Strengthening global health security by embedding the International Health Regulations requirements into national health systems

Kluge, Hans; Martín-Moreno, Jose Maria; Emiroglu, Nedret; Rodier, Guenael; Kelley, Edward; Vujnovic, Melitta; Permanand, Govin

stronger And more resIlIent HeAltH systems to Improve globAl HeAltH seCurIty This paper has made an initial case for better embedding the IHR (2005) into health systems, also highlighting WHO's crucial role in supporting this. But what the discussion has also underlined-for the IHR (2005) and for global health security more widely-is the importance of investing in health systems and activities to strengthen them, both as an end of their own and so that they become resilient to health emergencies and can deliver health services in times when they are most needed. This is also key in the pursuit of UHC. The message from the US Institute of Medicine is that as health threats require the deployment of the same skills and infrastructure that support routine healthcare, investing in strong viii This proposal developed out of an inter-regional meeting hosted by the WHO European Regional Office in Copenhagen in April 2016 (http://www.euro.who.int/en/health-topics/Health-systems/pages/ news/news/2016/04/who-to-embed-international-health-regulations-in-health-systems-strengthening-process). and resilient health systems facilitates their emergency response capacity. 30 Likewise, the GHRF Commission stresses the need to invest in national health systems to ensure a robust global health risk framework 13 and civil society too has pressed home this point. 20 Additionally, it should not be forgotten that public health crises also carry economic, development and social consequences that could be mitigated by better health system investment upfront. The World Bank estimated the economic impact of Ebola in Guinea, Liberia and Sierra Leone through 2015 at US$2.2 billion ix ; the majority of which were economic impacts that disproportionately affected the poor. WHO itself has consistently stated that health systems are at the heart of how countries respond to new disease threats, and sustained investment to keep them strong is required. 16 Ultimately, investing in stronger and more resilient health systems is investing in health security and towards UHC. 31 32 This is not a new message. And while its reiteration is important given recent public health emergencies, it needs to be more nuanced and mindful of different national settings. Simply calling on countries, such as those in West Africa, to invest more in order to contribute to global health security through the IHR is not helpful as a way forward. Strategies and policies at regional and global level, to help lower-income countries strengthen their systems, will be crucial in respect of future preparedness. In this regard, the need for a global strategy for local investment in core capacity to detect, report and respond rapidly to outbreaks is the first recommendation of the Harvard-LSHTM Independent Panel on the Global Response to Ebola, 7 and others have further noted the need for a new funding source entirely. 21 Equally clear is that governments need to see the IHR as 'theirs' and as part of the national health system, such that investment can be sustained and activities institutionalised. As Ebola, and other global crises have shown, health systems and global health security are only as strong as their weakest link-this points to the most fragile and unprepared states, and our collective need to work together to strengthen not just their IHR (2005) capacities, but more fundamentally their health systems. Insofar as the military provides an appropriate metaphor, it is important to plan, build and