Dr Muhammad Ali Pate, Global Director for Health, Nutrition and Population at the World Bank as well as Director of the Global Financing Facility for Women, Children and Adolescents, reflects on the impact of the current COVID-19 pandemic on the work that the global institution has been doing to promote the implementation of universal healthcare globally, the initiatives they are working on to address both the primary COVID-19 crisis as well as the secondary health crises emerging, particularly in developing countries; and the importance of cooperation and collaboration between all public and private stakeholders at this critical juncture in time.
Improving health financing resilience will be critical for achieving universal healthcare, particularly if countries are hit by second or third waves of COVID-19
Universal health coverage is one of the priorities for the World Bank Group’s global strategy for health, nutrition and population but the 2019 UHC Global Monitoring Report indicates that the world was already off-track to achieve the Sustainable Development Goal target of universal healthcare (UHC) for all by 2030. Has the COVID-19 further set this back? At the same time, do you think the pandemic has reinforced the critical importance of this objective?
The COVID-19 pandemic is having substantial health, social, and economic impacts in all countries, rich and poor. However, the poorest countries and most vulnerable populations are often the hardest hit – through illnesses, job and income losses, food supply disruptions, school closures and lower remittance flows. The virus threatens to push between 71 million and 100 million people into extreme poverty.
Health systems are also facing the dual challenge of responding to the outbreak while maintaining essential services. Many countries are facing a secondary health crisis due to disruption in access to life-saving health services – particularly for women and children in low- and lower-middle-income countries. It is a sharp reminder that everyone, everywhere should have access to quality and affordable health services.
Improving health financing resilience will be critical for achieving universal healthcare (UHC), particularly if countries are hit by second or third waves of COVID-19. We know that even before the crisis, people in developing countries paid over half a trillion dollars out-of-pocket for health care, causing financial hardship for more than 900 million people and pushing nearly 90 million people into extreme poverty every year. And even when health services are available, countries at all incomes levels often struggle to ensure health service quality and affordability.
Prevention and emergency preparedness, which are often neglected by countries, are also key to achieving UHC. In fact, UHC and health crisis management are two sides of the same coin. We need to pay special attention to things like disease surveillance, laboratories and diagnosis, health information systems, communications about changing behaviours, engagement of communities and building public trust in the health system. The relative neglect of these areas has left communities more vulnerable to COVID-19 and its economic shocks.
Nine months into the global outbreak, how do you broadly assess the global response across public and private stakeholders in terms of achievements, areas to improve, and insights and lessons for future healthcare crises, particularly with regard to the important role that vaccines play in public health
As countries around the world work to contain the spread and impact of COVID-19, the actions of all partners, working in concert, are important – including governments, the private sector, and international organizations.
The World Bank Group has been taking broad, fast action to help developing countries strengthen their pandemic response and health care systems and we are currently delivering record support to over 100 countries, home to 70 percent of the world population.
We have committed up to USD 160 billion of financing over 15 months tailored to the health, economic and social shocks countries are facing, including USD 50 billion of IDA resources on grant and highly concessional terms. In addition to ongoing health support, our operations emphasize social protection, poverty alleviation, and policy-based financing.
The crisis reinforces the need for global cooperation on priorities including addressing health workforce shortages and ensuring equitable access to new diagnostics, medicines and vaccines. We believe that fair and equitable access to safe and efficacious vaccines and therapies, when developed, is essential for all countries, including the poorest, to rebuild livelihoods and set a course toward recovery. We are working closely with partners across the public and private sectors to ensure global and fair access to COVID-19 vaccines, therapeutics and diagnostics that are being developed.
It is also key that governments work closely with local communities in responding to the pandemic; this was an important lesson from the Ebola crisis in 2014-15. For populations to be better protected in future, governments must create space for communities to participate actively in shaping more equitable health systems.
According to the Global Financing Facility (GFF) monthly COVID-19 surveys, “low- and lower-middle income countries are increasingly reporting significant disruptions to essential life-saving health services. How can beleaguered healthcare systems as well as public and private stakeholders continue advancing with the provision and delivery of essential healthcare services and strategies while battling COVID-19? What kind of resource allocation and prioritization are necessary and feasible?
COVID-19 is not only impacting emergency healthcare, but recent findings show it is also having a drastic secondary impact on essential basic healthcare services such as nutrition, antenatal and outpatient care. It is already disrupting immunization for measles and other infectious diseases. As a result, estimates have shown that millions of women and children may die or endure lifelong health impacts. The Global Financing Facility for Women, Children, and Adolescents (GFF) also estimates that as many as 26 million women could lose access to contraception across 36 countries, leading to nearly 8 million unintended pregnancies.
To support the most vulnerable countries, we need to pool resources and coordinate to prevent disruption of commodities such as medicines. This includes resources from governments, donors, multilateral organizations, non-governmental organizations, and the private sector.
The pandemic requires that governments prioritize health investments now: the costs are small compared with the economic costs of not acting. UHC2030 – the global movement to strengthen health systems for universal health coverage – has an important role to play in bringing partners together with a joint vision for resilient health systems and priority actions.
The current crisis is a chance to ensure better preparedness to future disease outbreaks, including a possible resurgence of COVID-19. To help developing countries get better prepared, the World Bank has established a new Health Emergency Preparedness and Response Multi-Donor Fund (HEPRF). The new fund will provide incentives to low-income countries to increase investments in future health preparedness in addition to supporting the immediate COVID-19 response.
The International Finance Corporation (IFC), the World Bank’s private sector arm, recently launched a USD 4 billion financing platform aimed at boosting the production and supply of critical healthcare products in developing countries to help fight the coronavirus pandemic. It is aimed at private sector projects to manufacture products such as personal protective equipment, ventilators and other medical equipment, coronavirus test kits, therapeutic drugs, and vaccines.
What kind of innovative financing approaches has the GFF introduced or plans to introduce to support this?
The Global Financing Facility for Women, Children and Adolescents (GFF) is helping countries build resilient health systems while ensuring that safe and equitable delivery of essential health and nutrition services for women and children is a central part of COVID-19 response and recovery efforts. Through flexible financing and technical assistance, the GFF is working with 36 countries to prioritize investments in essential services for women and children, strengthen frontline service delivery, and address constraints in demand for sexual and reproductive health and other services.
COVID-19 is threatening hard-earned progress in GFF partner countries, which are expected to face significant health and economic shocks. Health financing strategies will need to be agile to respond to shockwaves and budgets will need to be spent even more efficiently.
The GFF is helping countries to mobilize resources to tackle the impacts of the pandemic while ensuring the continuation of essential, life-saving health services for women and children.
For example, the GFF, in partnership with WHO, supports countries to systematically monitor COVID-19 related funding and spending to help identify funding gaps and help governments prioritize and plan better.
The GFF also provides flexible, catalytic funding linked to World Bank projects to ensure continuity of essential services for women and children. For example, in Myanmar a USD 10 million GFF grant tied to a World Bank project is helping to strengthen health systems and develop partnerships with private companies to scale up innovations to reach women and children in remote or conflict-affected areas. Building on existing support, the GFF has swiftly mobilized the public and private sectors to develop an action plan to help deliver quality primary health care services to the most vulnerable populations affected by COVID-19. The action plan enables the government to take full advantage of private sector capacity and resources in priority areas such as treatment, testing and referral, and supply chain management as the virus ramps up in Myanmar.