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The Covid pandemic has exacerbated weaknesses in health systems, particularly in poor countries

In many impoverished countries, the pandemic has had fatal consequences for people with health care needs. Children have not had the required vaccinations, women have had to give birth at home rather than at a clinic, more women have died because of pregnancy and delivery complications, access to contraception has fallen and 1.4-million women have had an unwanted pregnancy. And calls to hotlines for women who have been the victim of domestic violence and for lesbian, gay, bisexual, transgender and questioning people have increased by 700%. 

It is not until we become ill that we truly understand the value of being healthy, and we have never before discussed health issues as much as we are now. The pandemic is dominating the world, with appallingly high numbers of Covid-19 cases and death rates, lockdowns result in economic slumps, rising poverty and hunger. 

In spite of this, we must look beyond Covid-19 and focus on treating the illnesses that most people die from in poorer countries, such as tuberculosis, malaria, measles, pneumonia and diarrhoea. There are cures for all of these.

The pandemic has highlighted weak links and systems that need to be improved and developed — health and medical care is one and access to water and sanitation is another. 

Millions of people are falling ill, requiring intensive care, experiencing long-lasting symptoms or dying. It is estimated that, worldwide, 2.5-million people died from Covid-19 in the first year of the pandemic, 90% of whom are from high or upper middle-income countries. Covid has also caused many deaths in low and lower middle-income countries. But many more people, primarily women and children, have died from the indirect effects of the pandemic and the measures taken to combat it.

This is where government aid, alongside other players, has a major role to play. But we need to work towards better and more sustainable health care that is fair and accessible for all. We will not be able to achieve sustainable development for anyone in the world if we do not make major investments in good health and robust health systems that can withstand pandemics as well as environmental and climate disasters and conflicts.

According to data from the World Health Organisation (WHO) on more than 80 countries, 1.4-million fewer people received treatment for tuberculosis in 2020 compared with 2019 and it is feared that half a million have died from the disease because they did not seek or did not receive adequate health care. 

When clinics close and travelling to another clinic further away takes longer and is more expensive, people do not get the care or medicines they need and run the risk that their condition will deteriorate and they will die. 

The risk of falling ill with malaria has also increased. In Uganda alone, 120 000 malaria mosquito nets were not distributed last year. Millions of children are suffering from malnutrition and hunger, and in some areas the figure is higher among girls than boys. 

Societies have been in lockdown and, according to the United Nations Educational, Scientific and Cultural Organisation (Unesco), 168-million children are still affected by school closures in 34 countries. 

Added to these challenges are economic recession, rising food prices and the resulting famine, with the risk that global development will fall five to 10 years behind, and that the sustainable development goals of Agenda 2030, aimed at creating a better world for all and ultimately sustainable health for both people and the planet, will not be met.

In other words, health has been negatively affected on a broad front, and so has the health care system. The capacity of entire health care systems must be expanded to provide quality preventive and curative care so that far-sighted politicians can make wise decisions based on statistics illustrating actual needs, so that we have a more and better educated health care personnel in various categories, so that clinics and pharmacies are open where people live, and so that health care is provided according to local requirements. 

For many years, Swedish government aid has worked on developing capacity and financed education and training for health personnel, but it is vital that countries themselves earmark funds for health care to a greater extent. It is only when countries prioritise health and medical care themselves that the systems become sustainable in the long term. 

It is also important to boost capacity to deliver fair and equal, quality care that is free from corruption. Patients should not have to pay bribes to get good health care, be forced to undergo unnecessary examinations that inflate the bill or pay for expensive or fake medicines. Health care loses vast sums to corruption every year and these problems will escalate now that vaccine campaigns for Covid-19 have started.

Swedish aid has invested in building up research capacity in low and middle-income countries for decades, and used this research to improve the efficiency and quality of health care systems. Two examples are Sweden’s research collaboration with Makerere University in Uganda, which has helped reduce maternal and child mortality in the country, and Sweden’s support for the WHO’s Alliance for Health Policy and Systems Research, which takes a holistic approach to improving the ability of low and middle-income countries to organise good health care for all. The Swedish International Development Cooperation Agency’s (Sida’s) health programmes in Bangladesh, the Democratic Republic of the Congo, Myanmar, Somalia, Zambia, South Sudan, Uganda, Zambia and Zimbabwe have also provided aid to strengthen the health systems of these countries. In Somalia, Sida has helped new and improved health facilities provide the regions with much needed health services. Aid in Zambia, Uganda, South Sudan and Zimbabwe has ensured a good supply of food and nutrition.

The most pressing issue now is strengthening the vaccination programmes so that the Covid vaccine does not take personnel away from children’s vaccines and maternity and children’s health care can remain open and safe. 

People also need correct information so that they have the courage to seek health care in this age of “infodemics”. Investments in digital health care and information are crucial in this respect.

The pandemic and its consequences will leave no one untouched, but a crisis always presents new opportunities, and new solutions that need to be tested. Although there are many immediate needs that have been exacerbated by the pandemic, we can now build on and make improvements to change, for example, food, energy and transportation systems and urban development to ensure we do not exceed the planetary boundaries. 

Such far-reaching transformations are needed to reduce both the short and long-term vulnerability of society, and to enable “sustainable health” for people and the planet. But we need to start with the health and medical systems, which are a critical component in stopping the pandemic, and in preventing and detecting future ones. And we must ensure that all people, everywhere, have access to quality health and medical care.

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Carin Jämtin
Carin Jämtin is the director general of the Swedish International Development Cooperation Agency
Stefan Swartling Peterson
Stefan Swartling Peterson is a professor of global transformations for health at the Karolinska Institutet in Solna, and health specialist at Unicef, Sweden

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