The first Annual Conclave of the Global Learning Collaborative for Health Systems Resilience (GLC4HSR) was held on the 10th and 11th of March 2023 in New Delhi, India. The first Annual Conclave of the Global Learning Collaborative for Health Systems Resilience (GLC4HSR) was held on March 10 and 11, 2023 in New Delhi, India. As the lead of the GLC4HSR’s India Chapter, InOrder is happy to present the detailed proceedings of the Annual Conclave.
Over 40 speakers from 18 countries participated in the two-day conclave. The speakers represented global UN agencies, national governments, the private sector, civil society organizations, donors, and academia. With close to 150 health systems stakeholders in physical attendance and over 400 online attendees from across 20 countries, the event showcased the latest thinking involved in building resilient health systems. Being the first in the series, the conclave was designed to better understand the concept of health systems resilience and its assessment. The sessions were organized around people and their health as the central purpose of health systems, four core functions (provisioning, supplying, financing, and governing), and three cross-linking functions (information, communication, and relations), to reflect the new health systems framework that evolved as part of the learning journey undertaken by the GLC4HSR during its first year.
The deliberations over two days yielded rich insights from various stakeholders with different perspectives. These are summarized below:
Health Systems Performance Assessment:
- Existing health systems and their performance assessment frameworks and health security assessment frameworks could not reliably predict the performance of various health systems in the face of the COVID-19 pandemic. Hence, there is a need to evolve health systems resilience assessment frameworks based on the lessons learned during the pandemic.
People and their Health
- Community health literacy, engagement, and participation in governance are important for building resilience, starting at the local level and spreading to higher levels.
Provisioning:
- While strengthening conventional surveillance systems is paramount, there is also a need to explore the pros and cons of integrating digital and genomic surveillance systems into traditional systems.
- There is an urgent need to build the capacities of public health professionals who are required to manage increasingly complex health systems.
- Strong primary healthcare systems are critical to ensure the continuity of essential services during health crises
- Robust assessment and monitoring systems to identify demand-supply gaps in healthcare services and goods coupled with simulation systems that test various health shock scenarios are critical to prepare provider systems.
- As a majority of health systems evolve into mixed healthcare provider systems, proactive private sector engagement in preparedness and response is necessary.
- Adaptive innovations in healthcare delivery witnessed during the pandemic need reevaluation for their integration into the new normal.
- Unlike infrastructure and health goods, a health workforce cannot be created overnight. Hence, health systems should plan for surplus capacity in human resources to respond to and absorb the shocks. (Capacity building)
Financing:
- The concept of pooling, priority setting, and allocation used in health financing should be applied to healthcare infrastructure, health workforce, and health goods during crises situations.
- While the pandemic fund may address financial needs to some extent, countries should drive efficiency in public health financial management systems. Purchasing low-value services can unlock additional funds, given the limited fiscal space for increasing public health budgets.
- Phasing out detrimental subsidies and levying pro-health taxes are some of the means to mobilize additional financial resources.
- Ensuring broader social protection is essential to absorbing health shocks.
Supplying:
- Supply chain resilience is most vital for overall health systems resilience as witnessed during the pandemic.
- Supply chain resilience requires bilateral, multilateral, or global collaboration in research, development, standards, regulations, manufacturing, storing, procuring, and distribution among others.
- Supply chain resilience implies having sufficient reserves of essential health goods.
- Equitable access to essential medicines and tests can be ensured by further strengthening the concept of global public goods.
Governing:
- Strong institutions enable resilience in governance.
- Evidence-informed policies are essential for formulating appropriate responses.
- Enacting suitable laws is necessary to ensure preparedness and facilitate effective responses during public health emergencies.
Relations:
- Nurturing vertical and horizontal relations is crucial to integrating complex systems.
- Trust and transparency between key actors (government, private sector, and community) and participatory governance are essential for resilience.
Communication:
- Reliable communication from trusted sources is vital to addressing the infodemic stemming from social media and the internet.
Information:
- As the digital transformation of health systems becomes increasingly inevitable, prioritizing inclusive digital transformation is essential for bridging the digital divide.
- Digital transformation will enhance the agility, efficiency, and effectiveness of health systems in addressing people’s health and financing needs consistently and comprehensively.
- Investing in an interoperable and integrated national health information system goes a long way in building resilience.
While the Conclave offered profound insights, it is crucial to distill them further into actionable insights. These actionable insights can then be utilized to transform key learnings into impactful action. It is important to recognize that certain insights are applicable at the global level, while others are more relevant at national, subnational, or even local levels.
Global Level:
- Increase financing to strengthen weak national public health systems, enabling them to effectively prevent, prepare for, and respond to public health emergencies.
- Establish mechanisms to ensure equitable and timely access to essential health goods, particularly for underserved populations.
- Foster the harmonization of standards and regulations across countries to expedite access to medical countermeasures during emergencies.
- Promote the development and sharing of digital public goods to facilitate inclusive digital health transformation.
National and Subnational Level:
- Strengthen public health financial management systems.
- Eliminate detrimental subsidies and introduce pro-health taxes.
- Build the capacity for health systems assessment, performance monitoring, disease surveillance, and simulation.
- Make greater investments in the health workforce, including training, recruitment, and retention, to enhance resilience.
- Institutionalize participatory governance by involving communities, civil society organizations, and stakeholders in decision-making processes.
- Develop and implement a National Digital Health Policy to leverage digital technologies to develop interoperable health information systems.
- Increase investments in comprehensive primary healthcare systems, emphasizing preventive care, early detection, and community-based services.
Local Level:
- Promote health and digital literacy at the community level, empowering individuals to make informed decisions about their health.
- Encourage community participation in governance processes and in decision-making related to healthcare policies and programs.
- Ensure equity, dignity, and inclusivity in healthcare delivery, addressing disparities in access, treatment, and outcomes among different populations.
- Support the formation and strengthening of self-help groups within the community towards collective action for better health and well-being.
- Promote community engagement through trained health volunteers who can serve as liaisons between healthcare providers and the community.
In conclusion, the 1st Annual Conclave of the GLC4HSR brought out several key actionable insights for building resilient health systems. These include strengthening public health financial management, eliminating detrimental subsidies, investing in health workforce capacity, institutionalizing participatory governance, developing national digital health policies, and prioritizing comprehensive primary healthcare, among others. At the global level, there is a need for increased financing, equitable access to essential health goods, harmonized standards, and digital public goods. At the local level, promoting health literacy, community participation, equity, and community engagement are crucial. By implementing these insights, health systems can strengthen their capacity to better respond to health crises while ensuring inclusive and efficient healthcare delivery.