Building resilient health systems across the Commonwealth
Commonwealth Foundation November 22, 2015

KR Ravindran, President of Rotary International draws on the End Polio Campaign to explore how health systems can be made more resilient across the Commonwealth. 

The theme of this year’s People’s Forum focuses on resilience, and the question “What makes societies resilient?”

When we talk about resilience, we are talking about the capacity to withstand shocks: to survive them and to recover from them. Whether the shocks are economic, environmental, or social, a resilient society is one that has the resources in place to rebuild what is lost and continue moving forward. Government alone cannot create resilience: we must build it on the community level, through civil society actors, for it is on the community level that lives are lived, and the work of recovery must begin.

Rotary, the organisation I represent, is a key player in building such resilience. Rotary stands at the intersection of commerce and cause, at the crossroads of our private citizenship and our shared responsibility. We are both completely local, in our 34,000 clubs; and completely global, with 1.2 million members serving in virtually every country of the Commonwealth, and most of the countries of the world.

When the great tsunami hit my own country, Sri Lanka, in 2004, Rotary was able to respond in a way that no one else could do. We didn’t have to fly in staff, hire translators, or set up a local office. We simply identified the needs and organised ourselves to meet them.

There was a great need for drinkable water. The wells were contaminated all along the coast. Foreign NGOs flew in bottled water. We flew in sludge pumps, found jeeps and drivers, and put hundreds of wells back into use.

When the crisis was past, we built 25 new schools to replace the ones destroyed. The money came from Rotarians and partners abroad, and we at home did the work. Today, those schools serve more than 14,000 students, they are run by the Sri Lankan government, they receive no Rotary funding, and they are absolutely best in class.

This is how Rotary fosters resilience, locally, and on a national level. We also foster it globally, through our main corporate project: the eradication of polio.

Thirty years ago, we saw about 350,000 cases of polio worldwide every year. With polio, “cases” generally means “children”—children healthy one day, paralysed or dead the next. This was happening even though a vaccine existed that was safe, cheap, and easy to administer. Not only that, but the vaccine had the capacity to stop transmission of the disease: meaning that if enough children in a population were vaccinated, the disease would simply die out.

Yet no international body had taken this on. The wealthier countries vaccinated their own children, the poorer countries could not, and so it remained, until in the late 1980s, when Rotary made the commitment to step up to the challenge, and stop the disease.

The work Rotary began with that commitment is known today as The Global Polio Eradication Initiative. It is a partnership involving the WHO, the CDC, UNICEF, the Gates Foundation, and governments and health agencies throughout the Commonwealth, and across the world.

Together, we have vaccinated over 2.5 billion children.

As a result, the number of children paralysed by wild poliovirus this year stands at 56.

We have every reason to be optimistic that, with the continued strong support of Commonwealth nations, zero children will be paralysed in 2017. And it is incredibly important that we do reach zero. For only by reaching zero, and remaining at zero, can we stop routine immunisation against polio: releasing one billion dollars per year, back into local health systems.

But the legacy of polio eradication will go far beyond these cost savings, or the elimination of one disease. This effort has transformed the resilience of health systems around the world: by establishing capacity to address emerging needs.

This is something we have already seen very vividly, throughout the Ebola crisis last year. One of the most terrifying scenarios to be modeled was one in which the virus reached Nigeria, because Nigeria is a trade hub for all of Africa with a dense population, poor sanitation, and very high mobility. But when Ebola did reach Lagos, on a flight from Liberia, it spread no further—because of the resources that were already in place, to fight polio.

The emergency operations centers, the disease surveillance officers, the lines of communications between local and international health authorities, the capacity for real-time data analysis and modeling: all of this was ready and waiting, when it was needed most. Because this infrastructure was already in place, Ebola was stopped.

Today, we stand at a crossroads. It is with us to ensure that polio is fully eradicated, and that the resources developed along the way are fully and effectively transitioned. Neither of these goals will be reached without a conscious, deliberate effort, and the full engagement of governments and civil society.

How do we build resilient societies? We accept our shared responsibility, for our shared future. We capitalise on our investments, we learn from our experiences, and we finish what we start.


KR Ravindran spoke at the Commonwealth People’s Forum 2015 on Building resilient health systems for an ageing population