At the San Matteo hospital in Pavia, Italy. (Source: Claudio Furlan/LaPresse)
Robert Yates is an internationally recognised expert on universal health coverage and progressive health financing, who has previously worked as a senior health economist with the World Health Organisation. He speaks to The Indian Express:
Do most big public health plans stem from large crises?
It is definitely true that many of the world’s most significant and successful universal health coverage reforms have followed, and been a consequence of major crises. Good examples include the UK, France and Japan after World War II, Thailand after the Asian financial crisis, China after the 2002 SARS crisis, and even Rwanda after the 1994 genocide.
To what extent does the underfunding of bodies like the WHO impact global information-sharing on disease?
This crisis has once again put the spotlight on the underfunding of global health bodies like WHO which is limiting their ability to coordinate the global response including the sharing of information across national boundaries. In September 2019 the Global Preparedness Monitoring Board Report recommended that Member states need to agree to an increase in WHO contributions for the financing of preparedness and response activities and must sustainably fund the WHO Contingency Fund for Emergencies, including the establishment of a replenishment scheme using funding from the revised World Bank Pandemic Emergency Financing Facility. Looking to the future, it is vital that governments heed this recommendation and the other ones outlined in the GPMB report.
Poor countries do not have the money to make public health a top priority, many governments say.
I don’t agree with this. The amount that governments spend on public health, health systems, and health in general is a political choice weighed up against other priorities. Some countries choose to spend a higher proportion of their GDP through public health financing than others, and in many instances have increased public spending quite dramatically. China did for example, after the SARS epidemic in 2002. There are though, a number of countries that demonstrably give a low priority to public health spending, and regrettably that includes India.
Could something good and useful emerge on the other side of this pandemic?
Yes, I hope this terrible tragedy will be a wake-up call that the world collectively needs truly global universal health coverage whereby everyone on the planet receives the quality health services they need without suffering financial hardship. This clearly means access to and use of public and preventive health services to stop outbreaks becoming epidemics, and also curative, rehabilitative and palliative care services for those who become sick.
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This can only be achieved through publicly financing the health system so that the healthy wealthy subsidise the sick and the poor. And there are already signs of some countries recognising that they do need to socialise their health financing systems more (e.g., Ireland, Spain, South Africa) to tackle this epidemic and this may also happen in countries like India and America as well, which have become dominated by inequitable private financing. So hopefully in the long run, responding to this epidemic will take the world closer to the SDG goal of universal health coverage.
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