Eyes On The Final Prize: Integrating Services To Transform Global Health

This post was originally published at Health Affairs Blog.

As 2015 draws to a close, the global health community is examining the strides that have been made and how we can transform this progress into further gains across the public health spectrum.

The United Nation’s 17 Sustainable Development Goals (SDGs) for 2030 include SDG 3, a holistic goal for public health that aims to ensure healthy lives and promote wellbeing for all at all ages. It is with the backdrop of this collaborative, interconnected development landscape that two important meetings take place in Japan this week.

On December 16, a symposium on universal health care will bring together global leaders for a dialogue on how countries can achieve access to equitable and affordable health services for all citizens. On December 17, Japan will host the preparatory meeting of the Global Fund to Fight AIDS, Tuberculosis, and Malaria ahead of the 2016 Fifth Voluntary Replenishment Conference, at which global health leaders will discuss funding needs for efforts to tackle these epidemics for 2017-2019.

In these meetings and in the year to come, it is imperative that those of us working on specific disease investments keep our eyes on the final prize — that of integrating disease and wellness services to create a more responsive health system in every country that is capable of delivering essential services to the entire population. The necessity for such integrated service delivery is becoming particularly acute as we see a worldwide surge of non-communicable diseases, even as our fight continues against infectious diseases such as AIDS, tuberculosis (TB), and malaria. Hypertension, diabetes, and coronary heart disease typically occur in older populations, but are now presenting themselves at an alarming rate in much younger populations, particularly in developing countries.

An Opportunity For The Global Fund

The strengthening of health systems will greatly transform life for young and old alike, and the Global Fund is well positioned to be a central motor of this transformation. Although primarily focused on specific disease programs, the Global Fund spends nearly 40 percent of its investments on efforts to build resilient and sustainable health systems. By investing in better information systems, training health workers, improving access for marginalized populations, and optimizing financial management through procurement and supply chain reform, the Global Fund and its partners are supporting the creation of cross-cutting services that provide health benefits reaching far beyond AIDS, TB, and malaria.

For example, the Global Fund has entered into partnerships with the World Health Organization and UNICEF to align disease programs with reproductive, maternal, newborn, child, and adolescent health services for integrated community case management. Such collaborations aim to maximize access to medicines and commodities for pneumonia and diarrhea treatment, as well as antenatal care (e.g. provision of iron, folic acid, deworming pills, and syphilis screening and treatment for pregnant women).

Furthermore, the Global Fund has a unique ability to galvanize international support and resources, and then prioritize and allocate those resources through a dynamic decision-making process in which the recipient countries themselves play a central role. This process keeps allocations close to the governments and civil society organizations that run disease programs locally and that are, importantly, responsive to the patients who rely on health services. The grant-making process is consistently reviewed and receives feedback from the ground up, allowing the system to self-correct. The Global Fund is positioned to play a leadership role in the global health community’s movement toward universal health coverage.

The Need For Universal Health Coverage

As the former U.S. Global AIDS Coordinator and the current UN Special Envoy on TB, I see firsthand the need for universal health coverage. TB has now become the world’s most deadly infectious disease, surpassing HIV/AIDS. A shocking 4,400 people die each day from TB, despite the fact that we have tools that allow us to easily diagnose and treat 97 percent of cases. With TB, we have a disease that we have had the ability to diagnose and treat for 50 years and we’re still missing one-third of potential patients. It’s inherently a problem of access — inadequate health systems, financial constraints, and social exclusion.

Universal health care is necessary to win the fight against diseases like TB — and putting patients into another disease-specific program does not make any sense. Meetings such as those in Japan this week are critical to increasing country-level support of this goal, which is key to building integrated services on-the-ground.

As we look toward universal health coverage, we must preserve the gains that have been painstakingly won in the fight against individual diseases, which is only possible with steady funding of global health institutions. I am committed to supporting health service integration as a central tenet for the future of global health and the achievement of universal health coverage. I welcome others to join me as we build stronger and integrated health systems that improve and save lives around the world.