Health Systems: Speakout
Lola Dare
1. Is strengthening health systems a top priority to prevent and cure illness and extend life in developing countries?
"It is impossible to strengthen health systems within the uncoordinated investment environment that we currently have. Country-level action alone cannot resolve this problem, we need the synergy of country and global level action."
Lola Dare, Executive Secretary, African Council of Sustainable Health Development.
Yes! The evidence for the need to strengthen health systems is glaring, Assessments of prospects for achieving the health MDGs and other global disease targets all suggest that these goals will not be reached without investments in health systems. A resounding yes!
It is counter productive to conceive of health systems as a series of unconnected silos. There is a synergy across the different elements of health systems and we need to look at these elements holistically. That said, if pushed to identify priorities then I would say (i) physical infrastructure (ii) management and (iii) improved coordination between different actors in the health system are most important.
3. Are Global Health Initiatives such as GAVI, the Global Fund, Roll Back Malaria and Stop TB strengthening health systems (or undermining them)?
The Global Health Initiatives are undermining health systems. At country level particularly in Africa, Global Health Initiatives fragment our efforts, for example scarce management capacity is fragmented across multiple initiatives. Equally importantly they sap human resources and financial resources from the health system, undermining health care delivery. It is however, really promising that the Global Initiatives are now beginning to recognize such unintended negative impacts and are starting to invest in health systems.
4. How could an entity such as the Health Systems Action Network help to ensure a more coordinated approach to health systems strengthening?
It is impossible to strengthen health systems within the uncoordinated investment environment that we currently have. There is a lack of coordination within the health system and with other sectors such as education, finance, and public administration. There are too many donors and their efforts are fragmented - this has severe impacts at the facility level. In a recent study that we did, one health care facility had fifteen revolving funds (drugs, bednets etc). How can a facility manager, manage effectively under such conditions?
Country-level action alone cannot resolve this problem, we need the synergy of country and global level action. We need a Health Systems Action Network, with country roots and a global reach that can undertake advocacy and test innovations in coordination.