A country’s healthcare system must always be built with the aim of maximizing its benefits during times of uncertainty. After all, diseases and pandemics emerge unexpectedly, populations age and social and economic conditions constantly change. However, in recent years, uncertainty has intensified. The COVID-19 pandemic, climate change, economic crises and rapid technological transformation have exposed weaknesses in health systems worldwide. These uncertainties challenge governments, communities and healthcare providers to rethink how health services are designed, delivered and governed.
In such times, healthcare must be resilient, inclusive and innovative. Keeping this in mind, digital health and artificial intelligence (AI) are being promoted as solutions to manage health emergencies. However, as health technology rises, it also brings new risks of inequality and ethical concerns. At the same time, community-based interventions and grassroots initiatives continue to play a crucial role in reaching marginalized populations. Hence, to ensure the smooth operation of healthcare in times of uncertainty, there must be the right balance of technology, equity, governance and community engagement.
Uncertainty as a Defining Feature of Global Healthcare
Uncertainty in healthcare arises from multiple global challenges. Pandemics, such as COVID-19, have shown how quickly health systems can be overwhelmed. Further, factors such as recent climate change have contributed to heat stress, a spike in vector-borne diseases, malnutrition and displacement, all of which collectively affect health outcomes. Adding to that, due to growing wars across the world, economic instability has reduced public spending on health, while conflicts and migration have been disrupting healthcare delivery.
As per a 2024 World Bank report, nearly 2 billion people globally face severe financial crisis in accessing health services, highlighting the fragility of healthcare systems and how such financial uncertainty often prevents people from seeking timely care and increases the risk of preventable deaths.
Global health outcomes also remain uneven. For instance, maternal mortality continues to be a major health concern in low-income countries, with about 260,000 women dying from pregnancy-related causes in 2023, according to a report. Such statistics reveal that uncertainty disproportionately affects women, children, and vulnerable populations.
In addition, health systems also face an increasing uncertainty in financing and workforce availability. The World Bank anticipates a global shortage of around 10 million healthcare workers by 2030, which could severely impact service delivery, calling for systemic reforms and long-term investments.
Global Health Spending and Inequality
According to the World Health Organization database, which has been tracking country-by-country health expenditure since 2000 to help policymakers understand how much countries spend on health, who pays for it and how resources are distributed, spending levels vary widely. High-income countries spend significantly more per capita on healthcare than low-income countries, leading to stark differences in life expectancy and health outcomes. Many low-income countries rely heavily on out-of-pocket payments, which increases households’ financial uncertainty.
Hence, the World Bank has set a goal to expand access to affordable healthcare for 1.5 billion people by 2030, recognizing the need to reduce financial barriers and strengthen health systems. This highlights the global commitment to addressing uncertainty through systemic investment and reform.
Digital Health and AI: Managing Uncertainty through Innovation
Digital health technologies and AI are increasingly viewed as tools to manage several of these uncertainties and inequalities in healthcare. AI can analyze large datasets to detect diseases early, predict outbreaks and personalize treatment plans. Telemedicine can connect patients in remote areas to specialists, reducing geographic barriers.
The World Economic Forum argues that AI can help healthcare systems become more sustainable and equitable by improving efficiency and reducing administrative burdens. These tools can also help health systems anticipate crises and allocate resources effectively.
In uncertain times, predictive analytics and digital surveillance systems can help governments respond quickly to outbreaks. AI-driven models can forecast disease trends, optimise supply chains and improve clinical decision-making. Digital platforms can empower patients with health information and enable remote consultations.
However, technological innovation also introduces new uncertainties. Data privacy, algorithmic bias and unequal access to digital tools can undermine trust and exacerbate inequalities. Therefore, digital health must be governed by strong ethical frameworks and inclusive policies.
Equity Challenges in Technology-Driven Healthcare
While digital health promises efficiency, it also risks increasing the gap between those with and without access to technology. Many rural communities lack reliable internet, smartphones or digital literacy. Elderly populations may struggle to use digital platforms, while marginalized communities may distrust technology or lack representation in health data.
AI systems trained on data from high-income countries may not perform accurately in low-income settings. For example, algorithms developed using Western populations may misdiagnose diseases in other ethnic groups. Such biases can lead to misallocation of resources and unequal treatment outcomes.
In countries like India, social determinants such as caste, gender and income strongly influence access to healthcare. Women often face barriers in accessing reproductive health services. Migrants and informal workers may lack health insurance and rely on out-of-pocket payments. Therefore, technology alone cannot solve healthcare inequities.
Community-based Healthcare
In uncertain times, community-based interventions are most effective for reaching marginalized populations. In India, Smile Foundation provides a strong example of how grassroots initiatives can strengthen healthcare delivery.
Smile Foundation’s Swabhiman programme focuses on maternal and child health, nutrition and behavioural change. In 2024, the programme reached over 190,000 women across six states, sensitized 76,000 women on reproductive and child health and provided healthcare to 72,000 women and children. These interventions aim to improve awareness, access to services and health behaviours at the community level.
The organization also conducts health camps, immunization drives and counselling sessions for pregnant and lactating women. In one reporting period, Smile Foundation ensured 104 safe institutional deliveries and immunised 460 infants, demonstrating its role in improving maternal and child health outcomes.
Further, our mobile healthcare initiative, Smile on Wheels, provides free medical consultations, diagnostics and medicines in underserved areas. Mobile units help bridge the gap between remote communities and healthcare services, especially during crises when access is limited. Such community-based approaches reduce uncertainty by bringing healthcare closer to people, building trust and addressing local health needs. They complement formal health systems and provide resilience during emergencies.
Governance, Ethics and Trust
Trust is a cornerstone of healthcare systems, especially during uncertain times. People must trust health authorities, medical professionals and technologies to follow health guidance and seek care. Misinformation and a lack of transparency often erode trust and worsen health outcomes. Hence, frameworks must be put in place to curb misinformation through social media, while governance frameworks are necessary to regulate digital health and AI. Policies must ensure data privacy, algorithmic transparency and accountability. Ethical oversight is required to prevent misuse of health data and discriminatory practices.
Community participation is also critical. When communities are involved in designing health programmes, they are more likely to trust and use them. NGOs, local leaders and civil society organizations play an important role in bridging the gap between policymakers and communities.
Training Healthcare Workers for Resilient Health Systems
Healthcare workers sit at the heart of every health system, especially in times of crisis. Pandemics, climate disasters and humanitarian emergencies place immense physical and emotional strain on doctors, nurses and frontline staff. Burnout, stress and workforce shortages weaken health systems just when they need strength the most. To manage uncertainty effectively, countries must invest in training, recruiting and retaining healthcare workers who can adapt to rapidly changing conditions.
Training today must go beyond clinical skills. Healthcare workers increasingly need support in using digital health and AI-enabled tools to reduce administrative burdens, improve diagnosis and support decision-making. However, technology should complement care, not replace it. Skills such as empathy, clear communication and cultural sensitivity remain essential, particularly when working with vulnerable populations during crises.
Community health workers play a critical role in strengthening system resilience. In India, ASHAs serve as trusted links between health systems and rural communities, ensuring continuity of care even when formal services are stretched. At Smile, our programmes train local volunteers and community leaders to promote health awareness, maternal care and behaviour change. By building skills within communities, such efforts reduce pressure on overstretched facilities and make healthcare delivery more resilient.
A well-trained workforce also supports the sustainability of health systems. When healthcare workers understand local needs, use data effectively and engage communities, systems are better equipped to maintain essential services during disruptions. Partnerships between governments, NGOs and the private sector further strengthen this capacity. Through collaborations that deliver mobile clinics, nutrition programmes and maternal health services, we help extend care to underserved populations while reinforcing local health infrastructure.
Ultimately, resilient and sustainable health systems depend on people. Training healthcare workers to adapt, communicate and collaborate across sectors ensures that systems can respond to crises without losing sight of equity and quality of care. Investing in the workforce is a long-term strategy for building health systems that endure.
