Global Health Policy And Programme Challenges

By Mbuso Mabuza

This book aims to identify the policy and programme challenges for improving the health of populations in low- and middle-income countries. In this book we define policy as 'a purposive course of action followed by an actor or set of actors in dealing with a problem or matter of concern'. In looking at public policy, we are concerned with the formal institutions of government, since they provide the structure within which the public policy process takes place.

'Health policy embraces courses of action that affect the set of institutions, organizations, services, and funding arrangements of the health care system. It goes beyond health services, however, and includes actions or intended actions by public, private and voluntary organizations that have an impact on health'. Programme can be defined as the embodiment of the policy—that is, in translating health policy into practice through a series of targeted health and health-related programmes.

The intriguing discussions covered in this book are presented in the following topics: key issues of public health concern, global aid architecture and aid effectiveness in health, health systems strengthening, improvement in health, human resources for health, ensuring access to essential health services, leadership and governance in health.

The book will be invaluable for health professionals, health programmers, policymakers, donor agencies, and students in public health, medicine, political science and related subjects.

• Language: English
• Publisher: Mbuso Mabuza
• Release date: Oct 17, 2022
• ISBN: 9798201745004

Mbuso Mabuza

Dr Mbuso Mabuza is a highly motivated and multi-skilled international public health professional who has served in the public and private sectors of different countries. He has served as a prevention specialist at the Johns Hopkins Bloomberg School of Public Health, and as a consultant at the World Bank, among others. His mission is to improve health outcomes and to expand quality healthcare experiences amongst all groups of people and influence change and innovation.

Book preview

Preface

This book aims to identify the policy and programme challenges for improving the health of populations in low- and middle-income countries. In this book we define policy as ‘a purposive course of action followed by an actor or set of actors in dealing with a problem or matter of concern’. In looking at public policy, we are concerned with the formal institutions of government, since they provide the structure within which the public policy process takes place.

‘Health policy embraces courses of action that affect the set of institutions, organizations, services, and funding arrangements of the health care system. It goes beyond health services, however, and includes actions or intended actions by public, private and voluntary organizations that have an impact on health’. Programme can be defined as the embodiment of the policy—that is, in translating health policy into practice through a series of targeted health and health-related programmes.

The intriguing discussions covered in this book are presented in the following topics: key issues of public health concern, global aid architecture and aid effectiveness in health, health systems strengthening, improvement in health, human resources for health, ensuring access to essential health services, leadership and governance in health.

The book will be invaluable for health professionals, health programmers, policymakers, donor agencies, and students in public health, medicine, political science and related subjects.

Dr Mbuso Mabuza

International Public Health and Medicine Consultant

Chapter 1

Key Issues of Public Health Concern

The topics covered in this chapter are as follows:

Importance of reliable information about the burden of disease

Contribution of low- and middle-income countries to the burden of disease

The burden of communicable and non-communicable diseases

Effective and sustainable public health policies and interventions

Prioritising the management of non-communicable diseases and other issues of public health concern

1.1 Importance of reliable information about the burden of disease

IT IS IMPORTANT TO know and to have detailed reliable information from a statistical and epidemiological perspective about the burden of disease or the diseases that cause the most morbidity or mortality in a population as this would inform priorities and policies for public health interventions (Murray and Lopez, 1997). The burden of disease has become so complex in many settings largely because of fragmented interventions that focus on one aspect of the challenge and overlook the others.

As such, the former President Olusegun Obasanjo’s statement makes sense because tackling other diseases such as HIV/AIDS, malaria and tuberculosis first and dealing with chronic diseases later can be detrimental because if we wait, the problem of chronic non-communicable diseases will spiral out of proportion and become such a huge and costly problem to address (Liese, Rosenberg and Schratz, 2010).

While chronic and non-communicable diseases are often associated with high income countries which are going through epidemiological transitions whereby there is a higher proportion of older people and a smaller proportion of younger people in the population, the reality is that we are seeing a surge in chronic diseases among younger people in the low- and middle-income countries which already carry a high burden of communicable diseases (Alwan and MacLean, 2009). Such a surge in chronic non-communicable diseases has somewhat been ignored or not prioritised because there has been so much focus on the other high priority areas such as HIV/AIDS, tuberculosis and malaria. Even the bulk of the national, regional and global spend has been channelled towards HIV/AIDS, malaria and tuberculosis, and virtually forcing out other priority public health challenges such as chronic and non-communicable diseases (Liese, Rosenberg and Schratz, 2010). The negative socio-economic impact of this oversight, are enormous, because this exacerbates poverty and widens inequalities.

On the other hand, it cannot be generalised that tackling other diseases such as HIV/AIDS, malaria and tuberculosis first and dealing with chronic diseases later would not be beneficial because the burden of disease varies between regions and between men, women and children (Walley and Wright, 2010). Demographic and epidemiological transitions are of significance in terms of guiding us about the type of interventions that need to be prioritised for that particular setting. For example, very early in the demographic transition, countries experience high birth and death rates, which implies that the proportion of younger people in the population is higher while the proportion of older people is smaller, suggesting that communicable diseases might be a big issue as compared to chronic non-communicable diseases (Walley and Wright, 2010). As such, it may be necessary at times to prioritise and implement interventions that will tackle communicable diseases first and chronic non-communicable diseases later based on the most common causes of morbidity and mortality affecting that particular population. However, I would favour a holistic approach.

It is crucial to get reliable statistical and epidemiological information about the burden of disease as this will inform the interventions and policies for tackling these diseases, and that such interventions should be relevant for that particular context and setting (Walley and Wright, 2010). It is usually cost-effective to holistically tackle disease burdens early than to have a fragmented approach or to wait for later (Liese, Rosenberg and Schratz, 2010).

1.2 Contribution of low- and middle-income countries to the burden of disease

I WAS DRAWN TO YOUR enlightening discussion, particularly your second paragraph where you mention that in 2005, low- and middle-income countries contributed 80 per cent to the global mortality due to non-communicable diseases (Alman and MacLean, 2009). This is a very huge point, and it makes one realise the magnitude of the challenge that low- and middle-income countries are faced with, in addition to the already huge burden of communicable diseases such as HIV/AIDS, tuberculosis and malaria. In fact, the magnitude of such a challenge ceases to be just a low- and middle-income countries’ issue, but it now becomes a global challenge that requires urgent coordinated international interventions.

It is well and good for some of us to suggest that we need an integrated or a simultaneous approach and to strengthen health systems in order to address this challenge. It is worth remembering that health systems encompass the institutions, organisations and resources assembled to deliver health care services that meet population needs (Mills, 2014). The reality is that the health systems of some of the low- and middle –income countries have virtually reached a stage of paralysis, largely due to the deepening vicious cycle of poverty and the overwhelming burden of disease (Mills, 2014). 

In fact, in many of the low- and middle-income countries such as in the sub-Saharan Africa region, strengthening health systems may be easier said than done due to a number of complexities unique to each country or sub-region. Even if there was money pumped in by the government or by international role players, the money ends up not being utilised efficiently for the purpose of strengthening health systems. For example, complex emergencies in countries such as Sudan, Central African Republic, and Somalia present serious challenges, and dismantle whatever gains might have been made in terms of strengthening health systems (Merson, Black and Mills, 2012).

Poor leadership and poor service delivery present serious challenges in terms of strengthening health systems. Yet the scale of the challenge posed by the combined and growing infectious chronic illness (driven by HIV/AIDS) and non-communicable diseases has few parallels to other countries, and demands an extraordinary response that is within the capacity of South Africa to achieve (Mayosi et al, 2009). 

It is really high time for all of us including policy-makers, local and international role players to dig deeper into the root cause of this challenge than to just