ON 27 and 28 February 2023 a High-Level Workshop on Paving for Strong and Resilient Health System in South-East Asia was held in the city of Goa on the west coast of India. Referred to as high level meeting because indeed the participants in the meeting were seniors in the field of world public health and the Asian region.
India and Timor Leste were represented by their respective former ministers of health. From WHO, Dr. Anarfi Asamoa-Baah was present, who had been Deputy Director General of WHO for 10 years, and Dr. Shin Young-Soo who was also the Head of the WHO “Western Pacific Office (WPRO)” for 10 years, and also of course the head of WHO Southeast Asia. Furthermore, there were representatives from Thailand, Bangladesh, South Korea, and I from Indonesia, who aside from being participants, I was also co-lead rapporteur the meeting organized by WHO ”South East Asia Region (SEARO)”.
The material for discussion is quite broad, from future trends, leadership and organization, the role of the younger generation, to international cooperation, all of which can also be applied in our health analysis and policy in Indonesia.
Future health
The meeting began with an in-depth discussion of trends and aspects of health determination (Major trends and determinants for health) now and in the future, in order to realize good health resilience. Don’t let the bad experience of health resilience in the face of Covid-19 happen again.
Basically there are three main things. First, public health problems in the world and in every country cannot be solved solely by the health sector. Second, there needs to be interconnection between various sectors in dealing with public health problems. Third, there needs to be a systematic effort so that issue Health can also be an important concern for public policy makers, politicians, economic and financial policy makers, as well as various other related parties at all levels. Moreover, in the era of regional autonomy with various implementation systems in their respective countries.
We all know that when Covid-19 was at its peak, in almost all countries the response involved practically all sectors, obviously not just health. This happened because Covid-19 is an emergency that is felt in all aspects. What is now the challenge is how to maintain cross-sectoral participation and cooperation to deal with public health, even though Covid-19 has subsided.
This is a world challenge, a regional challenge, and also a challenge for our country. If later the Covid-19 pandemic is completely over, of course the formation of a special task force will no longer be needed, but that does not mean that the involvement of various non-health sectors will disappear. Especially for our country, 2024 will be a political year with elections being held. Of course, various sectors will be deployed optimally for the safety and success of the elections. However, the public health aspect should not be left alone. It is clear that we still need to work together across sectors, to realize our nation’s health resilience.
Leadership and organizing
The following discussion is about leadership as well as organizing/regulating public health to face the future health system (better leadership and governance for health system of tomorrow). In order to achieve excellent health resilience, a very broad and in-depth analysis is needed, regarding how good the mechanism for leadership and organizing public health is in a country, and also in the world, which clearly needs a strategic and systematic mechanism.
There needs to be a combination of health leadership skills, organizing, management, and the ability to invite various parties to work together. In terms of policy, of course it can’t just be sudden, it’s also not good if the policy is not sustainable. It is also necessary to examine what the impact of a decision will be in the future, also of course still taking positive values from past successes.
In general, it is clear that there are public health targets that must be achieved, both within the framework of “sustainable development goals (SDGs) or Universal Health Coverage (UHC), as well as the importance of implementing primary health services as a basis, together with secondary and tertiary health services.
In this context, it is discussed that various countries – also our country – are very aware of the main role of preventive promotion in health, it’s just that its implementation is not always easy. Just one example, it would be more popular and get widespread media and public attention if there was a new hospital with several floors with sophisticated equipment, rather than for example the inauguration of family latrines or leprosy control activities.
Another example, it will get more attention, if there is a discussion about the number of specialist and subspecialty doctors when compared to the news about the lack of public health extension workers, or the limited number of sanitarian staff, etc. Therefore, policies regarding the important role of promotive and preventive must be realized in three ways, policy priorities, budget priorities, and cross-sectoral and community support priorities, don’t just be a slogan.
In workshop In this regard, there has also been much discussion about the need for capacity building for the three parties. First, individual actors in public health at various levels. The second is health institutions that serve the community, not only curative but also preventive promotive ones, and the third is for the non-health sector which plays a role in our shared health status.
Apart from that, it is also realized that the health budget in many countries is inadequate, especially if it is used more for curative activities. It must also be remembered, the important role of various NGOs in the health sector that directly work in the field, as well as the private sector which is increasingly active in the health sector. It is clear that all the potential that exists needs to be managed properly, so that we work together in harmony for the sake of our health security and that of the world.
Youth and international cooperation
It is no doubt that the younger generation and millennials have a role -and are even the main actors- in the health system and resilience in the future, even starting now. Not only because future health security is certainly in the hands of today’s younger generation, but also the mindset and pattern of action in the future will change.
On the other hand, with improving health status, the number of elderly people in various countries continues to increase. This means that there needs to be a balance of health systems and management, to be able to serve millennials as well as the elderly, something that is complex and needs careful attention.
At the end of the meeting, it was formulated how to collaborate more synergistically and strategically between global health actors, between countries, various international organizations, and of course the important role of WHO. We know that before we only knew WHO on the world stage as part of the United Nations. Now there are various other organizations such as GAVI The Vaccine Alliance which supports vaccination programs for at least 17 diseases, there is also GF ATM, namely the Global Fund for AIDS, tuberculosis and malaria, and various others. Including, big philanthropists like Bill and Melinda Gates Foundation etc.
On the one hand, there is more potential. However, on the other hand, it certainly needs good organizational arrangements. In this case, Indonesia’s role is important, at least because last year we were the G-20 Presidency and this year held the ASEAN chairmanship, and Indonesia has always given a clear color to various WHO policies.
In closing, he said that the Covid-19 pandemic has again reminded us all that public health has many impacts on various sectors of life. Health is not everything, but without health, everything can be meaningless. On the other hand, health is not merely about being healthy and sick, but also about welfare, according to the SDGs health and well being for the world and also for us in beloved Indonesia.