The Covid-19 pandemic has made clear the importance of an effective and affordable health service. The immediate efforts need to focus on limiting the spread of the virus, providing care to those who fall seriously ill and ensuring that other health problems are not neglected. But, as governments around the world mobilise to address this emergency, they also need to keep in mind the longer-term aim of making progress towards universal health coverage. This is especially important if countries face a prolonged period of constrained public finances.
Five aspects of the Covid-19 response will be essential as part of a strategy for substantially improving global health services for the future:
1. The importance of government leadership
Governments are playing a key role in leading efforts to limit the spread of infection, prepare health services to meet demand and support efforts to develop effective treatments and vaccines and make them widely available. The public has relied on governments to provide advice and protect their well-being. Although Ministries of Health have provided technical leadership, the response has required cross-government action. Governments will need to build on this experience to strengthen their capacity to exercise effective oversight of future health services. This will require a significant effort in many low- and middle-income countries with relatively weak public administrative systems.
2. An appropriate mix of good quality hospitals, primary health care (PHC) services and public health
The Covid-19 epidemic makes clear the need for all three. The most visible impact has been on hospital beds, especially in intensive care units. The contributions of hospitals to an effective and resilient health system is clear. However, a rush of patients to hospital emergency rooms and outpatient departments can become an important focus for the spread of infection and can be very costly. That is one reason why PHC services near peoples’ homes are so important. Without effective PHC, many people are at risk of sickness and death from a wide range of common diseases, especially when hospitals are overcrowded and a potential source of infection. Also, measures to slow transmission require health workers with good local knowledge. In the rush to strengthen sophisticated hospital care, it is important that governments also invest in PHC and in measures to prevent the spread of infections.
3. Measures that enable people to manage their own health effectively
The infectious nature of Covid-19 has demonstrated the important role of individuals and their families, who are being asked to isolate themselves, when they have symptoms, treat themselves and only seek care if they fall seriously ill. This has led governments to help people play this role effectively. In the UK, for example, there has been a great deal of publicity on what people should do if they fall ill and the health service has established a special telephone line to advise people on when to seek hospital care. Similar efforts will be needed in future to enable people to manage other common health problems, such diabetes. Digital technology will become increasingly important in making this possible.
4. The need for all parts of the health service to contribute to national goals
In the UK, the treatment of Covid has been left exclusively to the national health service (NHS); private hospitals will provide services to NHS patients, at cost price. Private companies are manufacturing respirators to meet an urgent need. Communities are organising to provide support to vulnerable people who have been asked to isolate themselves. In other countries, governments, private providers and communities are playing complementary roles.
This illustrates the need to make good use of all resources in future efforts to make progress towards universal health coverage. It is well known that unregulated markets for health care can lead to big problems with safety and effectiveness, unnecessarily rapid cost increases and big gaps in access between rich and poor. To avoid this, governments will need to lead a process to agree the roles and responsibilities of different types of provider and to establish effective governance mechanisms. These mechanisms will need to involve a variety of civil society groups, as well as government regulatory agencies.
5. The potential contribution of new treatments, vaccines, diagnostic tests and applications of communications technology
Government leadership of the response to Covid has been important, but so has the participation of research organisations and private companies, which are leading the development of innovative technologies. This has involved new models for joint financing of research and development and a willingness to work together to integrate new approaches into ongoing health services. It will be important to establish a global mechanism to ensure effective surveillance and rapid response to future emergence of new viruses. A similar approach could be applied to address a wide variety of health problems, such as the challenge of anti-microbial resistance and the growing burden of chronic non-communicable diseases.
At a time of emergency there is a much greater willingness to act quickly and experiment at scale with approaches to organising services that previously seemed impossible. It will be important to ensure that the lessons we learn during this period are applied to the creation of more effective health systems that can help people live safe and productive lives in the face of a variety of health challenges.