Evidence to inform synergistic action in strengthening health system resilience (A proposed case Study on Bangladesh)

The concept of health security evolved from concerns arising out of global emergencies such as that from outbreaks of H1N1 influenza (2009), Ebola (2014) and Zika (2016) (and before that SARS,2003) with characteristics of cross-border and trans-border spread, and threat to public health and health system’s capacity to contain these. To prevent, detect and respond to infectious disease outbreaks posing threats to public health and backed by legal instrument such as the IHR (premise of health security), consensus is arising for a functioning and strong health system which delivers quality essential health care services, leaving no one behind and without financial consequences to its users (premise of universal health coverage).

Both UHC and HS seek to mitigate the effects of epidemics and cross-border pandemics on society and economics, at the level of individual and community/state, respectively. The quest for UHC and HS are conceived as two sides of the same coin, converging when looked through the lens of ‘human rights.’ In the global health agenda, synergies between the two and overcoming the fragmentations, is high up the agenda towards building a resilient health system which can prepare for, respond and sustain the epidemic crises. Thus, a ‘strategic, effective’ partnership between the two is suggested by a policy of health systems strengthening. This is to be achieved through ‘embedding GHS into UHC,’ paving the way for the development of an integrated health systems that also includes public health interventions. Also, a Lancet commission is established to look into the synergies between UHC, HS, and Health Promotion (HP), in consistence with WHO’s general programme of work (GPW) for 2019 – 2023.   

Cross-border spread of emerging and re-emerging infectious diseases, especially the Ebola crisis, has raised concerns among the public health professionals globally. A Global Health Security Agenda (with 12 targets) is proposed for coordination and partnership across nations for outbreak response, including a country-specific work plan for Bangladesh (using the ‘prevent, detect, respond’ framework). Bangladesh also has high political commitment to achieve UHC by 2030, leaving no one behind. It’s high time that we re-visit the concepts and activities related to UHC+HP and HS, identify the synergies and gaps, and develop an integrated system which not only provide quality health services equitably and without financial implications for the consumers, but also provide preventive health services which promote health lives, and which can prepare to prevent, detect early and respond immediately to an infectious disease outbreak including emergence of AMR. This study is expected to fill-in these knowledge gaps to inform the decision makers  the building of a ‘resilient’ health system.

Thus, a case study on Bangladesh isproposed to feed the lancet Commission country case studies section. The objectives of this case study will be:

i) What is the current situation with respect to UHC (including health promotion activities), and HS in Bangladesh in policy and practice?  Synergies/gaps??

ii) What is the perception and experience of the key stakeholders in policy and practice about these concepts and possible actions? According to them, what are the ‘enablers’ and ‘barriers’ to overcome current ‘fragmentation’ in activities related to UHC/HP and HS in Bangladesh??

iii) How health system can be strengthened where service delivery is combined with health promotion activities including ‘prevent-detect-respond’ to infectious threats+AMR through comprehensive surveillance and monitoring involving human, animal and envirobmental health? A resilient health system which can face the onslaught of epidemics…

iv) What is the most cost-effective way of integrating the two stream of activities (UHC+HP and HS) including e.g., surveillance and monitoring? Cost of the integrated package?? Cost-benefit outcome of a unified system???

The first draft is expected to be complete by Sept. 2019.