The WHO needs to be strengthened at country level

November 10, 2023 admin

An interview with Agnès Buzyn from the Tagesspiegel Background

Professor Agnès Buzyn served as the French Health Minister between 2017 to 2020. She is a physician by training specialized in cancer research. 

Professor Buzyn worked for the WHO, as the Representative for Multilateral Affairs for the office of the Director-General and Most recently has taken on the role Special Envoy of the G20&G7 Health and Development Partnership Initiative, a not for-profit organization which was founded during Germany’s G20 Presidency in 2027.

Professor Buzyn, the Paris Peace Forum is currently taking place in the French capital. What significance does such an event have for the healthcare, for pandemic prevention and for building a fair, global health architecture?

Health policy should have the same status as security and defense policy, therefore The Paris Peace Forum is exactly the right place to get this message across. A few years ago, the climate crisis and international peace cooperation were at the center stage of the discussions here, however the coronavirus pandemic has shown how important global health and equal access to healthcare services is for the world. Unfair access to healthcare services also leads to migration, for example. Solutions must therefore be found for a modern healthcare architecture.

What are the weaknesses of the current global health architecture?

The development of a global health architecture began with the founding of the WHO in 1948. However, it has always been difficult for the WHO to be active at country level. Therefore, more and more organisations came into play to fill this gap. Most of these international organisations were private /public partnerships and focused on one specific health problem such as the Gavi Vaccine Alliance or the Global Fund to fight AIDS, Tuberculosis and Malaria. This has led to a development of a complex architecture system where several international organisations and non-governmental organisations are working to help countries build their health systems, train health workers, distribute medicines and much more. The landscape is now too complex and not efficient enough. 

When did weaknesses become apparent?

The deficit first became apparent during the pandemic when masks and vaccine were needed and had to be distributed. There was no infrastructure for this. To accelerate the fight against Coronavirus, a coordination effort called ACT-A (Acces to Covid-19 Tools Accelerator) had to be done to synchronize the effort of all these international organisations, such as the Global Fund, GAVI, the Wellcome Trust and the Gates Foundation and develop a coordinated response to the pandemic worldwide. In response, efforts are now being made for the first time to build a coherent global health architecture that can address the many health challenges we currently face. The aim is to be more efficient and avoid overlaps between all the international actors in the fight against diseases.

What steps are needed to achieve this?

First of all, all these institutions have to come together and be prepared to work together. But that is not a given as each organisation has its own mission, agenda and internal board to report to. First and foremost, however, it’s about finding a long-term solution in terms of funding, as this is the main problem with global health programs.  We need funds to prepare for the next pandemic and to tackle it but also to strengthen healthcare systems worldwide. Organizations compete for funding as well and that stretches resources; imparing with the efficiency of the healthcare architecture.

Can you give us an example?

During the pandemic, we realised how fragile many healthcare systems are: it was impossible to immunize people in many LMICs; In some countries although vaccines were available, there was not an efficient distribution system in place and no health care workers to perform the immunization. There is currently no organisation that helps countries to modernise their healthcare systems. The WHO can advise. But how do we find an incentive at the international level so that these countries can spend what they should in bringing health to their population? OECD countries invest an average of ten per cent of their gross domestic product in health. For low-income countries, the figure is less than five per cent. If we don’t tackle this inequality, we will face the same problems in the next pandemic as we did with Covid-19.

Do you see the will of the organisations to work together?

Yes, definitely. There is no doubt that we need to further develop and strengthen the current healthcare architecture. During the G7 and G20 summits, the financing problem was addressed for three years during the pandemic. And those countries found a solution with the establishment of the Pandemic Fund at the World Bank. But it is only part of the solution since the fund is insufficient to encourage countries to invest in, build or strengthen their healthcare systems although that should be the current priority. For years, it has been the World Bank’s mission to help countries invest in their health systems. But we realized that development banks have mostly financed the building of hospitals. Now the world’s population is ageing rapidly, there is a shift from acute diseases to chronic diseases. In the future, we rather need to strengthen and reorganise primary health care.

What other challenges are there at the global health level?

In addition to an ageing and growing population, which is changing healthcare provision, we are faced with a shortage of healthcare professionals worldwide, a shortage of medicines or vaccines and, of course, the threat of a new pandemic. That should completely change our health organisations at the country level. Furthermore, the inequalities between poorer and richer countries have always existed, but there is now a growing awareness of them and specially during the pandemic leading to frustrations and anger. Ultimately, stable and peaceful countries need local access to healthcare services.

There is currently much discussion about the role of the WHO. How can the WHO be strengthened?

If more coordination is needed, someone needs to take the lead. And the WHO is the only institution positioned for this leadership. However, the WHO has deficits at country level. The numerous international organisations are much better represented here. WHO country offices are small and underrepresented. They therefore need to be strengthened. Indeed, Employees from Geneva HQ are now being offered the opportunity to work in country offices so that they are closer to the problems of the population. The second issue for WHO is once again funding. The obligatory funds provided by the member states are rather small. But these can be used freely according to the will of the WHO and are not tied to any purpose. Although the funding is better here, it is difficult to establish it sustainably and there is competition with other international organisations. The Director-General has already taken these two paths: more sustainable and efficient funding and more staff at country level.

Read the original article in German here