Transcript Health Systems Strengthening

Overview of Health System Strengthening
DLI HSS workshop
Ann Lion
August, 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
 Access
Drugs, supplies, and
equipment in stock
Equitable and efficient
financing
Health workers paid,
supervised, motivated
Rational planning,
professional
management based on
data
2) Health Workforce
A well performing health
workforce consists of…
 HR Management;
 HR skills
 HR policies
Financing to hire adequate
staff in National budget
Adequate drugs and supplies
for effective workforce
Data tracking of human
resources
3) Health Information System
Link use of data to resource
A well performing health
allocation, measurement of
information system
health worker performance
 Ensures the production,
analysis, dissemination and Share data with community
use of timely an reliable
information
National Health
Financing information
informing policy
Photo: David Lubinski, HMN
4) Medical Products, Vaccines and
Technologies
Procurement and supply
programs need to
ensure…
 Equitable access
 Assured quality
 Cost-effective use.
Health workers trained in
cost-effective prescribing
practices
Pro-poor financing of
essential products
Local capacity to enforce
regulations
5) Financing
A good health financing system…
 Raises adequate funds for health
Payment systems to reward
 Protects people from financial
health worker distribution
catastrophe
and retention
 Allocates resources and
Pro-poor financing of
purchases good and services in
essential products
ways that improve quality, equity,
and efficiency.
Use data to allocate
resources
6) Leadership and Governance
Effective leadership and
governance ensures…
 strategic policy
frameworks exist
 effective oversight and
coalition-building
 provision of appropriate
incentives
 attention to system-design,
and accountability.
Availability of accruate data
for policy and advocacy
Regulation of health workers
and medical products
Accountability to patients
Financing that empowers
consumers
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 preservice curricula,
ensure available
supplies
3. Obstacle: Weak governance
Disease/Service
Specific Response
• Short term training workshops
and tools to plan and manage
focal programs
• Parallel governance structures
and information systems for focal
services
Health System
Strengthening
•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
6
$US Billions (2008 Prices)
5
4
Infectious Diseases
Health Systems
3
Basic Health
Reproductive Health
2
1
0
2004
2005
2006
2007
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_busin
ess.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