Empowering clinical and public health leaders to strengthen small countries’ health systems

Francesca Caracci

As part of WHO’s ongoing support to small countries in building their health systems, a capacity-building event entitled “Strengthening governance in small-state health systems: the role of clinical and public health leaders” was organized in Valletta, Malta, on 10 May 2019 in collaboration with the Ministry for Health of Malta. The aim was to enhance the capacity of those attending to advocate for and contribute to strengthening health-system governance.

Small countries’ response to global challenges

Health systems globally are facing serious challenges related to rising demands associated with demographic change, increasing health inequalities and changing lifestyles.

Exposure to the impact of changing environmental factors in small countries often occurs more rapidly and is harsher than is the case in larger countries. Countries that succeed in dealing with such exposure tend to recognize its impact at an early stage and use the assets associated with being small to bring about a quick and complete transformation, thereby building resilience into their systems.

Capacity building to empower health leaders

The participants in the event explored the main challenges projected for the next 10 years and the role that clinical and health leaders in small countries could play in dealing with these challenges, and examined the data resulting from a survey carried out on health-system performance in Malta. They also identified ways of strengthening leadership and governance in line with WHO principles on achieving health equality in the context of the Sustainable Development Goals.

The participants included representatives of the WHO Collaborating Centre on Health Systems and Policies in Small States (University of Malta), the Mater Dei Hospital and the Ministry for Health of Malta, as well as the WHO Collaborating Centre on Health Policy, Governance and Leadership (Catholic University of Rome, Italy).

Malta - a model of health-system resilience for small countries

Literature and empirical evidence in Malta show that one of the hallmarks of success in building a resilient health system is the development of strong leadership and governance.

Within the health system in a small country, clinical and public health leaders have the added responsibility of having to work at all levels simultaneously. This, however, also provides a unique opportunity to shape and influence policy development.

The Ministry for Health of Malta has recently launched the development of the National Health Strategy 2020–2030, which promotes integration at all levels by:

  • building bridges within and beyond the health system;
  • equipping a multiprofessional health workforce;
  • empowering the next generation of health professionals;
  • increasing innovation;
  • exploiting digitalization and safe data links; and
  • enhancing equality and safeguarding sustainability

Clinical and public health leaders have an important role to play in jointly shaping and implementing this strategy to achieve health and well-being for all in Malta. Its process and methodology could serve as a model of good practice for other countries in the WHO European Region, especially small countries.