Dr Krishna Reddy Nallamalla, Regional Director, South Asia, ACCESS Health International and Deepali Khanna, Managing Director, Asia Regional Office, The Rockefeller Foundation in an interaction with Kalyani Sharma talks about the journey of Global Learning Collaborative Approach for Health Systems Resilience (GLC4HSR) and highlights that digital and molecular technologies, that came into forefront to play the most crucial role during the pandemic, will bring disruptive changes in the way surveillance and rapid response systems are designed

Please walk us through the journey of Global Learning Collaborative Approach for Health Systems Resilience (GLC4HSR) and its significance in combating the future healthcare crisis?

Dr Krishna Reddy Nallamalla: COVID-19 pandemic has exposed weak and fragile health systems across the world. We are entering the phase of gradual recovery from the shock. It is time for the leadership and governments to learn and formulate policies and strategies to build back more strong and resilient health systems to prevent future shocks and prepare for them if we fail to prevent.

GLC4HSR aims to create a platform for learning of various key stakeholders – policy makers, academia, private sector, and civil society. It will onboard these stakeholders across three regions of Asia for reciprocal learning from each-others experiences and expertise. With secretarial and technical support from ACCESS Health with its offices in South Asia, South East Asia, and East Asia, technical facilitators will pool relevant knowledge around key thematic areas that are relevant in building back better systems through systematic reviews, expert round tables, focus group discussions, interviews with leadership etc. These include pandemic prevention and preparedness, effective disease surveillance leveraging modern technologies, rapid response systems to face future shocks, and health financial and social protection to face them without hardships. The pooled knowledge will be processed into learning and policy briefs for the benefit of all the members and will be made available through a knowledge portal, and periodic peer to peer learning meetings across Asia. Pilots will be supported to implement some of the learnings relevant to a given context in improving the status of health systems within their resources.

Can you throw some light on the significance and possible challenges faced by the government and other stakeholders while working in a PPP model?

Deepali Khanna: We now know that COVID-19 has caused immense stress to health systems around the world and disrupted essential health services. Even reaching the pre-COVID status quo itself will take immense investment of human and financial resources.

Traditionally, investments in public health and other public goods remained sorely undervalued; investments in preventive measures, whose success is invisible, even more so. Many such investments were needed to be made in countries that cannot afford them. COVID-19 has changed this to an extent and has even expanded the pie when it comes to public health investing be it government investment or the commitments by supremely influential actors like the AIIB, which recently committed to setting up a healthcare investment portfolio.

How do you see the world moving towards the post-pandemic era in terms of the revolutionisation of the healthcare sector?

Dr Krishna Reddy Nallamalla: Health will occupy top of policy agenda of every nation. Digital and molecular technologies, that came into forefront to play the most crucial role during the pandemic, will bring disruptive changes in the way surveillance and rapid response systems are designed. Countries will move faster to put national health information systems in place as is evident from the announcement of Ayushman Bharat Digital Mission (ABDM) in the midst of the pandemic. Genomic surveillance of wastewater has brought in the concept of precision public health for planning the response in most precise way. Standards-based interoperable health records with health data of entire populations being accessible through health data exchanges will be a reality across many countries. Point of care diagnostics, wearable monitoring devices, telemedicine, and direct to home healthcare services will move healthcare from hospitals into communities and homes. Self care will become new norm with various supporting applications using AI tools. Majority of the countries will move towards universal health coverage through innovative financing solutions offered by fintech for health.

How crucial will be the role of multi-sectoral approach and knowledge/resource sharing in strengthening the global healthcare ecosystem? What is the need of the hour in this direction?

Deepali Khanna: Of the many lessons that COVID-19 taught us, one of the crucial one was to work together and not in silos. It made us share information, intelligence and have an exchange of knowledge and capabilities, which allowed several entities to work together and collaborate. The world demands collaboration, and the future is in collaboration. As globalization advances, new technologies and demographic, epidemiologic, and economic shifts are transforming health systems in countries around the world. There is a window of opportunity to promote strategies that steer this transformation toward better health outcomes and financial protection through improved health systems performance and the expansion of universal health coverage in low and middle-income countries.

The Foundation in recent years has committed itself to “connecting people to catalyse change” across the world. Even pre-pandemic, The Foundation aimed to advance the fields of public health and medical science to improve outcomes for all people, everywhere, improving health outcomes through equitable, data-driven health systems in communities around the world, and to accelerate a global movement calling for equitable health systems that leaves no one behind. The Foundation envision a world where community health systems everywhere are equipped to apply data-driven decisions to deliver the right health interventions to the right people at the right time.

The Rockefeller Foundation’s legacy in the public health space always has and continues to aim to catalyze system-strengthening activities that create broader access to affordable health services in developing countries. The initiative includes both global and country-specific work.

In a similar spirit of collaboration, we all have to find opportunities to partner and collaborate with varying other organisations and institutions that share the vision of a healthy and equitable society.

What is the need of the hour when it comes to achieving ‘Affordable & Accessible healthcare’? What are the current challenges especially in developing nations like India in this direction?

Dr Krishna Reddy Nallamalla: Geographic access to healthcare needs further improvement in healthcare supply in villages and towns. The greatest challenge to supply is the competent health workforce, especially the doctors in underserved areas. A well-developed telemedicine system coupled with strengthened primary health care may partially address this challenge. Strategic purchasing of primary care and hospital-based services from private providers through various public and social health insurance programs, bringing informal labour and self-employed small and medium entrepreneurs into health financial and social protection, innovations in health consumer financing will address the affordability of care. Accessing safe and effective care in an equitable and dignified fashion are the remaining major challenges. Two-thirds of preventable deaths in developing countries are not due to lack of access but due to poor quality of services. Similarly, two-thirds of longevity is attributed to social determinants like literacy, employment, hygiene, access to clean water, energy and air, nutrition, tobacco and alcohol consumption etc. Hence, it is equally important to address social systems as health systems.

Please tell us about GLC4HSR future plans and actions?

Deepali Khanna: Global Learning Collaborative for Health Systems Resilience is envisaged as becoming a sizable global community of health systems member countries who co-develop and share evidence to create region specific strategies for safeguarding all people against future crises.

The collaborative is designed to evolve organically. With enterprising goals such as:

• Creating an ecosystem of relevant organizations working toward a future ready resilient system.
• Creating a channel for knowledge creation, sharing and utilisation.
• Prioritising capacities and resource needs across the engaged collaborators.
• Creating an opportunity for innovators working in any of our focus areas to scale their innovations for a resilient health system.
• Creating a flexi-fund for strengthening health system resilience.

The collaboration aims to create a self-sustainable model that will evolve over time.

Dr Krishna Reddy Nallamalla: We are constituting a technical advisory group (TAG) consisting of people who have rich experience and expertise in global and national health systems across Asia to mentor and guide GLC, impart their wisdom, and mobilise key stakeholders. Members are being on-boarded from each country across Asia. Work on various thematic area has already begun and will be expended to themes that are relevant to members. Focus groups will be formed around each thematic area. Quarterly peer-to-peer learning events will be organized with participation from all regions of Asia. Periodic state- and nation-level meetings will be held as a build-up to these events. These will culminate in an annual event towards end of the year. Idea is to evolve GLC into a self-organising, self-governing, self-sustainable collaborative with initial seed funding from donors like Rockefeller Foundation. GLC will be expanded in due course to other regions of the world including Africa, South Americas, and fragile states in middle-east.

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