Last week WHO hosted a well-structured and intense workshop in Geneva, Switzerland on making hospitals fit for purpose. The overarching vision is for hospitals to contribute to primary healthcare-oriented health systems. As such, the event is part of a process of re-imagining care. Three main themes were addressed by over 50 participants who shared experience and insights from their work in or related to the six WHO regions: governance and financing, optimising service delivery processes and infrastructure/capital asset solutions. The I4H partner, Stichting Health ClusterNET, was represented by Prof Joanna Lane, who co-chairs the I4H Common Architecture Reference Group.
While hospitals retain political and emotional capital, they have not enabled health systems to meet the needs and challenges of increasing inequalities, the burden of chronic diseases, mental ill health and the COVID-19 pandemic. At the same time, the fiscal space that governments have to provide additional budgetary resources for all sectors is static or shrinking in most countries. A common issue was concern about ongoing difficulties in securing and maintaining financing to ensure the provision of healthcare services, especially in low-resource settings. These settings are actually common across all 6 WHO regions, including Europe. But their needs and circumstances differ.
Against this backdrop, it is hard to switch resource reallocation from hospitals to PHC and onwards to health promotion and disease prevention. Embedded patterns of demand continue to lock funds into costly treatment and care with narrow approaches to evaluating investment value. These are major challenges when looking to shift from hospital-centric to closer-to-home services and interventions, let alone a serious focus on pre-empting rather than repair, as part of a paradigm shift from healthcare to care for health. The latter should offer a better return on investment.
Accordingly, Joanna introduced the concept of Smart Capacitating Investment and the I4H project in several discussion sessions. SCI means sharing risks and resources to invest at scale across multiple levels within health ecosystems, generating sustainable returns and localised benefits. In low-resource settings, the SCI approach to sharing risks and resources (facilitated by new business and financial models) might offer one solution to address several factors that hold LRS back from sustainable development: financial shortages, human resource limitations, suboptimal healthcare service delivery, lack of knowledge, underdeveloped hard and soft infrastructure, restricted social resources (as identified and discussed by van Zyl et al. (2021).
So, while we continue to develop and test the different elements of SCI in EU test-beds, it’s becoming clear that SCI might have wider relevance globally. Appropriate discussions will be initiated.
Making hospitals fit-for-purpose: a triple imperative for people, health systems, and sustainable development
(31 October 2023 to 2 November 2023)