My Reflections: The World Health Summit 2021 — Global Health Development is not a Zero Sum Game

Written by Dr. Sarbani Chakraborty, Senior Advisor at the Health Finance Institute. This blog post was originally published via LinkedIn.

As a German citizen, I have become increasingly proud of the annual World Health Summit — as it grows in its prestige and importance as a key geopolitical gathering of Global Health Experts. This year — in its hybrid form — it delivered on its promise with a twin focus on topics of global importance — of course COVID-19. But then also digital — after all, was that not the key lesson from COVID-19? The world went digital and we survived (ok, it also took a mental toll on all of us at times, so it is not a 100 percent rosy picture).

So what did I learn from the WHS? I am a health economist — so I tend to put an economist´s lens on things. And my conclusion was — — we have to stop thinking of global health development as a ZERO SUM GAME. A zero sum game in economics simply means that there are winners and losers. Dr. Sanjeev Arora, the Founder of Project ECHO (Extension for Community Health Outcomes) (by the way one of my favorite global health programs) mentioned this… and then I started thinking: he has a point but this concept can be applied more broadly to global health in COVID times.

So in global health, we have tended to create winners and losers by setting it up as a disease agenda, or topic agenda. Money is a scarce and limited commodity — so how we invest it creates winners and losers. But the Sustainable Development Goal 3 (SDG 3) is about promoting health and well-being. And health and well-being dwells in every person. People often suffer from multiple diseases (comorbidities) so a NON ZERO SUM game would be to personalize care and focus on the person, irrespective of whether the person is suffering from TB, malaria, CVD, respiratory illness… the list goes on. And let´s prevent and manage diseases — before people get seriously ill. So that there is indeed money in the system for those who get seriously ill and need it — irrespective of whether it is communicable, non-communicable or rare. Investing in community and primary health care systems would be a way to do that. Yet, the COVID-19 pandemic showed us how fragile primary and community health systems still are in most countries.

The Zero Sum Game dilemma continues when we talk about health systems — building pandemic preparedness, Universal Health Coverage, vertical versus horizontal approaches, integrated people-centered health care services. For health financing folks that focus on the mobilization, pooling and allocation of resources, the multitude of health systems initiatives can create confusion. In the process we also create our winners and losers.

The danger of focusing on the TOPIC of the DAY is we get side tracked in our efforts to focus on the BASICS. So, my plea to the global health community is please stay focused on UNIVERSAL HEALTH COVERAGE — effective coverage and financial protection. And then we need to layer this basic principle with COMMON GOODS FOR HEALTH (environmental regulation, epi surveillance, disaster preparedness, AMR, safe roads and sanitation.. to name a few). These are indeed global public goods — many of which — have cross-border implications if not tackled as a collective, global topic and the private sector is often not interested in investing in these goods without clearly defined and regulated public-private partnerships.

So how do we align the disease agenda or topic specific agenda with the health systems agenda… by setting up clearly identified and defined tracers. Pandemic response is a huge tracer — — but do we have the minimum data set to track this effectively and even if the indicators are tracked, are joint accountability systems set up to take action? For diseases — tracers need be aligned to top disease burden and UHC indicators. After all the rapid growth of digital is about making data collection, reporting and taking action faster and better without creating winners and losers in the process.

So maybe I am simplifying things but has the COVID-19 pandemic not taught us what happens when the BASIC things fail and a virus is able to travels miles across countries without anyone noticing? Global health is likely to get even more complex in the future — therefore, we as the global health community have a responsibility to simplify, structure and take fast action by focusing on the TOP WINNABLE AGENDAS IN GLOBAL HEALTH. This is my list — (i) Universal health financing to (2) cover a basic package of health services, delivered through a strong primary and community based system, (3) streamlined hospital and diagnostic infrastructure and systems through hub and spoke models linked to primary and community systems, (4) maximum digital development and connectivity between financing and delivery of health services, public health planning and disease surveillance, (5) Health workers, health workers, health workers, (6) strong disease surveillance, tracking, reporting systems, and (7) a system for health where all players are brought along — whether public or private to drive the same outcomes which means more stewardship by governments, more accountability and more metrics and measurement. What are your top winnable agendas in Global Health?