Scholars’ Voices: Towards Resilient Health Systems – What Should Countries Do?

At the 2022 Baobab Summit in Kigali, Rwanda, University of Edinburgh Mastercard Foundation Scholars Program alumni Mary Adeoye was a roving reporter and participant in many breakout sessions. One session that resonated with her was a conversation on developing resilient healthcare systems. We asked Mary to share her thoughts on the topic and tell her story.

As a Global Health Policy Scholar, my interest in the role of resilience in improving global health security has grown over the years, particularly since the emergence of Ebola and the COVID-19 pandemic. I work to understand what it means for health systems to be resilient on a granular level, particularly in the Global South, where most countries have struggling economies and little funds to spare for healthcare expenditure.

Maintaining core healthcare functions when crises strike, like pandemics or insurgencies, is health systems resilience. Kruk et al. (2015), in a Lancet Publication, add nuance to the issue of resilience by spotlighting how both poor and rich (the United States) countries struggled to respond strategically and regulate public perception, which frequently takes the form of fear, in a way that prevents disease spread while also allowing daily life to go on [1]. In 2020, during the beginning of COVID-19, I had a personal experience with a health system resilience failure. The state hospital I visited in Abuja, my country’s capital city, for a dental procedure could not afford to provide personal protective equipment, such as N95 masks, for the dentists because funds had been diverted to COVID-19 response. I, along with all other dental patients, had to pay out-of-pocket for something so small but so essential. This demonstrates that, while resilience is a function of health system governance, its impact is felt by all citizens. It is not simply a framework for determining how prepared a healthcare system is; it is about quality of life.

Healthcare resilience isn’t just limited to infectious diseases. What about conflicts, insurgencies and wars? This brings to mind the Ukraine War; I recall reading on WHO’s website in June 2022 that one hundred days of the war had put Ukraine’s health system under severe strain. The attacks are destroying the healthcare infrastructure and reducing healthcare services. In addition, healthcare workers in Ukraine have been advocating that support with managing anxiety, grief, and psychological pain is currently the most frequently demanded service, demonstrating the strain that the lack of resilience has on mental health systems.

On a more personal level, the Boko-Haram insurgency in Nigeria, especially in the North-Eastern part, has also adversely affected the health system, The Nigerian health system hasn’t been able to effectively respond to the insurgency’s woes. For instance, having worked in Nigeria’s public health field, I am aware that a significant factor contributing to the country’s high maternal and infant mortality rate is armed conflict. Considering this, it is unsurprising that Nigeria is the second-largest contributor to maternal death globally.

Strengthening resilience is primarily a governance role and should not be considered an afterthought. All health policies must incorporate resilience into their planning, funding, implementation, and evaluation phases. The health system in Nigeria, for instance, cannot be said to be resilient if funds intended for a programme to offer free long-acting and reversible contraceptives to women of childbearing age were instead diverted to COVID-19 emergency response. Reproductive healthcare is a crucial component of healthcare, and we shouldn’t have to forgo it because a pandemic emerged or re-emerged. Policymakers should consider factors other than pandemics or epidemics. We need to rethink resilience to encompass different types of shock.

During the Baobab Summit 2022, At a breakout session, I listened to scholars recount their individual and collaborative efforts to address health issues affected by COVID-19, such as maternal health issues, access to healthcare for people with disabilities, mental health issues, and gender-based violence issues. I couldn’t be prouder of their accomplishments. But these are grassroots efforts with minimal or no government support, which raises the question: what should countries do to build resilient health systems? Globally, the least well-off suffer the most from health systems failures. Therefore, countries must build robust primary healthcare systems. Effective primary care is the most cost-effective and equitable strategy to attain universal health coverage and security. Primary healthcare means quality, timely, and appropriate healthcare services for the poor regardless of their ability to pay.

The catastrophic events that I have mentioned should serve as a wake-up call for nations to begin reinforcing their primary healthcare foundations. If a government does not begin fighting the battle before it begins, the battle is lost or harder to win!

[1] Kruk, M.E., Myers, M., Varpilah, S.T. and Dahn, B.T., 2015. What is a resilient health system? Lessons from Ebola. The Lancet, 385(9980), pp.1910-1912.

Read more of the highlights from the 2022 Baobab Summit.

Read more Scholars’ Voices

About Mary:

Mary is a recent University of Edinburgh graduate who studied Global Health Policy. Before her MSc, she spent six years in Nigeria working at the intersection of health, gender, and development. Mary believes that universal health coverage should be integrated into all development discourse, including climate change and education, as a strategic way to achieve sustainable development goals. She was a Women Deliver Young Leader and continues to work as an alum as a young advocate for good health and wellbeing and gender equality. She was also a Carrington Youth Fellowship Initiative fellow sponsored by the Lagos State-US Consulate. When Mary is not working in Health Policy, she enjoys reading, writing, and amplifying development efforts through storytelling. For example, while a scholar with the University of Edinburgh’s Mastercard Foundation Scholars Programme, she volunteered as a communications team member. Mary is currently interning at Gavi, the Vaccine Alliance in Geneva.