Reshaping international health cooperation: how excellence can trigger further development

Article 25 of the Universal Declaration of Human Rights recognises health and wellbeing as a fundamental human right. The World Health Organization constitution considers the “highest attainable standard of health” as a fundamental right of every human being. Over the last 70 years, governments, UN agencies and a wide range of stakeholders have been working to reach this ambitious goal.

In the 1978 Declaration of Alma-Ata, it was decided that the first step towards providing accessible and quality medical services for all would be to concentrate resources on basic healthcare services. The 2018 Astana Conference showed that this focus has not shifted – basic healthcare is still at the core of the discussion, despite the emergence of new data that suggest the need for a broader approach.

According to ‘Global Surgery 2030’, a report by The Lancet Commission on Global Surgery, surgical conditions account for approximately 30% of the global burden of disease. Analysing four dimensions of access – timeliness, surgical capacity, safety and affordability – 5bn people are shown to be unable to reach surgical services and a minimum of 143mn additional surgical procedures are necessary each year to save lives and prevent disability. In fact, the report recognises the pivotal role of a comprehensive strengthening of health systems to achieve Universal Health Coverage.

Healthcare systems should be founded on equality, quality and social responsibility. To improve health conditions in low-resource countries, it is crucial that national healthcare services be able to provide free and high-quality medical treatment replete with competent medical staff. To that end, the creation of medical centres in fragile and developing countries can have a positive impact on the development of health systems that guarantee access to secondary and tertiary-level care centres alongside basic healthcare facilities.

The goal is a full application of the universal human right to healthcare: if someone is sick, regardless of their disease, they shall have the right to access the proper level of care. Centres of Excellence offer specialised training, create a more resilient health workforce and contribute to the ‘brain drain to brain gain’ phenomenon. Only through a country-led, and -owned, process will it be possible to ensure universal access to quality individual care and prevention that will inspire confidence in a national health system capable of facing outbreaks and new emergencies. In these environments, a functional and resilient health sector can help consolidate regional cooperation and achieve the broader goal of transitioning out of fragility.

A successful example of this approach is the Salam Centre for Cardiac Surgery in Khartoum, run by the international NGO EMERGENCY in cooperation with the Sudanese Federal Ministry of Health. The centre provides high-quality surgical and medical assistance to children and adults with congenital and acquired heart conditions. It ensures treatment at a regional level and is the only completely free cardiac hospital in an area of over 300mn people. Since opening 12 years ago, the centre has performed over 8,000 open-heart surgeries and 70,000 specialised screening and follow-up missions. Thanks to the regional network and collaborations with other health ministries, over 1,400 patients from 30 countries have been referred to the Salam Centre.

The impact has received international acknowledgement. During his opening speech to the World Health Summit in October 2018, Dr. Tedros Adhanom Ghebreyesus, Director-General of the WHO said: “While I was there [in Khartoum] I visited a cardiac centre run jointly by the Ministry of Health for Sudan and an Italian NGO in a public-private partnership – a model partnership. The centre provides free treatment for people from Sudan and neighbouring countries.”

Today, EMERGENCY is replicating this model in Uganda. Currently, there is a new Centre of Excellence in Paediatric Surgery under construction that is expected to be operational by 2020. Through recognising the importance of these centres, both Sudanese and Ugandan authorities have committed to providing human and economic resources that will help guarantee free, high-quality healthcare that can facilitate future autonomy. These examples may serve as a baseline for donors and stakeholders. The ability to measure the impact and costs of such interventions is the first step in attracting the funding needed to make this system scalable.

With the 2030 Agenda for Sustainable Development serving as a guiding light, the EU and UN must reform how they invest in health systems. The ‘old way’ of delivering aid has not worked as expected, and the need for fragile states to forge a clear path to resilience is still a priority in many parts of the world. It is evident that healthcare systems cannot be approached in completely different ways according to their latitude.

The basic healthcare approach remains fundamental but it has to be integrated by providing accessible secondary and tertiary level centres. This innovative vision, which goes beyond the ‘North-South’ cooperation model, will help establish equal partnerships between recipient countries and the international community. The benefits obtained through this holistic approach go beyond the provision of basic care and make it possible to offer highly specialised training to local professionals. Ultimately, a long-term investment strategy will grant sustainability and resilience, moving beyond emergency and humanitarian responses to the creation of stronger, more stable and more efficient health systems.