Global Health Risk Framework Resilient and Sustainable Health Systems to Respond to Global Infectious Disease Outbreaks: Workshop Summary (2016) / Chapter Skim
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2 Fundamental Principles of Strong Health Systems
2 Fundamental Principles of Strong Health Systems
Pages 11-32
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From page 11... ...
• A crucial step toward building health system resiliency in a country is the achievement of the World Health Organization's International Health Regulations core capacities; achievement should be monitored using a country-specific "roadmap," which evaluates feasibility and progress for each capacity. (Anyangwe, Fitter, Kimball, López-Acuña, Tomori)
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From page 12... ...
Many participants throughout the workshop also highlighted the importance of effective leadership and management, and the need for more concerted efforts to foster better engagement among all sectors and stakeholders. LEADERSHIP AND MANAGEMENT "Leadership and decisions should be directed in the context of existing structures and take into account where we need to strengthen those structures to produce effective outcomes." -- Daniel López-Acuña, Former Director for Recovery and Transition, Cluster of Health Action in Crisis, World Health Organization Several participants returned frequently to the need for strong and effective leadership in order to steward efforts to strengthen health systems, and to manage emergency responses, by working within existing structures at all levels.
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From page 13... ...
Perl, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, suggested incorporating a bilateral decision structure to build trust, augment response activities, and ensure accountability; a further investigative component would inform an emergency response that is situated appropriately within its particular political and social context. Hanfling noted that the availability of resources can influence the ability to lead -- the response to an event needs to be constructed by local emergency management authorities, with the affected country setting the requirements for what is needed.
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From page 14... ...
While the ultimate goal would be the alignment of all of the partners in achieving capable systems that can deal with emergencies, Hanfling suggested that other beneficial outcomes could include • Building and strengthening capacity • Promoting emergency management systems and implementing a national emergency management plan (focus on process) • Building a systems approach to managing emergencies • Optimizing interemergency periods to build capacities and capabilities • Instilling leadership with the attitude and accountability to make good decisions and fulfill expectations, and • Strengthening of civil societies Joan Awunyo-Akaba, Future Generations International, Ghana, strenuously urged the African Academy of Sciences to take a much stronger leadership role in bringing together the top professionals and scientists in the continent to create roadmaps, set clear agendas, and seek out people and organizations with available resources to solicit support.
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Oyewale Tomori, President, Nigerian Academy of Science described it as a "toothless" document that gives assessed targets to countries but does not take any action if they are not achieved.1 Stella Anyangwe, Honorary Professor in Epidemiology at the School of Health Systems and Public Health at the University of Pretoria, South Africa, noted similarly that WHO does not currently "name and shame" countries for not signing or ratifying IHR, or take any real action against countries that fail to comply with the regulations, which needs to change. Kimball of Chatham House remarked that countries are not given adequate operational guidance about how to achieve IHR core capacities.
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She remarked that efforts to ensure and facilitate IHR adherence have thus far primarily been driven by global leadership, and she encouraged local leadership to take a more active role in advocating for compliance. Because of the importance of implementing IHR capacities as currently established (and any further stipulations that are agreed to)
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From page 17... ...
The opportunity would allow the donor community to become part of the process of sustaining health systems in the intercrisis period rather than contributing to fragmentation, and the self-interest needs of businesses can be brought to light ahead of a disaster. A few participants called for leadership to provide better guidance to donors to channel funds to where they are most needed; funding should focus primarily on public health priorities and infrastructure, not the "emergency disease of the day." As an example, Greenough of Harvard School of Public Health noted that while people are dying of EVD in Sierra Leone, children under 5 years of age are also dying of diarrheal illnesses, which will continue after the EVD outbreak is over.
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Multiple participants throughout the workshop echoed this strategy, in addition to recommending the use of short message service (SMS) alerts to deliver a range of health-related messages, especially in developing countries where SMS alerts can be a primary method for message dissemination.
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One is how different sectors such as government, civil society, and the private sector engage with each other; the other is how the different thematic sectors work together, such as water and sanitation, nutrition, education, energy, transport, and finance. As an example of poor cooperation between the health sector and other sectors, he cited the fact that 38 percent of health care facilities in low- and middle-income countries (LMICs)
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. Both are emerging infectious diseases with high morbidity and mortality rates that engender stigma and fear, he said, and they are both perceived threats to high-income countries that generate irrational political and emotional responses.
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Integration of Public Health and Health Care Many participants called for better integration of the public health and health care delivery divisions. Greenough highlighted the false dichotomy between the sector that provides health care and the public health infrastructure that should drive population-level health improvements.
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Hanfling called for recasting public health at the governmental level -- currently hampered by fragmentation and system failures -- to be inclusive of emergency preparedness and response; however, recognizing the prerequisite of solidifying fundamentals of care, such as care for noncommunicable diseases prior to achieving emergency preparedness capabilities. Educating the population and community health workers to dispel myths and misconceptions about emerging infectious diseases is another component of this process.
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This involves a wide range of partners, including regional and national governments, NGOs, civil societies, private businesses, and local leaders. Some participants explored strategies for integrating and coordinating with community partners to improve public health and health care delivery both during and between disease outbreaks.
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From page 24... ...
, cultural practices, and customs. Partners involved in this effort would be wide ranging and ideally "close to the ground": youth, colleges of medicine and public health, local NGOs, faith-based organizations, professional associations, health facilities, philanthropic organizations, and the media.
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From page 25... ...
In the absence of experienced community leaders and workers, cultural anthropologists often play a leading role in understanding and altering community behavior to ensure that medical professionals and communities understand each other and can work together to end outbreaks of disease. During the 2014 Ebola epidemic in West Africa, the American Anthropological Association and other societies urged governments and aid organizations to bring anthropologists to affected areas for support (Lydersen, 2014)
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From page 26... ...
Jones argued that small NGOs can have a powerful effect in these types of marginalized communities, which are often the last to receive external assistance. Particularly in such circumstances, groups that have a long-term and consistent presence in affected areas have the advantage of being able to: • Employ existing on-ground resources • Foster trust within underserved communities • React quickly and flexibly during crisis situations For instance, Jones contended that FACEAfrica's work with WASHrelated community engagement in Rivercess allowed the launch of an EVD awareness campaign more quickly and effectively than an international organization with no community ties.
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From page 27... ...
She concluded by calling for all sectors to recognize, respect, and support organizations working within communities; these groups promote the long-term health and strength of the communities they serve and will continue to do so when international players have left. Integrating Mental Health Care While mental health is in fact part of the health sector, it is a crucial component of a resilient and sustainable health system that often lacks sufficient resources and emphasis -- particularly during infectious disease outbreaks.
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From page 28... ...
Petersen recommended the use of a platform approach to decentralize and integrate mental health care into the health care system, as well as other service delivery platforms, to strengthen mental health overall and improve emergency response. She also noted that this type of approach allows for the identification of both of the roles played by different sectors and of areas where resources are needed.
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From page 29... ...
tunities to leverage nonfinancial private-sector resources, and enhanced clarity with regard to government strategies and how the private sector can help to facilitate their implementation. Rio Tinto is a British-Australian multinational metals and mining corporation that operates in 40 countries; Davidson is the managing director of Simandou, Rio Tinto's iron ore min
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From page 30... ...
He projected that the project's impact will double Guinea's gross domestic product each year for a number of years, in addition to employing up to 5,000 local people overall. Davidson described the emphasis that Rio Tinto places on the health and safety of its employees, as evidenced by the fact that none of its 3,000 employees in Guinea at the time contracted EVD during the 2014 outbreak in West Africa.8 To illustrate the impact that private-sector companies can potentially have in safeguarding the health of their local employees and contractors, he outlined the four main principles that they implemented in response to the epidemic to keep their employees safe (see Box 2-2)
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From page 31... ...
II. Practical support for front-line organizations To support organizations on the ground, Rio Tinto donated $3.4 million, with $2.9 million of that in-kind in critical equipment and logistics: vehicles, including helicopters; a fuel-pumping system and mobile camps to increase treatment ca pacity; food rations; and large-scale communication and awareness campaigns.
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From page 32... ...
32 RESILIENT AND SUSTAINABLE HEALTH SYSTEMS crisis in Ghana, her company reached out to organizations to see what was needed and how they could help, but it was difficult to get answers, and no one could clearly tell them what sort of help was required. She pointed to a lack of engagement prior to emergency situations, contending that it is only when disaster strikes that people think about calling the private sector.
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