Fragmented health systems in COVID-19: rectifying the misalignment between global health security and universal health coverage

Abstract

The COVID-19 pandemic has placed enormous strain on countries around the world, exposing long-standing gaps in public health and exacerbating chronic inequities. Although research and analyses have attempted to draw important lessons on how to strengthen pandemic preparedness and response, few have examined the effect that fragmented governance for health has had on effectively mitigating the crisis. By assessing the ability of health systems to manage COVID-19 from the perspective of two key approaches to global health policy—global health security and universal health coverage—important lessons can be drawn for how to align varied priorities and objectives in strengthening health systems. This Health Policy paper compares three types of health systems (ie, with stronger investments in global health security, stronger investments in universal health coverage, and integrated investments in global health security and universal health coverage) in their response to the ongoing COVID-19 pandemic and synthesises four essential recommendations (ie, integration, financing, resilience, and equity) to reimagine governance, policies, and investments for better health towards a more sustainable future.

Working short and working long: can primary healthcare be protected as a public good in Lebanon today?

“…Globally, Covid-19 has pushed health systems to their limits [15]. In resource -constrained contexts where the burden of disease and risk factors are often distributed unevenly in the population, factors such as siloed nancing and fragmented governance of the health system may well have contributed to an increased burden on the poor [15]. Today, service providers and policy-makers worldwide are pressured to decide which essential services must be protected as precious resources are reallocated [16].…”

“…Today, service providers and policy-makers worldwide are pressured to decide which essential services must be protected as precious resources are reallocated [16]. Making sound decisions is even more di cult in a context where political, economic or nancial interests might well result in fragmented directives that privilege the powerful and thus serve to increase inequities [15].…”

COVID-19 in Germany and China: mitigation versus elimination strategy

“…To control the COVID-19 pandemic globally, an epidemiologically informed, evidence-based public health response has been rightly called for, with the essential components of surveillance, outbreak investigation, TTT interventions, measures to reduce and mitigate transmission in public facilities and in the community, and research [ 17 , 61 , 74 ]. It needs to be embedded into comprehensive, resilient and publicly financed health systems providing universal health coverage, in order to be prepared for the next great pandemic [ 75 , 76 ].…”

Editorial: managing health and social care after covid: what works and who decides?

“…The covid-19 pandemic exposed the fragile nature of many health systems around the world. Enormous variations in states' ability to cope with the crisis were revealed (Lal et al 2021). These crises sat on top of many usual inequalities in service provision and health outcomes.…”