The Neglected Dimension of Global Security A Framework to Counter Infectious Disease Crises (2016) / Chapter Skim
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3 Strengthening Public Health as the Foundation of the Health System and First Line of Defense
3 Strengthening Public Health as the Foundation of the Health System and First Line of Defense
Pages 23-46
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From page 23... ...
A primary health care system without the levels are also important, but national capacities are the support of strong public health capabilities will lack the foundation of an effective global health risk framework. ability to monitor disease patterns and be unable to plan Regional and global capabilities cannot compensate for and mobilize the scale of response required to contain deficiencies at the national or local level.
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. This binding ments and by the international community, as reflected agreement also emphasizes the importance of containing in the 2005 International Health Regulations (IHR)
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, overall improvement over the previous year was limited ROBUST PUBLIC HEALTH CAPACITIES under several indicators. These assessments also provide ARE ACHIEVABLE IN THE CONTEXT OF further insight into the overall lack of health system BUILDING AND SUSTAINING STRONG capacity, especially in terms of preparedness, human re- HEALTH SYSTEMS source capacity, and at points of entry (which includes Before the current West African Ebola outbreak, Uganda ports, airports, and ground crossings)
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The GHSA seeks to cause Uganda had in place an operational national health achieve coordinated action and undertake specific, meapolicy and strategic plan, an essential health services surable steps to prevent, detect, and respond quickly to package that included disease surveillance and control, emerging infectious diseases. To facilitate this goal, the and a decentralized health delivery system (Mbonye et 11 action packages provide guidance in areas ranging al., 2014)
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From page 27... ...
Of course, corrup- Without a skilled, motivated, and well-supported tion and governance weaknesses are a problem for not health workforce, no health system can achieve its goals. only public health, but also every aspect of public ser- Yet the world faces a global health workforce crisis -- vices.
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From page 28... ...
Disease surveillance and health infor- guidelines should include procedures and reporting temmation systems should be developed with the long-term plates to comply with these obligations. vision of creating nationwide, interoperable, and interconnected platforms that are capable of collecting, ag- Laboratory Capacity gregating, and analyzing information at every level of the An effective nationwide laboratory network is another health system (community, district, other subnational, key component of a highly-functioning public health and national levels)
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. A tiered net- because outbreaks are typically first detected through work should be integrated with the disease surveillance primary health care, and because the health care delivery system at every level of the health care system to en- system is critical to executing a response strategy.
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Public health across professional communities, thereby facilitating programs requiring collective behavioral change to inter communication in times of crisis. The Mekong Basin rupt the transmission of infectious disease need the acDisease Surveillance Network, which was established in tive support and involvement of the communities they 2000, is an example of regional collaboration among six wish to assist.
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Also ance on how to engage communities before, during, and essential is a willingness to let go of preconceived ideas after infectious disease outbreaks. and recognize that local people may well be able to come
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Social media offers promising tools to reach prevent, detect, and control infectious diseases outbreaks; different groups with appropriate messaging. However, to protect their own populations; and to play their part messaging must be carefully researched and framed for in protecting global health security.
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country performance against the benchmarks defined WHO has received detailed self-assessment reports from in Recommendation B.1, building on current Interthe member countries since 2011 on an annual basis. national Health Regulations monitoring tools and During the past 5 years, 98 percent of all states parties Global Health Security Agenda assessment pilots, by have responded to the monitoring questionnaire at least the end of 2016.
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As discussed in Chapter 2, infectious disease sector, such as the World Bank's Doing Business reports, outbreaks represent a substantial threat to countries' ecowhich are detailed assessments of the regulatory and nomic prosperity. Appropriately reflecting the risk associinfrastructure environment for establishing a business, ated with under-preparedness in assessments of macroor the Financial Action Task Force Mutual Evaluation economic stability would allow economic actors to take mechanism, which is a peer-review process focused on such risks into account when making decisions about the effectiveness of anti–money laundering systems and investments and loans.
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SDGs will be used for holding country leaders account- Thirdly, the prioritization of global aid agendas and able and can also act as the entry point for bringing the financing mechanisms can create challenges in building global health security agenda into the routine work of coherent and resilient health systems. A focus on specific the UN, including the Security Council.
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From page 36... ...
of emerging strategies, such as national laboratory networks, would be applicable infectious diseases; and second, many of the elements of One Health to any emerging disease threat.
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However, it is clearly and the World Bank–funded Laboratory Net- in the interest of global health security to incorporate work in 18 countries in east, central, and south- consideration of infectious disease preparedness and re ern Africa; sponse challenges in determining the UN or broader in 3. through the creation of a new fund, with grants ternational strategy toward such situations.
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From page 38... ...
Strengthening public health capacdevelop domestic resourcing plans to finance improve- ities should be a health security priority for governments ment and maintenance of core capacities as set out in and the global community. To achieve this, WHO, in the country-specific plans described in Recommenda- coordination with member states, should develop clear tion B.6.
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created by egy, Uganda moved to strengthen WHO's "Integrated coordinating emergency capacities through receiving, Disease Surveillance and Response Strategy." evaluating, and distributing information collected from
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. sub-district level and grow increasingly more complex in scaling up the health system, with approximately 1,700 Integrated Disease Surveillance System health facilities providing basic minimum laboratory serThe disease surveillance system functions at all country vices (Kiyaga et al., 2013)
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These will In summary, taking the lessons learned from the 2000 further serve as the decentralized monitoring and evalu- Ebola outbreak, Uganda started a process of buildation centers for Integrated Disease Surveillance and ing public health core capacities that strengthened its Response countrywide. Surveillance efforts are boosted surveillance and response systems, which significantly with the CDC's FETP.
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In the case of Sierra Leone, a country The Vision 2020 policy, Rwanda's comprehensive na- hugely impacted by the ongoing Ebola outbreak despite tional plan, provides a clear, long-term development path more than $712 million in aid, only 5 percent was and objectives for moving forward post-genocide. These funneled into national systems, therefore bypassing comprehensive and transparent development plans allow communities who would stand to benefit most (Office of for coordination among the government, donors, and the Secretary-General's Special Adviser on Community implementing partners.
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. Although the containment measures in Guinea, Sierra Leone, and case-fatality of the disease varied widely, the primary Liberia during the Ebola epidemic, it is important to approach to smallpox put all the emphasis on control understand the history of public health approaches in rather than care: quarantine, isolation, ring vaccinathe region.
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2014a. Global Health Security Agenda: GHSA Immunization AcAbramowitz, S
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:e0143036. Mapping the Global Health Security Agenda to existing interna- Phalkey, R
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From page 46... ...
2016. Global Health Observatory data -- International Health nal of Public Health Policy 25:137-158.
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