Health Systems: Speakout
Anne Mills
1. Is strengthening health systems a top priority to prevent and cure illness and extend life in developing countries?
Most interventions rely on a service delivery infrastructure. The exceptions would include interventions that can be delivered through retail outlets without the need for a trained professional (eg insecticide treated nets), or through community based groups. If scaling up access to interventions is to be sustainable over the longer term, I feel that this dependence on an infrastructure must be confronted directly, in order that the infrastructure can be adequately strengthened. Setting a priority of strengthening health systems makes it clear that this is a pre-requisite for sustained health gains.
2. If yes, what do you think are the three most important elements of health systems that need to be strengthened to improve health outcomes?
- A progressive financing system, that ensure effective risk protection, especially for the poor
- Organizational structures that provide incentives for good performance
- Capacity at higher levels to plan and manage the health system
3. Are Global Health Initiatives such as GAVI, the Global Fund, Roll Back Malaria and Stop TB strengthening health systems (or undermining them)?
I don't feel I know enough about how these operate at country level to respond conclusively. However, the proliferation of different global initiatives clearly creates an enormous potential for them to be highly destructive of health systems, especially in countries with weak capacity and human resources, where each initiative will be competing for scarce staff time. It is easy for each initiative to say that they aim to strengthen health systems, but we lack the evidence that this is really happening. The onus should be placed on these initiatives to prove that they are supporting the health system, rather than weakening it.
4. How could an entity such as the Health Systems Action Network help to ensure a more coordinated approach to health systems strengthening?
I think that the health systems community still has to make a persuasive case for giving priority to health systems strengthening. It also has to make the case that there are successful strategies for health system strengthening. The Health Systems Action Network could help mobilize the health systems community to make a better case; it could also help advocate for increased attention to be paid to the need for research that can strengthen the evidence base on successful health systems strengthening approaches.