Health systems across the world are under severe pressure to contain and mitigate the infection rate of COVID-19. The pandemic is revealing serious vulnerabilities and gaps in the health systems of many countries. These are impacting the capacities to control the pandemic, stabilize health conditions and restore economic activity. The need for strategies and solutions to support social security institutions in facing these challenges is fundamental to ensure the right to health for all.
The coronavirus is a serious stress test for social protection and health systems. This unpredictable, large-scale health challenge affecting the global population and requiring urgent mobilization of resources revealed the different levels of preparedness of health care systems necessary to deal with an outbreak of this magnitude.
Even as countries struggle to sustain day-to-day operations, there is simultaneous emphasis on the need to build resilient systems that would be able to absorb and effectively respond to similar shocks in the future. Clearly, there is an urgent need to look beyond the current pandemic and to address long-term challenges.
Health is a priority of the 2030 Sustainable Development Goals (SDGs) as reflected by the comprehensive health goal of SDG 3: “Ensure healthy lives and promote well-being for all at all ages”. Through a range of activities, the International Social Security Association (ISSA) provides a platform of exchange on innovative solutions and strategies to enhance in a financially sustainable way the resilience of health systems in these troubled times.
An ISSA webinar on Building more resilient health systems: Good practices and current issues, held in January 2021, shared the insights and experiences of institutions in Indonesia and the Republic of Korea. Building on this webinar and further evidence, this article reviews key issues and innovative responses, namely:
- mobilising additional financing
- securing medical supply chains
- ensuring and reinforcing the availability of health workers & health facilities
- leveraging digital solutions and the use of data
- vaccination
Mobilising financing
COVID-19 revealed the inadequacy of the available resources to provide quality health care in a crisis context.and provided clear evidence for the need to prioritize investments in health systems in order to strengthen their capacities, responsiveness and resilience. Indonesia and the Republic of Korea pursued similar strategies to shore up the finances of their health systems.
In 2020, Indonesia increased the budget for its health recovery programme by 58 per cent. The country’s Social Security Administering Body for the Health Sector (BPJS Kesehatan) reallocated its social responsibility budget to COVID-19 management programmes. All COVID-19 hospital claims were verified by BPJS Kesehatan as a form of special assignment from the government, on the basis of a government-provided COVID-19 budget.
The Republic of Korea provided free diagnosis and treatment. Health insurance contributions were also reduced to relieve the financial burden. On the other side, due to the spread of COVID-19, mask wear and regular handwashing became the new normal, which induced a decrease in medical expenses, mainly for respiratory and infectious diseases. The National Health Insurance Service (NHIS) made use of big data to classify risk groups. In addition, it deployed mitigation measures to expedite payments to medical institutions and prevent the financial collapse of the health-care system.
Securing medical supply chains
In many countries, the pandemic showed the devastating human and economic costs related to shortages of critical medical supplies and personal protective equipment (PPE), with hospitals and health care facilities struggling to protect their staff and patients appropriately.
Indonesia provided quick responses to ensure the availability of COVID-19-related drugs and medical supplies, including through the tasking of local entrepreneurs. Donating medical supplies to hospitals was among the fast service response of BPJS Kesehatan in the early stages of the pandemic. Korea is accelerating the development of vaccines and treatments simultaneously at the national level.
Ensuring and reinforcing the availability of health workers and health facilities
Urgent measures to temporarily increase the number of hospital beds and the available equipment helped deal with the increased demands for treatment of COVID-19 patients. However, the lack of health personnel put health workers under intense pressure and exposed shortcomings in staffing as well as in policies on remunerations. To boost health workforce capacity, some countries have tapped into medical students and nurses who were still in training and mobilized retired health care workers.
To respond to the pandemic, Indonesia’s government funded the construction of 940 hospitals with a 70,495 bed capacity, and accelerated the recruitment of COVID-19 volunteer health workers and intern doctors. The government also provided incentives for health workers as a form of appreciation for their hard work.
The Republic of Korea implemented a government subsidy project to expand emergency medical treatment beds for confirmed COVID-19 patients and to recruit more nurses, radiologists, clinicians and nursing assistants. As part of a broad logistical strategy to diagnose people, the Republic of Korea implemented a drive-thru COVID-19 testing programme.
Leveraging digital solutions and the use of data
To cope with the pandemic, digital innovation and digitalization are key strategies pursued by most countries. IT systems have been critically important in numerous aspects, including for early detection and sequencing of the virus, contact tracing and online health care provision (telehealth). Artificial intelligence initiatives to track the spread of the virus and predict where it may appear next have also been developed.
Smartphones and mobile data have been leveraged for detection and control. The Republic of Korea developed advanced e-government and smart data-driven information infrastructure, enabling successful contact tracing and epidemiological mapping. The self-quarantined safety app is one of the innovative digital tools, allowing those in quarantine to report the evolution of their case and to monitor their quarantine compliance.
Indonesia accelerated its digitalization programme and piloted telehealth for chronic disease patients and doctors in primary and secondary health care facilities. Telehealth has many potential benefits e.g., reserving physical capacity in health care units for critical cases and ensuring the safety of people with serious health conditions unrelated to the outbreak.
This underlines the importance of data governance and data privacy. In line with data privacy regulations, the emergency nature of the pandemic is causing countries to lift certain technical barriers and adjust certain legal frameworks for effective use of such data.
Based on lessons learned from the Middle East respiratory syndrome coronavirus (MERS-CoV) in 2015, the laws and regulations enacted by the Republic of Korea proved to be prescient in enabling authorities to analyze and disclose personal information when the pandemic struck, based on public trust in the government.
Vaccination
Strengthening the capacity of health systems to respond swiftly and effectively to the pandemic includes administering COVID-19 vaccines. After lightning speed development and testing, vaccine campaigns are rolling out in many countries. The rollout of vaccination programmes is being done in a holistic way to foster transparent communication and a speedy response to the health emergencies.
In January 2021, Indonesia had procured 426.8 million doses of vaccines and plans to distribute these to more than 20 thousand primary health care facilities, in preparation for the second stage of the vaccine rollout to 17.4 million public workers and 21.5 million of the elderly population. In the Republic of Korea, vaccination began in February 2021, with the aim of completing the vaccination of half of the population within the first half of the year.
Conclusions
In light of this unprecedented health crisis, all countries have ramped up efforts to mitigate the pressure on their health-care systems. The crisis has exposed the importance of adaptable health systems. Countries have strengthened access to health care, emphasising the importance of high-quality universal health coverage. The health workforce capacity was boosted in many ways. Digital solutions provided access to telemedicine and real-time disease surveillance was enabled. Definitely, innovative digital tools hold an unparalleled potential to enhance the resilience of health systems.
While it is too early to draw conclusions, the health crisis has exposed the need for health systems to be more resilient to crises of such gravity and paves the way for important reforms to improve responsiveness to future crises.
Finally, to effectively address national public health challenges, the international community provides support to social security institutions facing these issues. The exchange of information among ISSA members will continue in the next ISSA webinars as well as articles, to identify paths for solutions and to ensure that adequate, effective and affordable health protection is available for all.
References and further reading
EU Expert Group on Health Systems Performance Assessment. 2020. Assessing the resilience of health systems in Europe: An overview of the theory, current practice and strategies for improvement. Luxembourg, Publications Office of the European Union.
European Commission. 2014. Communication from the Commission on effective, accessible and resilient health systems. Brussels.
ISSA. 2019. Ten Global Challenges for Social Security: Developments and Innovation. Geneva, International Social Security Association.
McCall, B. 2020. “COVID-19 and artificial intelligence: protecting health-care workers and curbing the spread”, in The Lancet Digital Health, Vol. 2, No. 4.
Oderkirk, J. 2017. Readiness of electronic health record systems to contribute to national health information and research (OECD Health Working Paper, No. 99), Paris, Organisation for Economic Co-operation and Development.
OECD. 2019. Health in the 21st century: Putting Data to Work for Stronger Health Systems (OECD Health Policy Studies). Paris, Organisation for Economic Co-operation and Development.
OECD. 2020. Beyond containment: Health systems responses to COVID-19 in the OECD (Tackling the coronavirus (COVID-19) crisis together: OECD policy contributions for co‑ordinated action). Paris, Organisation for Economic Co-operation and Development.