Global Health Capacities and Demands in Iran, West Asia and Eastern Mediterranean Region

The INPACT online kick-off meeting was held from November 18-19, 2020. At this international event hosted jointly by TUMS and University of Maastricht, some innovative approaches to the project various work packages were reviewed and discussed. The meeting shed light on the existing experience and paved the way for future intended steps on establishing a course on Global Health (GH) and a Center of Excellence (CoE) in Iran and the Region.

Hear from one of our distinguished speakers, Prof. Dr. Sameen Siddiqi from Aga Khan University, discussing global health capacities and demands in Iran, West Asia and Eastern Mediterranean Region as one of the very first steps toward developing a master of global health and a Center of Excellence in Iran and in the region.

Earlier, he worked for WHO as the Director, Health System Development in the Eastern Mediterranean Region and spearheaded work on universal health coverage. He has also served as WHO’s Representative to Lebanon and Iran.

He has worked for over two decades in health system development and has special interest its governance, quality and safety of care, private health sector and public private partnership. He has over 70 publications and is the reviewer of international journals. He is on the Advisory Group of the upcoming WHO’s Global Academy, Geneva.

We all know what Global Health (GH) is but it is sometimes good to remind that in the literature there are all these more academic kinds of explanations but also the one that I thought that, is coming from “Ilona” is that “what transcend national boundaries and governments and call for actions on the global forces that determine the health of people”.

So, I think there is certain elements of action that is important but there is also other ways of looking at GH so to my mind, there is no universally accepted perfect definition that covers every aspect; but, that’s s.th that we could discuss as we go along as how you would like to see this.

We all know the transition from MDGs to SDGs and I think at the discussion about the GH, the reason I brought it up, is that in any program that you develop I think it’s good to bring this discussion up front despite the fact that we are all confronted with COVID and to my mind the whole experience of COVID that we are facing globally is going to make a difference to the way that we look at SDGs in future but it is good to talk about SDGs in any GH program because a lot of work SDGs would be doing is relevant to GH.

There are not just health SDG which is SDG3 but there are these SDGs which are so important for health. The others are really the dominants of health in our part of the world or in any parts of the world for that matter but they could be much more pronounced so whether it is gender equality, or it is poverty or hunger or it is clean water sanitation. These are still unaddressed areas in our part of the world and so very much formed part of any discourse or discussion on GH. Therefore, I think it is good to keep that SDG thing on the agenda when you are actually in the process of developing the GH course.

Based on a recent systematic review we published in BMJ Global Health, on health-related SDGs implementation based on published data on 124 countries, and from a different perspective including national commitments, institutional set- ups, stakeholder engagement, we found that there were hardly any serious capacity development initiatives which address these issues and the one gap that I think is relevant to all of us whether you are in UK, or you are in Tehran  or you are sitting in Finland is capacity development. I believe the kinds of program that TUMS wants to develop should be grounded on these gaps that have been identified based on evidence.

We don’t need to convince each other why GH is increasingly important. The COVID-19 pandemic is a real example that we are living in a constantly changing world affecting all of our lives. International health regulations, NCD prevention and control, climate change and health, wars and conflicts, etc. are all instances of issues, which are extremely important, and we need to address through such a course by TUMS.

Some other examples of GH issues include a research by Stein and Sridhar in 2017 in which they demonstrated countries preparedness in exposure with pandemic risk and they showed that the world is unprepared in 2017 and I believe it is a global issue both for developed and less developed countries. The investment that we make in public health globally irrespectable whether we are, a poor or rich country has manifested in terms of how this epidemic or pandemic has actually affected all our countries and our parts of the world and so global approach is kind of a thing we should consider in this global discourse.

Let us take another local example from Pakistan. Many discussions are around climate change and air pollution. In the world, 3 billion people use bad quality fuels. In my part of the world, in Pakistan, almost 50% of the population consume solid fuels and in rural areas almost three forth of the population and of course, it has implications for local health. It is important to note that when designing such a course for the region, local health needs should not be overlooked at the cost of global health. Sometimes, I use the word “glocal” health because we do not want to be doing global health while in our countries the local health carries huge gaps.

A recent regionally initiative led by American University of Beirut is a Global Alliance on War, Conflict and Health. Many colleagues from many parts of the world are involved in this. The whole idea is to bring the whole discussion on wars. I mean we live in a region inflicted with war and conflicts. Various countries are suffering from conflicts. Examples include Afghanistan, Iraq, Syria, Yemen, Sudan, Somalia and Libya and just look at the amount of death, disease, disabilities, which is brought to this part of the world. Additionally, we should not forget about the neighborhood countries. War and conflict is not just affecting the countries but it also affects the neighboring countries like Iran and Pakistan. For instance, Iran has almost 3 million refugees or Pakistan 5 million refugees. Lebanon and Jordan has so million refugees. Thus, these are some major issues, which influence health and population health in these countries. So, it is global and is affecting health. Therefore, this would be a substantial part of a discourse on GH.

Additionally, what are those decision-making forums and organizations on GH? And of course this brings in the whole issue of GH governance. Any course or program on GH needs to know adopts in a very standard manner of the whole business of GH governance which you know brings in so many factors. So, there is of course the formal forums such as World Health Assembly and Executive Board of WHO and so on so forth, but then there are other forums where a lot of GH decisions are made not necessarily the formal forums. There are the donor countries who fund so much and I think lots of those decision makings come because of very much the influence of the amount of resources they put into these GH arena. Then, of course there are multilateral agencies such as World Bank and IMF and also we have Global Funds and Alliances. So, this is a kind of discussion that we need to have in this GH program but not to undermine the fact that even LMICs and the middle-income countries such as Thailand, Mexico and Brazil and Iran have a voice too. We have always felt then that these are the kind of gaps for many of our countries where we do not have necessarily in-depth understanding of these GH issues, we do not have the capacity to engage in GH dialogues and we do not have necessarily the kind of voice that we need to have in these forums where we can be heard from a LMIC or a low-income country perspective. That is very important; so, there is this fairness in the voice both from the North and the South that should be part of these kinds of programs that you are endeavoring to go ahead with.

Global health diplomacy is another area, which is quite important, and we should build those kind of skills in to how you engage, what is global health diplomacy, how do you engage in these kinds of things. This might be obvious but these are the kinds of things that should be an integral part of the GH program.

As an example of a GH institute, let’s take a look at Institute for Global Health and Development at AKU. Founded in 2019, we try to work and collaborate with AKU multi-campuses around six countries including Pakistan, Afghanistan, Kenya, Uganda, Tanzania, Tajikistan and United Kingdom. So, we try to build that link and have identified some target areas in the region to work on it like

• Climate change, environmental health and food Security
• Culture, gender issues and girls’ empowerment
• Integration of nutrition, health and human capital enhancement
• Precision public health linked to the data science initiative. Particularly that data science is a gap in our part of the world and we need to bring it into our discussions.
• Innovations and opportunities in emergencies and conflict

At the Institute, we are also committed to build strategic collaborations with the best universities and think tanks globally and regionally such as TUMS.

To finish off, when you are looking at options for GH initiatives by academic institutions you need to think of capacity developments and I would like to see it not only at the institutional level but also at the individual level. I am happy with your amazing job at TUMS to establish a GH CoE. We should notice that in our part of the world we suffer with recurrence institutions so we need to also strengthen our institutions to be able to do that, to train individuals through short term programs or blended programs that offer a formal qualification. To do so, we need to do a market assessment to see what is there and the needs and benefits and who would be interested in this program.

Of course, in addition as I said we need to provide advocacy by webinars and seminars and policy debates and dialogues. I would also say that do not forget the research part. Good research and evidence fits into a training program and I think that is some thing which we need to be doing more. The research should go hand in hand with academic and training program because one fits into the other.

We at AKU would be absolutely delighted to assist and partner in any initiative that addresses global health agendas in a fair and equitable manner. Thank you for inviting me