ACHIEVING Global Health Security and Universal Health Coverage

Reflections on the Georgetown- Edinburgh workshop

By K Srikanth Reddy

Very few research centres study Universal Health Coverage (UHC) and Global Health Security (GHS) at the same time. In May this year, the Achieving Global Health Security workshop held in Edinburgh countered that trend by exploring the intersections between these two most important initiatives in global health. The workshop was jointly organised by the Global Health Governance Programme at the University of Edinburgh and the Centre for Global Health Science and Security at Georgetown University. The workshop had a mix of young or early career global health fellows and leading global health experts like Lawrence Gostin, Rebecca Katz, Devi Sridhar, to name a few. The workshop was a unique opportunity for early career global health researchers like me; I work primarily on infectious disease governance and the workshop enabled me to understand how harmonised and/or disharmonised these two-global health initiatives were. The participants shared their expert viewpoints, opinions, comments and the empirical research findings of their on-going research projects that were related to these two initiatives.

The discourse around these two global health initiatives has been taking place around the world for quite some time. The global health community, the political leadership and the multilateral organisations have all been emphasising these initiatives. Of late, the World Health Organisation’s General Programme Work for the next five years (2019-2023) has been structured around three interconnected strategic priorities – achieving universal health coverage, addressing health emergencies, and promoting healthier populations.

While reflecting upon these initiatives, this workshop focused on exploring the 'intersections' between these two initiatives: how harmonized or disharmonized these initiatives? What are the tensions or conflicts between these two initiatives? How do global institutions pursue the aims of GHS and UHC? Another important aspect of the discussion was the relevance and application of the 'One Health’ approach to these initiatives as there are emerging re-emerging infectious diseases including antimicrobial resistance. As each of these two initiatives were complex systems in themselves, systems thinking was found to be relevant in examining the UHC and GHS nexus.

Systems thinking is an approach to problem-solving that views "problems" as part of a wider, dynamic system. Systems thinking involves much more than a reaction to present outcomes or events. It demands a deeper understanding of the linkages, relationships, interactions and behaviors among the elements that characterize the entire system. The discussion added another dimension namely health systems strengthening. Efforts to build health systems in resource- poor settings would help in achieving the aims of UHC especially the aspects of access and equity as well as the aims of GHS particularly strengthening of public health systems. Strong and resilient health systems are essential for a world safe from the threat of infectious disease outbreaks. But building health systems means continued investments by the governments and donors.


Fig.1 The WHO’s Health System Framework (Source: World Health Organization. Everybody’s Business: Strengthening health systems to improve health outcomes—WHO’s Framework for Action. Geneva: WHO, 2007

Fig.1 The WHO’s Health System Framework (Source: World Health Organization. Everybody’s Business: Strengthening health systems to improve health outcomes—WHO’s Framework for Action. Geneva: WHO, 2007

As an active participant, I had a great learning experience during this workshop and an opportunity to explore the intersections of the GHS and UHC with experts and fellow participants. In addition, I also had the opportunity to share the global health security research project that I am lead investigator on, and gave a brief presentation that reflected upon a question: “Does infectious disease surveillance system and diagnostic capacity development move us towards UHC? An insight from India.” India has a robust surveillance system named Integrated Disease Surveillance Systems (IDSP), started in 2004 with the World Bank's aid, and scaled up to the whole country in three phases. Currently, the IDSP is entirely a Government of India-funded program. The principal objective of IDSP is to strengthen/maintain decentralized laboratory-based IT-enabled disease surveillance system for epidemic-prone diseases to monitor disease trends and to detect and respond to outbreaks in early rising phase through trained Rapid Response Teams. The IDSP also focuses on the strengthening of public health labs and developing lab capacity in the country. With regards to access to health services, I argued the infectious disease surveillance system and laboratory strengthening in the country are helping India move towards UHC. However, surveillance and laboratory capacity for the non-communicable disease would add value to this process.

The engaging discussion with the global health experts and fellow researchers during the workshop has impacted my on-going global health security research in three ways:

i)  Earlier, I engaged in research that aimed to understand the role of civil society organisations in UHC in India. But I did not have a comprehensive understanding on how to achieve UHC in the country. With the workshop learnings, I would now contextualize the relationship between UHC and health systems strengthening in the country.

ii) My research focused on global health security but did not think of GHS intersections with the other global health initiatives such as UHC. The workshop gave leads for exploring these intersections that would help pursue research further.

iii)) The workshop helped to build networks and research partnership from experts and scholars from the global north and global south for interdisciplinary global health research in the cross-cutting areas of GHS, UHC, and HSS.

The workshop co-chairs Devi Sridhar and Rebecca Katz have rightly pointed out in their blog that that there are established researchers working on these global health initiatives but wanted to identify who else is engaged in this research. I do believe there are significant others especially young and early career global health scholars across the geographic settings involved in the research around these initiatives. This workshop brought in some of those new and diverse voices in global health if not all. I do hope academic activities of this kind would help to include the rest and the recommendations proposed by them would help in bringing them to the forefront of the global health discourse.

Lastly, I believe achieving Global Health Security and Universal Health Coverage is a global public good. The International Task Force on Global Public Goods has defined global public goods as “issues that are broadly conceived as important to the international community, that for the most part cannot or will not be adequately addressed by individual countries acting alone and that are defined through a broad international consensus or a legitimate process of decision-making.” In achieving global public goods, there needs to be continued engagement among the stakeholders including academics.