Making health and healthcare really matter in less resourced countries

Abstract

As we emerge from the COVID-19 pandemic, we have no choice but to rethink how we deliver healthcare and facilitate health and wellness, particularly, for less resourced countries where the pandemic is now hitting the hardest due to the weaknesses of their health systems and low access to vaccines [1]. The pandemic has revealed the fragility of our health and healthcare systems [2, 3]. The construct of the past in which policy makers, politicians and officials make decisions about what is important needs to be replaced by sharing power with the people who require health and healthcare services. The Sustainable Development Goals [4] cannot be achieved unless this transfer of power to the people starts to happen. The three reports of 2018 about global levels of quality of care demonstrated the failure of our current system to deliver health and quality healthcare in less resourced economies of the world [5–7]. We have to make choices for the ‘new normal’ [8]. One of these choices is to coproduce the systems of the future.The current supplement of the IJQHC offer theoretical and practical ways to move to the next phase of quality in healthcare, having collected a number of experiences in coproduction for different settings. These reports show us the way forward to redesign health systems in order to face old and new challenges. For low- and middle-income countries (LMICs), the post-pandemic phase offers an opportunity to think differently and to coproduce systems focusing on universal quality health and healthcare rather than ones that are focused solely on disease management as promoted during the last decade [9]. People are willing to coproduce the services they require, if this is true participation—as demonstrated in water service provision in Ghana and Nigeria [10]. Several actions will be required to make this happen.The first of them is to coproduce the knowledge that is required for the improvement of health outcomes in LMICs. This will require a change in the way research is conducted, with the development of true and equal partnerships among academics, clinicians and the community so that the research questions asked reflect the contextual needs of the population in the LMICs rather than the research requirements of funders and academics in the upper income countries (UICs) [11]. Funding and realignment of research will not be easy, and publications such as this one will need to realign the publishing processes to ensure that knowledge is freely available to those who need it most.The second action is to acknowledge the lived experience of coproduction in LMICs and to gather as much information on this knowledge to share and develop new solutions [12]. This requires addressing the power differentials in learning and accepting the rich experience of communities and their ability to develop solutions that are not dependant on the technologies and financial interests of UIC academic institutions and corporations.The third action is to ensure that policy development considers the learning from the successes and failures experienced, for instance, during the COVID pandemic, across a broad spectrum of LMICs. There are good examples of how coproduction benefited the development of policy during the pandemic [13].The final action is to translate theory and policy into implementation so that services are coproduced in a participatory way. The aim is to develop systems where fairness normally precedes justice with full participation of the communities [14].This approach of improving and developing can result in strengthening health systems [15] so that they are able to deliver safe and high-quality Universal Health Cover and the Sustainable Development Goals. The opportunity is now for today´s citizens most in need to provide adequate services based on responsive and resilient healthcare systems they can trust.