This blog post is written by Nidda Yusuf, Leading on Health Financing, and Margot Nauleau, Senior Health Advocacy Adviser.
Over the past three years, children have suffered immensely from the health and socioeconomic impacts of the COVID-19 pandemic. Across the world, it has threatened their rights to health, education and protection.
The pandemic led to an education crisis, further exposed women and girls to gender-based violence, and left at least 8 million orphaned children. COVID-19 has also disrupted essential health and nutrition services, resulting in the largest sustained decline in childhood vaccinations in approximately 30 years. As many as 18 million children did not receive any vaccines at all in 2021. This, coupled with record rates of malnutrition, has created conditions for an unprecedented child survival crisis. World leaders’ attention to the pandemic prevention, preparedness and response agenda provides a pivotal opportunity to build resilient health systems and realise children’s right to health.
There is consensus that a lack of predictable and sustainable investments in health systems left the world underprepared to detect, contain and respond to epidemics, as well as maintain essential health services. This culminated in the official launch on 13 November of the Pandemic Fund. This new fund has been established to address pandemic prevention, preparedness and response (PPR) gaps seen in low-middle income countries during the worst of the COVID-19 pandemic.
The pandemic highlighted inequities in access to essential health services, diagnostics, vaccines and medicines. This has shown up the urgent need to strengthen health systems in order to achieve the goals of universal health coverage and health security. People rely on one health system within their country to tackle health emergencies and deliver lifesaving essential services. It is critical to build robust foundations of national health systems to make progress towards our common goals and objectives.
A contraction in many resource constrained countries' health budgets (as well as development assistance for health) means it is more important than ever to use these limited resources well. Whilst arguing for more health financing is good, we also need to make the case for greater effectiveness – to deliver health outcomes that are in the interests of children.
An integrated approach to Universal Health Coverage and Health Security
In recent months we have seen a multitude of ideas on what the Pandemic Fund should focus on. It has become clear that the new fund must concentrate on both strengthening primary health care to boost resilience for health shocks and building core preparedness capacities. Moreover, these initiatives must accelerate adaptations to ensure the continuity of health services during emergencies - be that the next global health threat or climate-related crisis.
If the global health community and governments are truly committed to achieving health for all, in peace time and during emergencies, then we need to move towards more horizontal and integrated approaches. Importantly, it is also necessary to align financial and technical assistance to the needs and specific contexts of countries. Funding priorities must reflect gaps identified in countries, with national governments, civil society and communities as in the driving seat of proposals development. This will ensure alignment with national health policies, strategies and plans.
The Pandemic Fund should play a role in incentivising governments to allocate more financing for PPR. However, this must be matched by a responsibility to ensure these efforts do not crowd out financing for other health priorities – in line with the countries’ current burden of disease. Moreover, similar to other global health institutions, the Pandemic Fund must play a role in strengthening and reforming health financing arrangements, to protect the rights of women, children and adolescents.
The Pandemic Fund has to date been a good example of an inclusive and participatory approach. This has included consideration of the priorities of low-middle income governments, civil society, and communities – not least reflected in the structure of its governing board. The fund has currently raised approximately 13% of the initial requirement from external financing ($1.3bn out of the $10.5/ year projected) – grossly insufficient to solve PPR and universal health coverage gaps. However, if designed and delivered well, the Pandemic Fund can incrementally strengthen the health system, improve child health, and set a good example for the future.
A blueprint for success
Our paper ‘The Pandemic Fund: A blueprint for success’ provides a guiding framework for how the Pandemic Fund could make gains in child survival and improve health outcomes for all women, children and adolescents:
Photo: Husnia*, 6, and Hakima*, 4, lost their baby sister due to a lack of healthcare in Afghanistan (photo: Sacha Myers/Save the Children).
* names changed
