Changes in Mindset and Decision-making Needed to Improve Health Coverage
Panel on synergies in global health: (L-R) David Heymann, co-chair of the Commission; Masa Moshabela, Irene Agyepong, co-chair of the Commission; Francisco Songane, former minister of health of Mozambique

Changes in mindsets, decision-making, and accountability are the keys to improving synergies between the different agendas of Universal Health Coverage (UHC), health security, and health promotion, a new report shows.

Marking the 76th World Health Assembly and Geneva Health Week 2023, Professor Irene Agyepong, co-chair of the “Lancet Commission on Synergies between universal health coverage, health security, and health promotion,” spoke on the publication of the Commission’s findings.

Speaking at a panel titled “Synergies In Global Health and Why They Matter,” Agyepong stated that maximising any potential crossover between the three agendas is vital to increasing the potential for synergies to occur. 

“We suggest that the way forward requires changes in mindset and decision-making,” Agyepong said. “[We need] to help people realize that sometimes paying attention to the interests of others is the best way of advancing your self-interest, and then maximize synergies among global health actors and ensure transparency.”

Reframing goals

According to the Commission’s report, changes in mindset include the reframing of individual health goals into a single, comprehensive vision; recognizing that it is necessary to promote synergies in health rather than prioritising one particular issue; and developing shared values and principles to achieve this vision at national and international levels.

Changes in the decision-making process are also a top recommendation for the Commission. The report looks at the relationship between international organisations and individual countries, which function on many different levels, due to differing factors such as financial capabilities, the political system in place, and the overall structure of the health system in that country. 

The report states that adopting a decolonised approach and developing nationally-owned health priorities can allow global health agencies, such as WHO, to offer the flexibility for countries to adapt investments, policies, and national priority programs.  

“You cannot just build it by giving money or throwing money at the problem. It needs to enable countries and people within countries and society of local contextually-relevant innovation,” Agyepong pronounced.

This point was echoed by David Heymann, co-chair of the Commission and Professor of Infectious Disease Epidemiology at LSHTM, who stated, “It is countries that have to make the decision on what synergies they want to develop.

“It is not the donor agencies that are developing the systems. It is not the World Health Organization [WHO]. It’s countries. They need to make the decision.”

“If leadership comes from WHO where they can connect health promotion, universal health coverage, and health security in one continuing activity instead of three different silos, then it would really do a lot to help countries follow that example.”

Dr Francisco Songane, former minister of health in Mozambique, agreed that countries must take their own initiative, saying, “The crux of the matter is the leadership from the country level. 

“It is extremely important that there is clarity and coherence within the government of a particular country to devise an agenda and to sell it to the different stakeholders to make it the one-country agenda,” Songane told the panel. “I think that is the very beginning of the whole issue.”

The stakeholders’ view

In the second half of the forum, several stakeholders from different arenas sat down to discuss the Commission’s findings and recommendations for the future. 

Dr Atul Gawande, Assistant Administrator for Global Health USAID, told the panel, “It is difficult to build with intention systematized health systems because of the many different actors coming to play.

“The examples cited earlier of Ethiopia and Rwanda, I want to highlight in particular. The notion that a country would have a ‘one budget, one plan,’ that the people in the country coalesce around and the donors and other parts of the community come together – this is what made Ethiopia and Rwanda successful.”

One of the report’s conclusions was that donors also bear responsibility for fragmentation or dis-synergies in health systems.

Agnès Soucat, Director of Health and Social Protection at the French Development Agency (AFD), agreed that the “evidence is overwhelming that donors contribute to fragmentation. So despite greater public commitment to harmonization and alignment, we are moving backward, and it is because the incentives are not aligned. Something like the alliance of all the partnerships under UHC2030 is very promising.”

Justin Koonin, Co-chair of UHC2030, the international multistakeholder partnership for universal health coverage, said there were opportunities soon for the Commission’s ideas to form into a more realised vision.

“In September in New York, we have not one but three health-related high-level meetings on UHC on pandemic preparedness and tuberculosis,” Koonin said.” So I think it will be a really good test of how serious the world leaders are around actually integrating.”

The Commission’s report will attract plenty of attention for its proposals and recommendations, and it is clear that the stakeholders feel that something has to change.

“What we have been doing in the past has gotten us where we are,” Soucat told the panel. “Where we want to go will require a new approach.”

“Synergies In Global Health and Why They Matter.” was organised by the Geneva Graduate Institute, The Global Health Centre and the International Geneva Global Health Platform, The Lancet, London School of Hygiene & Tropical Medicine (LSHTM), Ghana College of Physicians and Surgeons.


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