Financing Common Goods for Health: Core Government Functions in Health Emergency and Disaster Risk Management

David H Peters,Odd Hanssen,Jose Gutierrez,Jonathan Abrahams,Tolbert Nyenswah

doi:10.1080/23288604.2019.1660104

Abstract

In the absence of good data on the costs and comparative benefits from investing in health emergency and disaster risk management (EDRM), governments have been reluctant to invest adequately in systems to reduce the risks and consequences of emergencies and disasters. Yet they spend heavily on their response. We describe a set of key functional areas for investment and action in health EDRM, and calculate the costs needed to establish and operate basic health EDRM services in low- and middle-income countries, focusing on management of epidemics and disasters from natural hazards.We find that health EDRM costs are affordable for most governments. They range from an additional 4.33 USD capital and 4.16 USD annual recurrent costs per capita in low-income countries to 1.35 USD capital to 1.41 USD recurrent costs in upper middle-income countries. These costs pale in comparison to the costs of not acting—the direct and indirect costs of epidemics and other emergencies from natural hazards are more than 20-fold higher.We also examine options for the institutional arrangements needed to design and implement health EDRM. We discuss the need for creating adaptive institutions, strengthening capacities of countries, communities and health systems for managing risks of emergencies, using “all-of-society” and “all-of-state institutions” approaches, and applying lessons about rules and regulations, behavioral norms, and organizational structures to better implement health EDRM. The economic and social value, and the feasibility of institutional options for implementing health EDRM systems should compel governments to invest in these common goods for health that strengthen national health security.

Highlights

The enormous costs of emergencies and disasters, including epidemics, are in the headlines every day
We focus on the costs to national governments to provide the core health emergency and disaster risk management (EDRM) functions for which the health sector has primary responsibility, we recognize that additional investments are needed in other EDRM components, related to all-hazards emergency preparedness and response and post-disaster recovery efforts
Once these functions are specified, we determine the costs involved in establishing the key health EDRM functions in low- and middle-income countries (LMICs).b We limit the scope to those functions that fulfil the conditions of common goods for health (CGH), including a demonstrated impact on human health with respect to managing the risks and consequences of emergencies and disasters and having direct involvement of the health sector in their financing

Summary

Introduction

The enormous costs of emergencies and disasters, including epidemics, are in the headlines every day Each year these devastating events affect millions of people through illness, injury, and death or by loss of home and livelihood. Human vulnerability, including poverty, health, and nutritional status, remain problematic, while inadequate levels of capacity in areas like prevention and preparedness to anticipate and respond to such events further threaten people’s health and wellbeing. These factors combine to create disasters and emergencies that stress communities and social institutions and undermine human economic growth, development, and security

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Discussion

Conclusion