8 countries are part of the Better Health Programme, led by the UK Foreign & Commonwealth Office
The Global Better Health Programme is part of the UK Foreign and Commonwealth Office’s (FCO) Prosperity Fund. It aims to address the growing burden of Non-Communicable Diseases (NCDs), such as heart disease and diabetes, and strengthen local health system structures by creating systems to improve quality of care. On behalf of FCO, BMJ facilitated that brought together key stakeholders from the eight countries of the Better Health Programme (BHP) to:
8 countries are part of the Better Health Programme, led by the UK Foreign & Commonwealth Office
5 cross cutting themes: strategies to counter NCDs; digital health initiatives; education and training; provider performance improvement; life sciences initiatives
£79.3m investment by the UK government over the next three years
Middle income countries are now having to deal with the health challenges associated with growing, ageing populations, chronic non-communicable diseases, and a need for domestic resource mobilization for health. These are having an impact on demography, epidemiology and aid. To address common challenges between countries, effective coordination and collaboration are essential. There is a growing shift globally with how overseas aid is dispersed, moving away from technical assistance and towards technical partnerships.
Institutional health partnerships are long-term, institution to institution partnerships between high income and low and middle-income countries. They aim to improve health service delivery and health outcomes through capacity building and health systems strengthening.1 Institutional health partnerships also allow for co-discovery, shared decision-making and shared accountability of deliverables, deeper insights into the local context and greater focus on sustainable solutions.
The UK is not new to institutional health partnerships and has a considerable track record working collaboratively with institutions in low and middle-income countries. One such programme is the UK’s Global Better Health Programme, led by the UK Foreign & Commonwealth Office. Launched in July 2019, the programme aims to improve health and will invest £79.3m over the next three years in eight partner countries (Brazil, Mexico, South Africa, Malaysia, Myanmar, Philippines, Thailand and Vietnam). The programme is part of the Prosperity Fund, which supports inclusive economic growth and poverty reduction in middle-income countries.
The overarching objectives of the Better Health Programme, which have been co-developed with partner countries, is to address the often overlooked growing burden of non-communicable diseases and strengthen local health system structures, processes, governance, regulation, and capabilities to drive improvements in quality of care. The work of the programme will contribute towards the UN’s Sustainable Development Goals (specifically SDG 3: Good Health and Well Being, SDG 5: Gender Equality and SDG 8: Decent Work and Economic Growth)
The list of stakeholders involved in the programme is extensive. On the UK side, the governmental departments involved include the Department of Health and Social Care, Department for International Trade and the Department for International Development. The NHS Joint Unit is also involved but as a strategic partner for the programme. The Unit brings together various NHS Arms Length Bodies, such as Public Health England and Health Education England, to provide quality assured technical expertise and strategic advice to the programme as well as identify opportunities for the UK to learn and strengthen the health system. Healthcare UK is therefore a key partner for the programme, helping to build new partnerships between the world-renowned UK health sector and overseas health providers. The programme also includes UK and global partners from academia, policy, civil society, multilateral donors and the private sector – each contributing expertise needed to ensure the programme meets its desired objectives.
It is important to note that there are mutual benefits and bidirectional learning opportunities for all stakeholders involved in this programme. Institutional health partnerships promote long-term peer to peer support and critically, country partners are not obliged to use UK expertise. Through the Better Health Programme, the UK isn’t just providing technical assistance but rather enabling collaboration and facilitating debate on technical solutions to health challenges which many countries are facing simultaneously. Innovation may help in tackling these challenges, but in many cases, there is no need to reinvent the wheel. Sharing and developing the existing repository of global experience can benefit all stakeholders involved, including the UK.
Currently, most of the countries in the Better Health Programme are commencing their delivery phase and initiating activities as part of their interventions. This year’s Prince Mahidol Award Conference (PMAC) on progress toward Universal Health Coverage provided the setting for a half-day open panel discussion and half-day closed workshop on the Better Health Programme. Facilitated by BMJ, the workshop brought together stakeholders, including top health officials and experts from the UK and the majority of partner countries, to share best practices, facilitate learning, and create a stronger network across the programme. The backdrop of Universal Health Coverage provided by PMAC, was pertinent to discussions on the Better Health Programme, a tool primarily for health system strengthening. The Prosperity Fund, of which the Better Health Programme is part, frames health as a key determinant of inclusive and sustainable economic growth. The value of this approach was outlined in the first plenary panel discussion of PMAC, by one of the Regional Directors from the World Bank. In the quest for Universal Health Coverage, the question is not just what the economy can do for health, but also what good health can do for the economy.
The workshop included a mix of presentations and interactive activities. First, Foreign & Commonwealth Office programme leads based on the ground in each country, provided a country showcase through posters, which outlined how the Better Health Programme would tackle different components of the non-communicable disease agenda. Later group sessions involved delegates from different countries and sectors working together to discuss how to facilitate the exchange of learning and expertise on these common challenges across the countries involved. Several themes emerged from the discussions, and if taken forward and implemented successfully, can help not only to shape the Better Health Programme and wider Prosperity Fund, but also future global health collaboration.
Delegates recognised that in order to tackle common challenges and improve performance, they would need to tap into the collective skills, insights and expertise of all involved. How to facilitate the sharing of experiences and expertise is not unique to the Better Health Programme, nor to the health sector. Technology is often heralded as the all-encompassing solution to deficiencies in communication. But given the complexity of decision-making and policy work on health systems, discussions revealed that more work is needed to understand how virtual approaches, such as online platforms for knowledge sharing, can be successfully integrated into initiatives like the Better Health Programme. Building on existing mechanisms usefully rather than additionally, is possible, but not without its risks. This is something the Better Health Programme team will seek to utilise and build on during the delivery phase.
The meeting culminated in a session on how to make sure the interventions in the Better Health Programme can be scalable, so that the programme achieves a lasting impact beyond the lifespan of the programme. Commonalities were clear; needing to plan evaluation early on, measuring impact at multiple levels with complementary methods, and gaining political buy-in from stakeholders (possibly through the use of incentives). Evidence-generation, ownership and sustainability were key challenges in achieving this broad multi-sector buy-in for non-communicable disease projects. Again, there is much support the UK can provide in this vain through the Better Health Programme, distinctly in the sharing and development of policy-relevant public health evidence.
The opportunity to convene at the PMAC side meeting has helped the Better Health Programme progress by sharing experiences through the diverse array of experts in attendance. The common challenges, nuanced insights and innovative solutions being included in the programme, cement the importance of multi-directional partnerships in health systems strengthening. Repositioning the discourse from aid assistance to collaboration will be challenging, but events like this can serve as critical junctures from which momentum is built. We look forward to seeing what lessons the Better Health Programme will provide for the international health community and similar institutional health partnerships in the future.
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