The COVID 19 pandemic put the provision of healthcare back on the international agenda and highlighted the crucial role of hospitals in patient care.
Although the crisis has had a much smaller impact on the countries of Africa, the Mediterranean and South-East Asia (see the WHO’s assessment on 5 May 2023: COVID-19: WHO chief declares end of global health emergency | ONU Info (un.org) ), it has nevertheless highlighted the critical nature of hospital operations in every country in the world, and particularly in those that are economically fragile.
In Dakar, the Cuomo Centre, a cardio-paediatric surgery centre set up by Chaîne de l’Espoir (CDE) in 2017 within the Fann University Hospital, was particularly affected. Its intensive care unit was requisitioned during the crisis, due to the quality of its infrastructure, the modernity of its equipment and the presence of highly skilled resuscitators. As a result of this requisition, cardiology activity was virtually shut down for eighteen months, despite the fact that it is the only paediatric cardiology establishment in Senegal.
In Kabul, the French Mother and Child Hospital (IMFE), run by the Aga Khan Development Network (AKDN) and the CDE, also put some of its traditional activities on hold to accommodate COVID patients in its intensive care unit, thanks to the quality of its equipment and its doctors. Many other operations have been postponed, putting the lives of many Afghan patients at risk.
Particularly critical situations in economically weak countries
While hospitals in France are also suffering from a shortage of medical staff and insufficient budgets, the problems in economically weak countries are alarming. In many cases, governments, made vulnerable by political crises, uncertain security situations and a lack of financial and human resources, are struggling to run a public service that is incapable of meeting the health needs of a growing population. As for the private sector, it serves only a small proportion of the population, while many NGOs focus on primary health care and communicable diseases. Humanitarian crises continue unabated (Ukraine, Israel-Palestine, Sudan, etc.), pushing long-term health issues out of the spotlight.
In recent decades, funding allocated to the health sector by the international community has focused primarily on communicable diseases and major pandemics. For example, the Global Fund to Fight HIV, Tuberculosis and Malaria, created in 2002, invests more than $5 billion a year (https://www.theglobalfund.org/fr/about-the-global-fund/ ). The GAVI Vaccine Alliance Fund has received $37.9 billion since it was set up in 2000 (https://focus2030.org/Qui-finance-l-acces-a-la-sante-dans-le-monde).
Meanwhile, in 2015, the Lancet published a study (https://els-jbs-prod cdn.jbs.elsevierhealth.com/pb/assets/raw/lancet/stories/commissions/Global_Surgery_execsum_French-1437661469833.pdf ) warning that ‘5 billion people do not have access to safe and affordable surgical and anaesthetic care when needed. This access is most limited in low-income and lower-middle-income countries, where 9 out of 10 people do not have access to basic surgical care’.
As highlighted by the Think Tank Global Health 2030 in its ‘World Health Review: The Last Two Decades’ (https://santemondiale2030.fr/nouvelle-publication-deux-decennies-de-mutations-de-la-sante-dans-le-monde-document-diagnostic/), low-income countries suffer from a ‘double burden’ (infectious diseases and non-communicable diseases), combined with a demography that continues to penalise them, a cruel shortage of healthcare workers, unequal access to medicines and a serious lack of investment in healthcare.
In addition, the effects of climate change on health (air pollution, antimicrobial resistance, drought) increase the need to tackle the environmental determinants of health. The health sector’s climate footprint continues to grow, accounting for 4-6% of global carbon emissions. While most of these emissions originate in high-income countries, the so-called ‘southern’ countries bear the brunt of the consequences. This climate crisis is therefore changing the framework for action by all the players involved, and commits us, as medical NGOs, to supporting the transformation of healthcare systems towards resilient, sustainable, low-carbon trajectories.
How should healthcare players think about the hospitals of tomorrow ?
It was around this question that Agence Française de Développement (AFD), the Geneva Sustainability Center (GSC) and AKDN came together at the end of 2023. They were soon joined by two European NGOs, Climate Action Accelerator and Chaîne de l’Espoir, which are respectively active in adapting organisations’ practices to climate change and in training hospital teams in “southern” countries. These different organisations now want to call on a broad community of healthcare players, in particular medical NGOs, international organisations and funding bodies, to reflect together on these crucial issues for the health of millions of human beings.
As part of an ad hoc working group set up at the beginning of 2024, we are working on how to meet the new challenges we have identified, and in particular : the acceleration of the epidemiological transition and the treatment of non-communicable diseases, which will require investment in infrastructure and human capital; a new, patient-centred approach to care, involving ongoing dialogue between the different levels of the health pyramid; the shortage of human resources in health, the need to train more of them and to retain trained staff in their establishments; improving hospital governance and strengthening skills at all levels; the constraint of limited financial resources, which will require a new model for allocating funds.
Acting together through a new initiative
Our initiative, The future of hospitals and their health systems in low-resource settings (A collaborative initiative for people, places, and planet) was launched in Geneva on 6 June, bringing together 280 people in a hybrid format to discuss human resources, climate resilience and hospital financing. Our day was introduced by keynote speeches from Dr Gijs Walraven and Prof Karl Blanchet. The aim of our initiative is to create a platform bringing together professionals and stakeholders from the hospital ecosystem in order to create a space for exchange, generate knowledge on future hospital models, and support a transformation programme at the political level, in line with the WHO’s recommendations.
Our next meeting will be held online and on-site in Rio on 11 September, during the World Hospital Congress organised by the IFF (https://worldhospitalcongress.org/), and will focus on quality of care. Come and join us !
Nathalie De Sousa Santos
Project steering committee:
AFD: Camille Perreand, Yara El Eleywa Le Corff, Christophe Saint Martin
Geneva Sustainability Center: Sonia Roschnik, Sylvia Basterrechea, Renzo Costa
AKDN: Zeenat Sulaiman
Climate Action Accelerator: Alexandre Robert
Chain of Hope: Nathalie De Sousa Santos
Nathalie De Sousa Santos has been working in the international solidarity sector since 1993, after several years in financial auditing.
She began her career as a volunteer with MSF in Rwanda and Tanzania during the Rwandan genocide, an experience that led her to become involved with NGOs.
She then joined the NGO Partage avec les Enfants du Monde, where she set up the Programmes Department and became involved in creating partnerships on education issues. Since 2012, she has been working at Chaîne de l’Espoir, where she is Deputy Managing Director in charge of operations. She is particularly interested in hospital cooperation issues. In this capacity, she is a trustee of the Dominique Ouattara Mother and Child Hospital in Bingerville, Côte d’Ivoire, and the French Mother and Child Hospital in Kabul. She has also been a director of the F3E on several occasions over the past 20 years.
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