Why are health systems weakening in developing countries?

It's been more than 6 months since the outbreak of the coronavirus and the declaration of COVID-19 as the global public health issue. As of today, more and more countries and states are struggling to respond to the rising scale of the pandemic. In the United States, states are opening their economies because of lower COVID-19 numbers reported. However, as of today June 28, 2020, states like Florida, Texas, and Mississipi are slowing down their opening because of increasing infection of COVID-19. This is by no means to say the pandemic is at its peak in these states but to respond to suddenly increased infections.  This situation shows that collective responses are needed across states in order to achieve universal control.

Blood collection tubes
Whereas developed countries like the United States are focusing on responding to the pandemic with minimum disruption of services in other disease areas, the same cannot be said of developing countries with burdened or weak health systems. I am particularly sudden with the recent report from Global Funds indicating the decline in critical services for HIV, TB, and malaria in developing countries. The report indicates that in the next 12 months, there will be increased mortality associated with the 3 killer diseases. This situation arose because of the fragmented and parallel health systems in these countries.

For decades, health systems in developing countries have focused on donor-funded disease-specific areas. So, for PEPFAR, the focus is on responding and controlling the spread of HIV/AIDS. For Global Funds, the focus is on malaria and TB elimination; for GAVI, the focus is on increasing vaccination, etc. These parallel health systems support have contributed to weakening health systems in developing countries. After all, what good is it that an HIV patient attending a clinical can get viral load services from the lab, but the person with diabetes cannot get glucose test because there are not "diabetes-funded" reagents. Should this be the case? Should patients be discriminated against because of their infected diseases, of which they have no control? It is time for public health practitioners, governments, and donor communities to realign their so-called support to health systems, beyond specific disease cases.

An example of a "consulting room" in a village clinic in Ghana
The COVID-19 pandemic is a clear manifestation of our parallel thinking in building health systems. So far, billions, if not trillions of dollars have been raised, promised, and spent in responding to COVID-19 while other diseases are left to struggle in our communities. Why are developing country governments and agencies not taking leadership to set their health priorities? Why should they allow donor agencies to define their health priorities? Why are developing countries not building comprehensive health systems beyond funding or disease areas? And, why are they not thinking beyond and strategize for the future? These are questions that keep bothering me as I work with developing country governments in health systems strengthening. I hope that thinking beyond the COVID-19 pandemic will dictate our ideals and goals of building sustainable health systems in developing countries.

This is my reflection for today. Please send your comments on what you think should be done to create a culture of sustainable health systems beyond diseases or pandemic!





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