Written by Sarah McCormack and Gianluca Quaglio,
Investing in health in the developing world: an introduction
Many challenges face healthcare in the developing world. The Science and Technology Options Assessment (STOA) workshop entitled ‘The case for investing in health within the developing world‘ provided an opportunity for Members of the European Parliament (MEPs), international experts and the broader public to examine the importance of financing health systems in low and middle-income countries (LMICs). The workshop was chaired by Carlos Coelho, MEP and STOA Panel Member. In his introductory speech he explained how economic development was long considered a precondition for creating improvements in health systems. The policy implication of this was that decision-makers, particularly in poor locations, felt that prioritising investment in health made little sense. However, more recent evidence has turned this notion around and provided indications that improvements in health are crucial for economic growth.
MEP Norbert Neuser from the European Parliament’s Committee on Development (DEVE) highlighted that the topic of investment in health provision is important and needs political support. The workshop also discussed the current workforce crisis in the developing world. According to Mr Neuser, the situation in Sierra Leone is an example. This country, which was devastated by the Ebola virus, has only around 200 doctors and 1 000 nurses for a population of 6 million people. At the same time, the number of migrant doctors and nurses working in OECD countries has increased by 60% over the last 10 years, leaving less health care workers in LMICs. Bruno Gryseels from the Institute of Tropical Medicine Antwerp agreed that the health situation in LMICs is one of the most important challenges of our time, as health sector issues have wider impacts on society, particularly in the developing world.
The Global Burden of Diseases and the importance of research
Khassoum Diallo from the World Health Organization (WHO) explained that examining the Global Burden of Diseases (GBDs) helps the identification of health-related gaps and challenges preventing people from living long and healthy lives. By looking at the GBDs, policy-makers are able to compare the toll of different diseases on health. This, in turn, can help them to decide on priorities for their health services, such as allocating and mobilising resources. This indicator can also be used to compare the health of a population at different points in time, enabling monitoring and evaluation of the development of a health system, and better evidence-based policy decisions.
Research is a crucial factor in the fight against diseases worldwide, especially in LMICs. This links to the work of the European & Developing Countries Clinical Trials Partnership (EDCTP) programme. Dr Michael Makanga, Executive Director of the EDCTP, highlighted the major characteristics and recent achievements of the programme, which is funded by Horizon 2020. Dr Makanga underlined that the EDCTP plays an innovative role in capacity building and networking on research for poverty and neglected infectious diseases, particularly in Sub-Saharan Africa.
Financing health systems in the developing world: the time to act is now
Contrary to previous beliefs, health expenditure is not a drag on the economy, but rather a multiplier for inclusive growth, according to Ibadat Dhillon from WHO. Dr Dhillon also drew attention to the situation in Europe, where health and social services bring an added value of roughly €800 billion annually to the European economy. It is also a sector which, during the financial crisis, was a source of sustainable jobs when others were in decline.
MEP Linda McAvan, Chair of the DEVE Committee, stressed that countries should not wait to reach a certain level of wealth before investing in health policy, but rather that building a welfare state is the basis for development. Ms McAvan highlighted that China is richer today than Britain was in 1948, at the time of the introduction of the United Kingdom National Health Service (NHS). In the case of the Ebola crisis, Ms McAvan pointed out that it cost countries more to tackle the crisis than it would have cost for the introduction of a basic health system, the lack of which was the root cause of the resulting issues.
According to Inke Mathauer from WHO, Universal Health Coverage (UHC) could be the solution to the issues of health in the developing world. UHC is defined as access to key preventative, curative and rehabilitative health services of good quality for all at an affordable cost. The focus upon affordable costs is important, as evidence shows that poorer individuals are particularly vulnerable to succumbing to poverty when trying to meet healthcare costs. The two required conditions for UHC are compulsion (i.e. automatic affiliation) and subsidisation (i.e. the use of government revenues when needed). The road to UHC will differ for each country, yet strong technical assistance and coordination at country level will be required by all.
Anne Nicolay from the European Commission’s Directorate-General for International Cooperation and Development (DG DEVCO) explained how the best way to channel aid is to provide budgetary support to the Ministries of Health in LMICs. This, she noted, is the EU’s preferred method of providing aid.
Closing the workshop, MEP Carlos Coelho highlighted that the promotion of health in developing countries represents more than just an opportunity to improve the physical lives of the poor. Rather, he stressed, ‘it forms a vital step, without which our climb to global prosperity and security will be impractical, inefficient and ethically indefensible’.
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