha Abeykoon

The COVID-19 pandemic has thrown into bold relief the need for an all-of-society response supported by regional and global partnerships to control the epidemic. Addressing the social determinants of health, Universal Health Coverage, the non-communicable disease (NCD) burden, the other communicable diseases and the achievement of the Sustainable Development Goals (SDGs) all would require a close collaboration among different sectors and stakeholders, including the private sector. Partnerships connote three fundamental themes—a relative equality between the partners, mutual commitment to agreed objectives and mutual benefit for the stakeholders involved. The decisions are made jointly, and roles are not only respected but are also backed by legal and moral rights. The World Health Organization (WHO) has been and continues to be the foremost promoter as well as the host for many of the global and regional partnerships in health. A typological classification would include technical assistance partnerships supporting service access and provision of services including drugs, partnerships focusing on research and development, advocacy and resource mobilisation and financing partnerships mainly to provide funds for definite disease programmes. Partnerships in health have brought and continue to bring multiple benefits to the countries. But they also engender several challenges, including the duplication of effort and waste, high transaction costs (usually to government), issues of accountability and consequent lack of alignment with country priorities. As partnerships become increasingly significant in the twenty-first century, better coordination, particularly in terms of donor harmonisation with national priorities, would be needed. It is not ambitious to attempt the elusive ideal where all parties will benefit from one other with a give and take between all stakeholders. Partnerships in health could well herald a new dawn for health development in the South-East Asia Region.


2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Amare Worku Tadesse ◽  
Kassu Ketema Gurmu ◽  
Selamawit Tesfaye Kebede ◽  
Mahlet Kifle Habtemariam

Abstract Background Evidence exists about synergies among universal health coverage, health security and health promotion. Uniting these three global agendas has brought success to the country’s health sector. This study aimed to document the efforts Ethiopia has made to apply nationally synergistic approaches uniting these three global health agendas. Our study is part of the Lancet Commission on synergies between these global agendas. Methods We employed a case study design to describe the synergistic process in the Ethiopian health system based on a review of national strategies and policy documents, and key informant interviews with current and former policymakers, and academics. We analyzed the “hardware” (using the World Health Organization’s building blocks) and the “software” (ideas, interests, and power relations) of the Ethiopian health system according to the aforementioned three global agendas. Results Fragmentation of health system primarily manifested as inequities in access to health services, low health workforce and limited capacity to implementation guidelines. Donor driven vertical programs, multiple modalities of health financing, and inadequate multisectoral collaborations were also found to be key features of fragmentation. Several approaches were found to be instrumental in fostering synergies within the global health agenda. These included strong political and technical leadership within the government, transparent coordination, and engagement of stakeholders in the process of priority setting and annual resource mapping. Furthermore, harmonization and alignment of the national strategic plan with international commitments, joint financial arrangements with stakeholders and standing partnership platforms facilitated efforts for synergy. Conclusions Ethiopia has implemented multiple approaches to overcome fragmentation. Such synergistic efforts of the primary global health agendas have made significant contributions to the improvement of the country’s health indicators and may promote sustained functionality of the health system.


2021 ◽  
Vol 15 ◽  
Author(s):  
Shyh Poh Teo

During the 74th World Health Assembly, a resolution was passed aiming to achieve better oral health as part of universal health coverage, with plans to draft a global strategy and action plan. Oral diseases are a significant problem globally, with implications for older people’s health and quality of life. Oral health is important for healthy aging. Integration of oral health into primary care settings and use of a life-course approach have been shown to be effective in the 8020 campaign in Japan. Accurate data on prevalence of oral disease is required to monitor effectiveness of public health approaches, which should be segregated based on setting, sociodemographic status, and comorbidities. These public health approaches should also be adapted and tailored for implementation during the current COVID-19 pandemic. These considerations are essential to progress the agenda of oral health for healthy aging.


2018 ◽  
pp. 24-42
Author(s):  
MARÍA DALLI

In 1948, the General Assembly of the United Nations adopted the first international text recognising universal human rights for all; the Universal Declaration of Human Rights. Article 25 recognises the right to an adequate standard of living, which includes the right to health and medical care. On the occasion of the 70th anniversary of the Declaration, this article presents an overview of the main developments that have been made towards understanding the content and implications of the right to health, as well as an analysis of some specific advancements that aim to facilitate the enforcement thereof. These include: a) the implication of private entities as responsible for right to health obligations; b) the Universal Health Coverage goal, proposed by the World Health Organization and included as one of the Sustainable Development Goals; and c) the individual complaints mechanism introduced by the Optional Protocol to the International Covenant on Economic, Social and Cultural Rights (adopted on the 10th December 2008, 60 years after the UDHR).


2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Shahirose S. Premji ◽  
Jennifer Hatfield

The 13 million nurses worldwide constitute most of the global healthcare workforce and are uniquely positioned to engage with others to address disparities in healthcare to achieve the goal of better health for all. A new vision for nurses involves active participation and collaboration with international colleagues across research practice and policy domains. Nursing can embrace new concepts and a new approach—“One World, One Health”—to animate nursing engagement in global health, as it is uniquely positioned to participate in novel ways to improve healthcare for the well-being of the global community. This opinion paper takes a historical and reflective approach to inform and inspire nurses to engage in global health practice, research, and policy to achieve the Sustainable Development Goals. It can be argued that a colonial perspective currently informs scholarship pertaining to nursing global health engagement. The notion of unidirectional relationships where those with resources support training of those less fortunate has dominated the framing of nursing involvement in low- and middle-income countries. This paper suggests moving beyond this conceptualization to a more collaborative and equitable approach that positions nurses as cocreators and brokers of knowledge. We propose two concepts, reverse innovation and two-way learning, to guide global partnerships where nurses are active participants.


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