Overview of Health System Strengthening DLI HSS workshop Ann Lion August, 2011
Mar 27, 2015
Overview of Health System Strengthening
DLI HSS workshop
Ann LionAugust, 2011
Session Objectives
Understand the WHO Building Blocks as a foundation for health systems strengthening
Understand the difference between supporting and strengthening the health system
What is a Health System?
A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health.
WHO Health System Framework
Source: World Health Organization. Everybody’s Business: Strengthening health systems to improve health outcomes—WHO’s Framework for Action. Geneva: WHO, 2007, page 3.
1) Service Delivery
Good health services delivery…
Quality
Health workers paid, supervised, motivated
Drugs, supplies, andequipment in stock
Equitable and efficientfinancing
Rational planning, professional management based on data
Access
2) Health Workforce
A well performing health workforce consists of…
HR Management;
HR skills
HR policies
Adequate drugs and supplies for effective workforce
Financing to hire adequate staff in National budget
Data tracking of human resources
3) Health Information System
A well performing health information system
Ensures the production, analysis, dissemination and use of timely an reliable information
Photo: David Lubinski, HMN
Link use of data to resource allocation, measurement of health worker performance
Share data with community
National Health Financing information informing policy
4) Medical Products, Vaccines and Technologies
Procurement and supply programs need to ensure…Equitable access Assured qualityCost-effective use.
Pro-poor financing of essential products
Health workers trained in cost-effective prescribing practices
Local capacity to enforce regulations
5) Financing
A good health financing system… Raises adequate funds for health Protects people from financial
catastrophe Allocates resources and
purchases good and services in ways that improve quality, equity, and efficiency.
Payment systems to reward health worker distribution and retention
Use data to allocate resources
Pro-poor financing of essential products
6) Leadership and Governance
Effective leadership and governance ensures…strategic policy frameworks exist effective oversight and coalition-buildingprovision of appropriate incentivesattention to system-design, and accountability.
Accountability to patientsFinancing that empowers consumers
Regulation of health workers and medical products
Availability of accruate data for policy and advocacy
The 7th Building Block – People
Individuals, households, and communities as:
Civil society Consumers Patients Payers Producers of health through
knowledge, attitudes, behaviors, and practices
Graphic: Bob Emrey, USAID
When a patient is sick…
Treat patient’s symptoms?
Strengthen the patient’s health?
What is Health Systems Strengthening?
improving [the] six health system building blocks and managing their interactions in ways that achieve more equitable and sustained improvements across health services and health outcomes
Beyond a single disease Beyond a single building block - harness the
interactions between the building blocks Beyond the life of the intervention -
sustained improvements Country ownership
Support vs. Strengthening - Examples
Support Training
Net distribution
Immunizing babies
ART distribution
Strengthening Add technical content to
nursing school curricula Add nets to national
health budget and procurement plans
Add immunization and ART training to pre-service curricula, ensure available supplies
3. Obstacle: Weak governance
Disease/Service Specific Response
Health System Strengthening
• Short term training workshops and tools to plan and manage focal programs
• Parallel governance structures and information systems for focal services
•Community oversight of health facilities•Rational allocation of health funds based on need, not politics•Policymaker accountability to constituents
A way forward: Harness earmarked health funds to strengthen health systems to sustain results
0
1
2
3
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2004 2005 2006 2007
$US
Billi
ons
(200
8 Pr
ices
)
Infectious Diseases
Health Systems
Basic Health
Reproductive Health
The truth about health system strengthening
Not prescriptive Objective, evidence-based and
tailored to the country Indirect link between HSS and
health outcomes Attribution difficult Few photo ops
Donor coordination REALLY matters
Long-term process
Group Exercise – Systems Thinking
Scenario: US NGO distributes condoms at the community level.
Task: At your table, discuss whether this program supports
or strengthens the health system, and why. Propose ways the condom distribution activity can be
developed as a systems strengthening program You have 10 minutes
Report-out
Resources
WHO. 2007. Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes. http://www.who.int/healthsystems/strategy/everybodys_business.pdf
USAID. 2009. Sustaining Health Gains – Building Systems. http://pdf.usaid.gov/pdf_docs/PDACN511.pdf
2010. Implementation of the Global Health Initiative: Consultation Document. http://www.pepfar.gov/documents/organization/136504.pdf
Thank you
Reports related to this presentation are available at www.HS2020.org