Observatory Partners gather in Madrid in a public discussion on how countries can use lessons from the pandemic to build more resilient health systems
Preparing health systems for future threats requires being mindful of lessons from the COVID-19 pandemic, taking a long-term vision and involving all countries and sectors, Partners of the European Observatory on Health Systems and Policies agreed during a debate in Madrid.
Organised by the Spanish Ministry of Health and the Observatory, the public session focused on responses to the current perma-crisis, with a consensus that the pandemic served as a catalyst for an already much-needed reform in health systems. Senior representatives from the European Commission, WHO and several Member States shared their lessons of resilience managing the pandemic at national and European level.
“It was necessary firefighting, but it was not long-term sustainability,” warned Stefan Eichwalder from the Austrian Ministry of Social Affairs, Health, Care and Consumer Protection. “If we don’t manage now to take what really worked well and transform that into standard care and standard practice, we will fail.”
The pandemic unveiled the potential of a European Health Union and its legislative, funding and coordination tools for supporting health system reform. Isabel de la Mata, Principal Advisor at the European Commission’s DG SANTE, recalled that “during the COVID crisis everybody was desperate to coordinate, to be able to fight together to strengthen health systems”.
Cross-sectoral and cross-border collaboration
Panellists highlighted the dangers of criticising international organisations before realising that countries are, ultimately, in charge: “In cases where international architecture is not working it’s because the national architecture is not working,” pointed Martin McKee, Chair of the Monti Commission’s Scientific Advisory Board.
Professor McKee, who is also research director at the Observatory, identified several ways to bring about a “true democracy”, such as consulting civil society on key issues that concern the population and co-creating solutions.
“You cannot claim that you are not leaving anybody behind if you don’t really assess the needs of those that are left behind and address their needs appropriately,” agreed Vesna Kerstin Petrič, representing the WHO Executive Board in the debate.
To respond to a health system in crisis it is vital to analyse how all these elements interact with each other. Hugh Alderwick from The Health Foundation explained that, with 7.3 million of the UK’s NHS users waiting for routine treatments, “the problem extends beyond the matter of insufficient beds or staff; it has to do with strengthening the underlying capacity of the entire system”.
Primary care at the core of health system reform
Using the primary health care community leaders in Slovenia as an example, Dr Petrič called for the values of solidarity and equity to be voiced by civil society through social participation and to guide any political action moving forward.
The crisis in primary care was also highlighted by the Spanish, Dutch, French and British Partners, with Patrick Jeurissen from the Ministry of Health in the Kingdom of the Netherlands warning that we must learn how to “fix it before we consider it a solution” to other problems within a health system.
In France, the fragmentation of management across sectors means that primary care and public health care are not coordinated within the same governance, with even the budget lines being split. Sophie Lopes from the National Health Insurance Fund told how digital innovations that worked in the pandemic are not being integrated as best they might nowadays.
In Switzerland, the transition from a traditional decentralised decision-making health care system to a more national one during the pandemic allowed for a more coordinated response in a federal country. On the other hand, decentralisation helped the Kingdom of the Netherlands become more oriented towards collaboration, putting regional health care at the forefront and allowing a better control of where funding goes.
Presidency of the Council of the EU: Sweden, Spain and Belgium
Several country examples demonstrate how informing policy through evidence can allow more resilient responses to future crises. With antimicrobial resistance (AMR), Sweden used the momentum of the Presidency of the Council of the EU in the first half of 2023 to bring together the knowledge from over a decade to present a plan that countries can use to address over-prescription of antibiotics and animal feeding regulations.
Further health priorities are on the table for the EU Presidency of Belgium in early 2024, as explained by Anne Swalue from the Ministry of Health in Brussels: “We are asking the Observatory to scan the evidence that the COVID crisis provided in terms of health and health systems resilience”. The Presidency will also focus on affordable access to health care, the European Beating Cancer Plan, the health workforce, and medicine storage.
Moving forward, the requirements to reform the multiple health systems across Europe will go beyond coordination and primary care improvements. Pilar Aparicio from the Spanish Ministry of Health added the need to improve the capacity of public health services, ensure universal health coverage and create a sustainable digital health plan.