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Prevention is better than cure

Last week a report was published by a joint panel from the London School of Hygiene & Tropical Medicine and the Harvard Global Health Institute, looking at the global response to the Ebola crisis. It’s not the first such report and it won’t be the last. President Kikwete of Tanzania is chairing a UN one which should report soon. Our own contribution back in February was called Wake Up Call.

The panel’s report is very comprehensive and its recommendations for better warning systems and a more coordinated global response to future outbreaks of infectious diseases are really important. My concern is that it didn’t say anything about the way that allowing weak, fragmented, underfunded and understaffed health services in countries meant they could not cope with an outbreak. I was hoping that the panel would include a recommendation to build Universal Health Coverage (UHC).

Peter Piot, Chair of the panel, did agree with this when I put the question to him, although another audience member said, unhelpfully, that building health systems was like “trying to boil the sea”. As a concept, UHC is often seen as dangerous, too ambitious and unrealistic. That’s why we and GSK did this video to debunk these myths.

Next year, Japan is the Chair of the G7 and has decided that it will make Universal Health Coverage one of its main topics. This is very exciting but there are lots of questions about what the G7 should actually do. Germany this year started off a “Roadmap” for health systems strengthening. We’re hearing that Japan is particularly interested in how the global community responds to outbreaks.

If UHC is only seen as responding to infectious disease outbreaks, then we are missing the chance to help build decent quality everyday health services for their own sake, as well as to be better able to cope with crises.

We need wealthy countries to play a much better part in supporting low- and middle-income countries to build UHC. We need them to explicitly endorse the principles of UHC – universal coverage of essential healthcare without anyone being excluded or pushed into poverty by having to find cash when they need services. We need the global community to support increased fair taxation and public spending. We need to ensure that bilateral and multilateral aid helps build comprehensive health systems. To do this, we need to reassert the Paris Principles for Aid Effectiveness – principles that have become unfashionable in the desire for donors to show results of their ‘investment’.

One idea worth exploring is the resurrection of the Health Systems Funding Platform, a good idea that was just too ahead of its time. This could pool multilateral – and why not bilateral – money to support national health plans, aligned through the International Health Partnership+. These mechanisms are in place but are not used enough.

Japan has a chance to take a great leap forward in G7 commitment to UHC and in access to healthcare for the poorest and excluded groups. We all need to encourage them to take this leap by asserting that preventing health problems is better than just dealing with crises that get out of control.


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