U.S. Statement on Strengthening Health Systems during ECOSOC Development Cooperation Forum

Natasha Bilimoria
Deputy Assistant Administrator for Global Health
U.S. Agency for International Development
Washington, D.C.
May 6, 2021


Mr. President, Excellencies, and distinguished guests, it is my honor today to join this session and this opportunity for important dialogue with you.

This session comes at a time of an unprecedented health crisis–the scale and severity of the global damage to countries’ health systems and economies caused by the COVID-19 pandemic remains difficult to estimate. It has strained some of the world’s best equipped public health systems, including our own. And it continues to be a deadly and catastrophic situation for millions of people, especially in low-income countries, where financial, medical, and human resources have been shifted to secondary and tertiary care at the expense of other essential services that millions of people rely upon. No country in the world was adequately prepared for this pandemic.

Just last week, WHO announced that more than 60 mass immunization campaigns are currently postponed in 50 countries, half of which are in Africa. This leaves approximately 228 million people, mostly children, at risk of deadly but preventable diseases such as measles, yellow fever, and polio. And prior to the pandemic there were already an approximate 20 million children who were missing critical vaccinations.

This grave statistic is just one of many that show how infectious disease outbreaks such as COVID-19 tend to result in a lasting breakdown of health systems and long-lasting reversals of public health gains in almost every disease area.

The rapid spread of this virus and its emerging variants also demonstrate that no nation can act alone in a global pandemic. Vaccinating as many people as possible, as quickly as possible, is the only way to reduce the tragic loss of life, end the pandemic, and move us toward economic and social recovery.

However, as this Forum highlights, multilateral cooperation, through organizations like the COVAX Facility and more broadly within the ACT Accelerator, is key to ensuring that people everywhere receive safe and effective vaccines against a virus that knows no bounds.

Ensuring adequate supply and equitable vaccine distribution is critical. But we all know that vaccines don’t administer themselves, so it is also critical that we support countries to prepare to administer vaccinations to everyone.

Currently, epidemic preparedness and control programs in low-income countries are often vertically aligned and not fully integrated at all levels of the health system. And that’s where we can work together with countries to fully integrate public health functions into the subnational and primary health care systems and address cross-cutting health system needs and improve local ownership and effectiveness.

It is important for the global community to transition from reacting to emergencies; and go beyond preparedness and response; and now really direct attention toward fostering everyday health system resilience. This means improving the ability of partner governments to leverage and coordinate capacities across public, private institutions and community health structures to deliver high quality effective health services that protect people from catastrophic health expenditures and promote equity of access.

As a community, we should bolster the capacity of institutions and promote the importance of integrating public health functions and health security efforts to achieve the SDGs and make progress towards universal health coverage.

We know that longer-term pressures will continue to exist, and health emergencies will continue to occur.

But, that’s why it’s critical to expand the global health security agenda from national level efforts to approaches that address cross-cutting aspects of the health system with deliberate attention to subnational and community level issues and actors.

And that is why USAID focuses on strengthening health systems so that they are able to respond to both shocks and stressors. Our work underscores the importance of building resilience to acute, time-bound events such as a disease outbreak, as well as the capacity of health systems to address longer-term challenges such as protracted population displacements, weak public health authority or legitimacy, population pressure, social exclusion, and climate variability.

When we support health systems, we are helping them to become resilient. But I think as we’re are all aware….a strong health system is not necessarily a resilient health system. To be resilient, health systems must be flexible enough to adjust resources, policy, and focus in response to constantly emerging challenges.

When we talk about health system resilience, we are talking about improving the health system’s ability to absorb, adapt and transform under expected pressures and emergencies, while maintaining quality of health service delivery.

The COVID-19 pandemic is providing us with an important opportunity to adapt and transform.

We’ve seen examples of this—one was demonstrated when countries expanded use of digital technologies across programs to provide virtual and telehealth services during lockdowns and also created an opportunity to integrate better and utilize accessible digital health platforms and at scale.

USAID’s ten-year Vision for Health System Strengthening 2030 underscores the importance of integrated approaches – leveraging the strengths of the private sector, public health and NGOs. It highlights the inclusion of all stakeholders such as communities; and it emphasizes the need for locally driven solutions and social and behavioral change.

We hope this new vision can serve as a useful tool for the global community when considering ways to increase the ability of a health system to withstand and effectively respond to shocks and stressors.

As a global community we need to think how we provide and implement technical assistance, and how we can do so in a way that better fosters local capacity and locally generated sustainable solutions.

The COVID-19 pandemic again offers us the opportunity to examine how we can help countries become more resilient, and our cooperation more effective.

We recognize the importance of health system strengthening for our collective health security and the opportunity that we have in this moment in 2021 to capitalize on the global attention and support for this topic.

Thank you again for this opportunity, and I look forward to our discussion and the paths for collaboration that this forum will help us identify.