Health Systems Strengthening (HSS) has caught the world’s attention and is attracting lots of resources and interest. What is GAVI’s support for HSS?

(Frank Nyonator (FN)) The GAVI HSS funds are to address the “bottlenecks” or barriers in the health system that make it difficult to improve the provision of and demand for immunisation and other child and maternal health services. The GAVI Alliance Board approved an initial US $500 million for HSS between 2006 and 2010. These funds will contribute to the GAVI Alliance’s current efforts to reduce child mortality (Millennium Development Goal 4) and maternal mortality (Millennium Development Goal 5) rates.

Which countries can apply for HSS funds? What are these countries using these funds for and what have been the effects so far?

(FN) All GAVI-eligible countries can apply for HSS funds. Several countries in attendance have already started implementing GAVI HSS program. In the majority of these countries, HSS has had a catalytic effect. For instance, in Ethiopia, other donors are now supporting one of previously underfunded areas addressed in the HSS proposal: health centre infrastructure. In another example, Burundi has used its HSS proposal as a tool to align other donors around a package of services provided at the district level.

What are some key advantages and disadvantages of using disease-specific funding to strengthen the overall health system in countries?

(LeeNah Hsu (LNH)) The key advantages of using disease-specific funding to support health systems strengthening in developing countries is the availability of source of funding through such global health initiatives such as GAVI, GFATM, Roll back malaria, etc. The resources provide focus and depth in dealing with specific health system related issues encountered in responding to these specific diseases. It is also identifiable and accountability could be pin-pointed to specific disease services within a country’s health system.

The key disadvantages of relying on disease-specific funding support to strengthen the overall health system of a country is evident in that the effect will depend very much on the capacity of a specific disease program in a country’s health system. The improved resources for a particular disease program often rob the other disease programs that did not have global funding support of their capable human resources (internal brain-drain within the health sector). Shifting resources and emphasis to specific diseases may set-back further the already resource-poor program responses of these other diseases. The results-based financing encourages strengthening vertical response approaches for specific diseases at the expense of other diseases coordination. In some countries the available disease specific funding further imbalances the overall health system and increase inequity among people living with other diseases.

What are some non-health sectors’ contributions to health system strengthening? How can these potential partnerships be taken into account in appraising health systems strengthening support by global health initiatives?

(LNH) There is a limit to the disease specific focus responses. This is because a specific disease response would also require collaboration with other disease services. For example, effective HIV responses require effective control of TB, responsive management of mental illness, attention to the spread of Hepatitis B and C, among other diseases. Unfortunately, beyond TB, the coordination with other health services in HIV responses have not been adequately considered in global health initiatives supporting HIV specific health systems strengthening. This is within health system’s cross-disease service system collaboration and strengthening. Going beyond the health system, the penitentiary TB service system, which are often under the Ministry of Justice, are often inadequately coordinated or strengthened to ensure effective national TB responses by the Ministry of Health.

When one considers the entire system for health, it is necessary to take into account both the public and private charitable sectors. However, in addition, to ensure the smooth functioning of a health system, other sectors’ contributions are vital. For example, the function and maintenance of the road and transport systems and infrastructure, the education system, the telecommunication system, the legal system of a country to support the rights of access by its people to health services and to the protection of the people’s health through assurance of the quality and minimum standard of delivery of health services, and the legal framework for civil societies are all important in effective disease specific responses.

On the other hand, the capacity of other sectors and systems has implications for the effectiveness of disease specific responses. This has been amply demonstrated by SARS and Highly Pathogenic Avian Influenza. The role of agriculture, transport, commerce and trade are critical and must be coordinated for effective response and protection of people’s health.

The relevance of partnerships with these key sectors has not been adequately addressed in many disease-specific proposals from developing countries for health systems strengthening. A health system does not function in isolation from other systems in a country. It is relevant for global health initiatives in their support to health systems strengthening to address and acknowledge the relevant linkages with the other sectors and systems.