Policy and Global Development

Strengthening Health Systems in Asia
Building resilient and inclusive health systems, and addressing future pandemics and other disease outbreaks in developing Asia.

Policy measures critical to build a resilient and sustainable recovery
1. Fortifying health system through health investments
2. Helping small enterprises adopt technology in their business
3. Consolidating and streamlining budget and raising revenues to cut public deficits and debts
4. Strengthening regional cooperation to build better health care services

Increased Investments in Health
Growth in Southeast Asia could go up by 1.5 percentage points with higher health investments as the increased health spending results to:
• Improved health care coverage
• Reduction in disease burden
• Higher labour force participation rates
• Increased workers productivity

Beyond investments in service delivery/supply side:
• Adoption of demand-side financing through national health insurance/health purchasing funds with government revenues financing coverage of the poor, non-formal sector workers, and other population groups deemed as vulnerable (elderly, women, unorganized sector workforce and others)
• National Health Insurance (NHIs) can be single fund or work with other health funds of social security schemes and government health coverage scheme
• Mobilization of domestic resources to finance NHI coverage/national health funds
• Fiscal autonomy among health care providers
• Facilitates the utilization of incentives and disincentives in provider payment methods to improve efficiency and address inequity
• Moving away from line-item budgets and un-regulated fee for service into payment per case and per capita, and/or performance-based payments

NHIs enables private sector engagement
Strong government purchaser in the health sector (includes national health insurance organizers and Ministries of Health allowed to enter into purchasing arrangements with the private sector)
• Presence of laws and policies enabling private sector contracting including PPPs such as laws on Universal Health Coverage and procurement
• Private health sector capacity and willingness to engage and contract with the government which we have seen during the pandemic to be present in the region
• Government willingness to work with development partners who will provide support in the development and implementation of PPPs.

Building a Comprehensive Framework for Health and Social Protection Systems
Strengthening Health and Social Protection Systems in Asia: Challenges and Policies
Key characteristics of a comprehensive framework: Access to affordable and quality healthcare
▪ A significant 13 percent of Asian households spent more than 10% of their income on health (indicator of “catastrophic” expenditure) before the pandemic (WHO 2020)
▪ Main reason was lack of universal health coverage and social protection schemes
▪ – “Social protection floors” protect the vulnerable and also have positive spill over effects (ILO 2012)
▪ Rectify structural underlying determinants of poverty and inequality which have been thrown into sharper relief with the pandemic 3 Social protection measures implement

Important components of a comprehensive framework in the recovery of health support schemes
▪ Access to vaccines, boosters, testing and high-quality healthcare remains key especially for the most vulnerable o Versatile and flexible social protection programs
▪ Important to remain cognizant of dimensions such as gender (women in the garment sector, for e.g.), location (rural/urban), and proportion of formal employment and adequate financing
▪ Cost of a basic universal social protection package would be 1.7% of GDP in South Asia

Health Policy Goals Universal and Timely Access to Sustainable: Affordable, and Quality Health Care that Advances the Health and Well-Being of the Population
1. To ensure all members can access to healthcare/ health services they need
2. To protect financial risk/hardship of household due to illness- Key features of National Health System administration include policy design for the benefits package, budgeting, design and management of the provider payment method, billing, clinical auditing, quality assurance, and consumer protection.

Crisis management: Establishing the Centre for the Administration of the Situation due to the Outbreak of the Communicable Disease Coronavirus (COVID-19). In order to strengthen public health emergency management systems through a collaborative approach that involves all sectors, both public and private sectors are contributing to the research, surveillance, vaccine procurement, risk assessment, epidemiological analysis, and control of emergency events.

Academic data and policy decisions:
• Academic support for medicine and disease control is required, particularly for emerging new diseases and pandemics.
• Health investments in the past are doing reasonably well, but they cannot support the situation of emerging diseases, which are fluctuating, uncertain, and enormous.
• During the pandemic, comparing the number of patients with Covid and non-Covid and the health system’s capacity. The issues of the four waves of the pandemic.

The Challenges: The remaining challenges of the health system are
1) The Roles of medical and health professional schools;
2) The primary health care strengthening reform movement;
3) Producing quality and committed health professionals and supporting their career development; 4) Supporting high-tech health services; 5) Transformative education in the 21st century is based on community, inter-professional and IT-based learning, close collaboration with users, and institutional/instructional reform (NHSO 2019).
Major Concerns about the Sustainability of Public Funding…
• Sustained Economic Growth
• Aging of the Population
• High Cost of New Technologies and Products; and
• Increased Demand for Health Care. … and have given rise to increased interest in private financing options

Policy Suggestions:
• Changing from a free market and technology-driven to a sustainability driven concept.
• Continue accelerating the implementation of laws and regulations defined in the Communicable Diseases Act (2015) for disease control at the domestic and international levels.
• Stimulating the full implementation of the health security policy. Consider supporting both the budget and human resources in terms of amount, technical, skill, and quality.
• Defining duties and Job responsibilities of all agencies clearly, implementing continuous practical interaction and collaboration between agencies in public and private sectors to keep the momentum operational, not just designing at the organizational level.
• Engaging the private sector and communities as key stakeholders in preventing, detecting, and responding to all events and disease control.
• Roles of medical and health professional schools to strengthen the primary health care system.
• Producing quality and committed health professionals and care workers and supporting their career development.

Resilient health system: Resilience Approach
• Systematic integration of active all hazards emergency preparedness planning (planned resilience) • Awareness that things may not go as planned (adaptive resilience)

Simultaneously Increase resilience & maintain stability
• Health system strengthening
• Universal health coverage
• Health security
Conceptualization of resilience as
• Outcome/ goal
• Process
• Capability

Building resilience Ghebreyesus et al. (2022) – WHO’s recommendations Durski et al. (2020) –
Recommendations for conceptual framework leverage:
(1) Include health experts
(2) A multidisciplinary team in the policy arena
(3) Develop network of thought leaders
(4) Develop a toolkit for outbreak response
(5) Develop a cadre of health-systems strengthening (HSS) and emergency response experts
(6) Conduct research to identify most effective policies
(7) Adjust HSS framework to include outbreak response
(8) Set up contingency funds
(9) Strengthen policy communications
(10) Align outbreak response with HSS goals- (i) Community engagement (ii) Governance & financing (iii) Public health functions (iv) Health service delivery (v) Health workforce (vi) Medical products & technology and collaboration across sectors Invest in essential public health functions(vii) Build strong primary health care(viii) Promote environments for innovation Invest in mechanisms for engagement(ix) Increase domestic and global investment and (x) Address pre-existing inequities

Health System Strengthening
A. WHO’s 6 Building Blocks: (i) service delivery, (ii) health workforce, (iii) health information systems,
(iv) access to essential medicines, (v) financing, and (vi) leadership/governance

B. Harvard’s Flagship Framework: (i) financing, (ii) payment, (iii) organization, (iv) regulation, (v)

Summary: Resilience = combination of pre-, during- and post-crisis processes: “Improve, expand,
extend” + “adapt, innovate” + “learn, lead”