Health Diplomacy For Universal Coverage

South Asia faces numerous shared health challenges, including high maternal, infant and child mortality rates, malnutrition, and the burden of infectious diseases. Rapid urbanisation, limited water and sanitation services, air pollution, poor health infrastructure, natural disasters, conflicts and climate change are growing concerns for sustainable human development. Despite noted progress, there are still visible disparities in health, education, income and living standards within and across South Asian nations. 

Additionally, the increasing trend of non-communicable diseases, degrading environmental health, and pandemics is alarming. The socio-economic, cultural and political inequalities are profoundly affecting health outcomes within and across social groups. In particular, the inequalities based on gender, caste, ethnicity, income, education, human resources, health infrastructure and place of residence have profound impacts on the ability of underserved populations to access health care. 

Health trajectories 

Undoubtedly, the emerging economies are shaping rapid transformations in socio-economic development, communications and digital technologies, which are instrumental in shifting health trajectories at large. The struggles to achieve universal health coverage are intensifying within and across countries. According to the 2024 report in the Asia Pacific Journal of Public Health, in 2021, South Asia had the second lowest level of universal health coverage and the highest level of catastrophic health spending compared to other regions globally. 

While many countries have implemented a range of policy and strategic interventions to address persistent health inequalities between poor and rich in both rural and remote areas, desired progress is minimal so far. More worryingly, these efforts have largely failed to address the unmet health care needs of poor, socially marginalised communities. Consequently, ensuring a more just, healthy and sustainable future for all is easier said than done. Although questions about resilient and sustainable health systems have raised significant policy attention over the years, there are limited interventions to consider social and political determinants of health. 

Such a lack of progressive interventions is a frustrating scenario because it cannot adequately address social inclusion, equity and diversity in health care delivery. Indigenous practices and knowledge ecosystems in health care are often ignored in the world of biomedicine. With an interdisciplinary analysis, it is crucial to identify socio-political, cultural, economic and historical contexts that shape how health, people, and infrastructures are appropriated in support of pro-poor and inclusive health systems. From an anthropological perspective, culture plays an important role in how people experience health and illness, and how they access and experience health care. 

Unfortunately, health policies and plans most often do not take into account people’s choices and local perspectives in health care. Health infrastructure alone is not sufficient. Ensuring access to health care constitutes a diverse set of forces that underpin various forms of health care delivery, thereby appreciating historical, political, economic and cultural aspects of social groups in different contexts. So far, no cutting-edge research exists to further explore the structural barriers and struggles in accessing health care. Moreover, there is little evidence and clarity on how health care systems have evolved, and what futures they envision. Political horizons to ensure equitable health services are still messy. 

In light of contemporary political, economic, cultural and demographic transitions in the region, the political manifestos offer opportunities to take stock of how health inequalities are impacting on social vulnerabilities and community resilience in diverse ways. The discourses on culture and practices of inclusive health governance need to be debated and redefined in the changed socio-political context for seeking innovative solutions. Because health services largely remain fragmented, under-financed and over-burdened in the region. In this scenario, regional efforts to promote health equity clearly demand meaningful community engagement and collaboration beyond health sector.

Health in all policies is merely a popular political slogan as no concrete progress is achieved yet. Therefore, reorienting health systems towards primary health care must be a high priority agenda for actions. Across the region, child marriage, early pregnancy and human trafficking are significant social challenges causing different health risks. On the other hand, cross-border migration can have differential health threats spreading the diseases while people are on the move. Moreover, climate-induced disaster and health risks are not adequately addressed in national health policies, strategic plans and interventions. Therefore, regional cooperation strategy is instrumental in tackling diverse and yet challenging public health issues in a holistic approach.

Even though SAARC Tuberculosis and HIV/AIDS Centre (STAC) is playing a vital role in combatting TB and HIV, more collaborative efforts are needed in the area of capacity building among member states, strengthening multi-sector responses, advancing cross-border disease surveillance, sharing resources and good practices for evidence based strategic interventions. Such sharing among SAARC countries enhances trust, common understanding, and willingness for locally adapted solutions to emerging health challenges. 

Health diplomacy 

Other regional initiatives in the area of non-communicable diseases, nutrition-sensitive agriculture, antimicrobial resistance, air pollution, health security and few others need to be further strengthened in terms of political leadership, ownership, financing and accountability. In doing so, nurturing health diplomacy is crucial to address the shared health challenges in the face of the region’s geo-politics and transnational health issues.  

Given the region’s shared geography, transboundary health risks, and climate vulnerabilities, harvesting health demands political stability, common framework for increased investments in social protection, health security, pandemic preparedness and responses. Besides, a bold regional roadmap is urgently required to address structural inequalities in health care. Further, health diplomacy as a pathway can foster cooperation and collaboration for fulfilling international commitments and declarations in health. 

(Bhandari is a health policy analyst interested in anthropology.)