“All for Health and Health for All.” With this rallying cry of the 77th World Health Assembly still ringing in our ears, now is an apt time to ask where our collective efforts could benefit from new approaches.
Improving global health is a formidable challenge. The latest World Health Organization/World Bank Universal Health Coverage (UHC) progress report underscores a concerning reality. Over half of the global population lacks full access to quality health care and progress on UHC has stalled.
Additionally, significant financial hardships prevail. In 2019, over 1 billion people faced catastrophic out-of-pocket health spending and nearly 17 percent of the global population was pushed into poverty due to healthcare costs.
An array of intertwined challenges
From climate to conflicts to finances, policy makers face an array of intertwined challenges. Government spending through 2028 is projected to contract or remain stagnant relative to 2019 in nearly two-thirds of all low- and middle-income countries (LMICs). At the same time, the priority of health in government spending has dropped close to or even below pre-COVID levels in most low-income and lower-middle-income countries.
We need to rethink our approaches and strategies for ensuring population health. Strengthening health care in LMICs remains critical for unlocking human potential and fostering a healthier, more prosperous world.
Hospitals are an important part of the equation
While primary care serves as the bedrock of a robust health care system by supporting prevention, early diagnosis, and ongoing management of common and chronic conditions, hospital-based care plays a pivotal role in ensuring access to acute and operative care, specialized interventions, and advanced treatments, as well as in preparing for and responding to emergencies.
According to the Lancet Commission on Global Surgery, in 2015, there were about 5 billion people across the globe who lacked access to safe, affordable and timely surgical and anesthesia care, including access to life-saving surgeries like emergency cesarean sections and appendicectomies. In LMICs, 9 in 10 people fell into this category. Without addressing the deficits in capacity and access to hospital care, progress on many important health indicators, like maternal mortality, will remain suboptimal.
Despite this dire state of affairs, coupled with the fact that hospitals frequently consume a large percentage of the resources and personnel in a country’s health ecosystem, hospitals are often a side note in broader health discussions or they are considered in isolation.
But from a patient’s perspective, what matters is whether they can get the care they need when and where they need it, at a price they can afford—and that the pieces of the system work together seamlessly to produce the best possible outcomes. As such, competition between hospitals and primary health care, whether perceived or real, hinders the holistic approach that is needed to plan national investment in health care. It also undermines workforce optimization and ultimately compromises the quality of patient experience in the quest for seamless, quality care.
Hospitals need more focused attention
Hospitals—the services they provide, their infrastructure, expertise, and workforce—must be an integral part of a high-quality health system that addresses the health needs of the population. This requires a systems-based approach, placing primary health care and hospitals together within a broader health system framework.
Building on earlier work on hospital governance and leadership and management capacity, a new World Bank report on hospitals and health systems spotlights critical factors to jumpstart country-level conversations to facilitate this shift. More specifically, it emphasizes three key principles for building better systems:
- An unrelenting focus on patient-centered continuity of care
- Adaptability to climate and other system shocks
- A combination of leveraging proven strategies and innovating for the future
It then focuses on entry points for reform—efficiency, quality, and integration—as well as cross-cutting issues including governance, health care innovations, and systems resilience. With its focus on supporting country-based teams, each section includes a series of chapters with a mix of case studies and reviews of relevant elements of reform.
Health for all is an important and laudable goal. But the road is complex, requiring us to bring together all our resources from across the health sector. Hospitals must be an integral and integrated part of that effort. With a focus on a few key entry points, country teams can begin that important journey.