The Ebola outbreak in West Africa has renewed debate about the effectiveness of health systems and how best to support collective regional action.
Having comprehensive, accessible and sustainable systems in place can prevent and contain the spread of communicable diseases like Ebola, curtailing their effects and caring effectively for those infected. But the limitations of international action to support health systems and respond to specific diseases have been laid bare.
World leaders have come under fire for their inadequate and slow response to the outbreak. But how are West African countries responding collectively? And what does this tell us about the potential for regional state groupings to support health systems and programmes and to contribute to global poverty reduction goals?
One of the first responses to the crisis was a regional one. In July, the Economic Community of West African States (ECOWAS) – an inter-state organisation aimed at promoting economic integration among its 16 countries, including those affected by Ebola – announced it was setting up a US$3m regional solidarity fund. This is to be spent on education and technical support to help contain the spread of the Ebola virus.
The amount may be dwarfed by the World Bank’s injection of US$230m into the emergency response and a further US$170m for medium and long-term projects, but calls to strengthen regional action on Ebola have grown louder.
In September, Kadre Ouedraogo, president of ECOWAS, appealed for other partners to contribute to the solidarity fund to extend regional resources to fight Ebola:
The spread of the epidemic shows that purely nationalist approaches are counter-productive … we should give priority to concerted and co-ordinated but more regional actions.
Ouedraogo also called for support for regional initiatives aimed at “strengthening epidemiological surveillance, health facilities as well as epidemiological and therapeutic research in order to prevent and control the epidemic”.
Time will tell whether the Ebola regional solidarity fund turns out to be the precursor of a more substantial ECOWAS social development agenda. What – in principle – would be the benefits of a strengthened regional governance of social policy?
Pooling resources and risks can help scale up social provision, and better respond to disasters and other calls on aid. A regional fund uniting forces and resources could help create stronger regional provision in education, training and health facilities. Take health, for example. When there aren’t enough health workers and health systems are weak, population health suffers and people die. The reasons for these shortages are many and complex, but a regional strategy that pools states’ resources can help increase provision where there are regional imbalances and address under-capacity.
Regional social strategies can protect, promote and reshape a regional division of labour, trade and production to promote co-operation and generate fiscal resources to fund social development. Common regional trade and tax rules can help support and build fiscal capacity in the region in support of regional social priorities. Regional co-operation can galvanise support for higher social standards on health, labour, social protection and education in the region, for example, and help foster ownership of and long-term commitment to them.
Pooling risks and resources regionally can help address imbalances in education, health and welfare provision. Limitations of small-scale social insurance schemes can be addressed through regional risk pooling. Specialist health facilities and higher education provision can benefit through pooling resources regionally. Regional co-ordination offers the possibility of more effective preparedness for and responses to disasters and other calls on aid - which often have health consequences.
Beyond West Africa
The question of how regional groupings can respond better to health problems and develop robust health systems is not just a matter for Ebola-stricken West Africa and ECOWAS. It is one that is being considered under the ambit of the expanding ambitions and agendas of regional groupings across South America, Europe, Africa and Asia.
Regional public policy agendas now go well beyond the established, but limited, ambitions of “open” regionalism – namely, the hub of markets, trade and finance. Social policy is increasingly central to regional agendas, whether that is increasing access to affordable medicines, extending social protection, universalising healthcare, or promoting educational co-operation, answers to seemingly intractable social problems are increasingly framed in distinctly regional terms.
Regional groupings of nations are increasingly addressing the relationship between trade, labour and social standards, and the question of how to maintain fiscal capacity and social solidarity in the face of international competition. These questions are on the political agendas of regional groupings as diverse as the Southern African Development Community, the Association of South East Asian Nations, the Union of South American Nations, and the Caribbean Community.
International organisations need to wake up to the role that empowered regional groups could play in attaining international development goals. The EU, Pan-American Health Organisation and the World Bank have a track record of promoting regional leadership, capacity and strategies in support of greater health equity. The World Bank could channel some of its promised US$400m Ebola fund into strengthening regional – and not just national – health strategies for the long-term.
The UN’s open working group on sustainable development goals is lamentably only now starting to consider the potential of regional bodies to intervene on issues of cross-border interest. It could usefully revisit its work on regional groupings as agents for social development, public health and poverty reduction.
European integration may be suffering a backlash but the growing appetite elsewhere in the world for the development dividends regional integration and cooperation can potentially deliver makes it an indispensable feature of the global political landscape. Regional integration has the potential to support comprehensive health systems needed for targeted health interventions that deal effectively with health threats like Ebola. Regional strategies for strengthening social investment need to be supported and properly resourced to foster pro-poor, inclusive social, health and welfare systems, reduce social inequality and defend human rights.
And with little more than a year to go before the end of the Millennium Development Goal period, and as discussions about what happens post-2015 continue to be waged within the UN and elsewhere, now is the time to take stock of what regional groupings have already achieved and identify concrete ways in which they can be better supported to strengthen health systems and reduce poverty.