Universal health care and political economy, neoliberalism and effects of COVID‐19: A view of systems and complexity

Abstract

Sturmberg and Martin's application of systems and complexity theory to understanding Universal Health Care (UHC) and Primary Health Care (PHC) is evaluated in the light of the influence of political economy on health systems. Furthermore, the role that neoliberal approaches to governance have had in creating increased inequities is seen as a key challenge for UHC. COVID‐19 has emphasized long standing discrepancies in health and these disadvantages require government will and cooperation together with adequate social services to redress these discrepancies in UHC.

Preparedness, impacts, and responses of public health emergencies towards health security: qualitative synthesis of evidence

“… Cameroon, Congo, Mali, Nigeria, Iraq, Eastern Medicterrain Region (EMR), Libya, Yemen Constraints in service delivery Lack of trained workforces [ 46 ], failure of coordinated support overburdened hospitals [ 47 ], lack of primary care [ 45 ], high priority of hospitals services [ 48 ], health workforce workload [ 49 , 50 ], an increase of infections [ 15 ], the hotspot of epidemics but blind spot of PHC services [ 28 , 37 ], the spread of Ebola [ 43 ], increase of pre-existing diseases [ 34 ], reduced availability of services [ 45 , 51 ]. Italy, Australia, Brasil, Malawi, SSA, CAR, Ecuador Multiple impacts on building blocks of health systems Inadequacies of service provision [ 47 , 51 , 52 ], isolation, lockdown, restriction [ 53 , 54 ], collateral damage, interruption of service [ 53 , 55 – 58 ], post-disaster disease outbreaks [ 33 , 34 ], shortage of workforce and heavy workload [ 33 , 34 , 47 , 50 , 51 , 55 – 58 ], reliance on short term staff [ 46 ], poor data quality [ 56 ], poor resource coordination and readiness [ 29 , 52 , 59 ], unavailability of digital tools [ 16 , 27 ], poor digital interoperability remote areas [ 60 , 61 ], poor partnerships, inadequate investment [ 56 ], market-oriented health systems [ 62 ], fail...…”

Public Health Management of the COVID-19 Pandemic in Australia: The Role of the Morrison Government

“…However, the critical issue is that Australia was not well prepared for the SARS-CoV-2 pandemic, which is ‘to a large extent a neoliberal pandemic’ [ 277 ], the first Australia has faced since the downsizing of public sector capacity. Others have also linked the pandemic to neo-liberalism [ 278 , 279 , 280 , 281 ]. However, neoliberalism is a contested concept, plagued by conceptual confusion [ 282 , 283 ].…”

Universal Health (UHC) and Primary Health Care (PHC)—A complex dynamic endeavor

“…9,10 The political economy of PHC (UHC) professional and sectoral funding and power struggles is an ongoing dynamic with changing government priorities, and responses to challenges such as COVID-19. 11,12 The degree of commitment to equitable access to core health and social services is essentially a political decision. In democracies and non-democracies, economic prosperity for certain sectors can be pitted against the health needs of the vulnerable by undermining primary health care services and thereby equitable (not equal) health outcomes.…”

“…6,9,[13][14][15] Peterson and Walker emphasize the political dynamic, health inequities and consumer-driven needs. 11,12 A complex systems approach with bottom-up self-organization should ensure that the top-down principles of UHC enable and promote a PHC approach.…”