In 2023, the World Economic Forum warned the world about polycrises. It’s annual Global Risks Report highlighted how a combination of re-emerging old risks and the introduction of new risks, such as climate change, natural disasters, conflict, infectious diseases, and large-scale involuntary migration, are coalescing into interconnected crises in the coming decade.
Due to the ripple effects of these crises, ranging from conflict to the collapse of public infrastructure and services, the risks are unprecedented and their impact far-reaching. We must therefore improve global preparedness to these risks. While many countries have been able to build new capacities, the levels of preparation to respond to future threats is inadequate.
To respond to health emergencies, the World Health Organization has articulated a health security framework that brings together the roles of the International Health Regulations (2005), health systems and other sectors. It’s based on key principles that acknowledge the need to recognise common elements in managing multi-hazards, that risk of a hazard is based only on the extent of community exposure and, in the health sector, to the strength of the public health system. This multi-sectoral and whole-of-society approach addresses each risk and its interconnectedness and calls for robust national measures, including having appropriate legal, strong financial mechanisms and good governance structures.
Through our health system strengthening and climate-focused work in Nepal, Kenya and Sierra Leone, we’ve learned three valuable lessons on building health system resilience to polycrises and risks:
Effective health sector governance and ownership, backed by strong policies and financing, are the linchpin for resilient health systems and sustainable changes. It defines the extent to which a system is responsive to shocks, including political, economic, epidemiological and environmental disasters. The pace and depth of public financial management reforms, a well-designed health financing strategy and robust laws and policies that can oversee and regulate the system are crucial.
Through the Nepal Health Sector Support Programme (NHSSP), we supported the government to modernise its approach to improving healthcare facilities and to make them multi-hazard resilient. This included developing policies, streamlining procurement planning, developing standard designs for multi-hazard resilient and climate friendly buildings, strengthening local capacities, upgrading building standards and codes, and retrofitting large hospitals. Recognising the salience of this approach, the government integrated it into the Ministry of Health and Population’s forward looking Nepal Health Sector Strategic-Plan 2023-30 – the development of which the programme also technically supported. This may be a long-track approach but that which has enabled wide ownership locally thus ensuring sustainability.
There is evidence that this approach can help ensure continued health service provision at times of utmost need. Jajarkot Hospital in Karnali Province survived an earthquake that struck this district on 3 November 2023. Over 150 people died and 375 people were injured, 20 healthcare facilities were destroyed and over 60 000 houses were damaged or destroyed in this and the surrounding districts. But Jajarkot Hospital was able to continue to provide health services to survivors and the local population as well as triage, casualty treatment, and served as a logistics hub.
The Ebola outbreak and COVID-19 pandemic have brought into sharp relief the global inequities in health security practices. Global learnings from these only reinforced the need for system wide reforms and not knee-jerk reactions to individual episodes if we are to help protect populations from exposure and consequent morbidity and mortality.
This entails laying strong health system foundations by, for example, creating robust data systems and procurement mechanisms. How invaluable these efforts are became evident as we supported the Nepal government during the COVID-19 pandemic and Sierra Leone’s government during the Ebola outbreak.
Because we were firmly placed at the heart of the action in the Health Emergency Operations Centre (HEOC) and in the different programme divisions in Nepal, we were able to mobilise technical assistance embedded in the Ministry to provide surge capacity to prepare and respond to pandemic from the outset. Our team helped develop standard operating procedures and guidelines that were subsequently set out in the government’s Emergency Response Plan as well as product specifications and procurement guidelines for COVID-19 related supplies. The team also led on managing information to monitor daily COVID-19 infections and responses. We know this work was crucial as the government continued to draw on the strength of these systems throughout the pandemic.
During Sierra Leone’s Ebola outbreak in 2014-15, the country’s laboratory system needed support to cope with the demands for rapid and reliable testing, and to ensure the safety of laboratory staff. To do this, we supported the government to improve data management, information flows and laboratory system coordination to reduce Ebola testing turnaround time from above 24 hours in December 2014 to below 12 hours by mid-2015.
In addition to highlighting the fundamental role labs play for health systems, these more recent infectious disease outbreaks also demonstrated the need for pathogen vigilance and zoonotic disease surveillance.
Estimates suggest that global health systems are responsible for 5% of the world’s greenhouse emissions – the same as a mid-sized country. Addressing the highly interconnected nature of health and energy is crucial to reducing the environmental footprint of health systems.
In Bungoma county in Kenya, for example, we aimed to improve the quality of health care for women in remote areas while making the health centres more environmentally friendly. To do this, our Maternal and Newborn Improvement (MANI) project supported the county to install clean energy units in 33 health facilities, each with a capacity of 55 Kwp, 13 solar water heating systems and rainwater harvesting systems in 40 facilities. Over a six-month period, the facilities equipped with panels reduced their carbon emissions by 17,208kgs by producing their own energy. We learnt that such ventures are valuable as demonstration projects, and for their potential for replication.
Nepal faces multiple natural hazards and disaster risks, including earthquakes, floods, and landslides, all of which are exacerbated by climate change. Designing hospitals and health facilities that integrate energy efficiency and climate resilience into structures that can withstand earthquakes is therefore critical.
To do this, we ensured that maternity wards are built south facing to take advantage of the natural heat of the sun to provide warmth for newborns, reduced lighting in favour of daylight, where possible, and that air conditioning uses natural ventilation rather than relying on damaging hydrofluorocarbons. We also replaced old systems by energy efficient systems and appliances, and upgraded water, sanitation, and waste systems to integrate water and waste treatment plants at the hospital level to minimise environmental impact. These examples demonstrate that that there is a real opportunity to replicate these designs in other low resource contexts that are prone to natural disasters and vulnerable to the effects of climate change.
Stark injustices in the distribution of power, finance and access to health have steered us to the brink of the impending crises that we now see. It is not impossible to mitigate these risks, but the world needs to act now to build stronger health systems that are cognisant of the interconnectedness of these risks and responsive to the particular demands these generate.