Health Systems: Speakout
Hernán Rosenberg
1. Is strengthening health systems a top priority to prevent and cure illness and extend life in developing countries?
Yes in the declaratory sense: it definitely should be! Everybody is aware of the need to have strong systems in order to improve health conditions, however several factors push in the opposite direction:
- Short-term perspectives: health systems are difficult and expensive to improve and do not provide the quick impact of “vertical” interventions such as vaccination campaigns or improved sanitary systems.
- Isolation of the sector: the health sector is poorly equipped to deal with ministries of planning and finance, who control access to resources. Furthermore we have not successfully argued the value of health as a right and an investment.
- Fragmentation and segmentation: health authorities in most developing countries have not yet found an effective way to coordinate and manage the plethora of providers, insurers and mechanisms that work with different segments of the population.
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 better mix of health workers including competencies in planning, investment, negotiation, and other aspects of economic endeavors
- Opening barriers between different segments of the sector to facilitate coordination and a more efficient provision of services. At a minimum health authorities need to be able to dialogue with public, private and Social Security sub-sectors
- Increase (or in many cases establish) a dialogue with civil society to make sure that we shift from a supply to a demand driven system in which the users have a bigger say
3. Are Global Health Initiatives (GHIs) such as GAVI, the Global Fund, Roll Back Malaria and Stop TB strengthening health systems (or undermining them)?
Although they could help reinforce systems, the GHIs tend to undermine them because they create islands of prosperity in the middle of oceans of poverty. As mentioned because system-oriented approaches do not have quick impacts on health indicators there is a big temptation to bypass systems to reach users quickly, rather than try to fix the system. This approach does indeed improve indicators in the short run, but eventually the systems fail to catch up and sustain the efforts, resulting in a waste of resources.
4. How could an entity such as the Health Systems Action Network help to ensure a more coordinated approach to health systems strengthening?
- By improving coordination and integration of all health sector partners, and dialogue across sectors
- By facilitating research and analysis of experiences, and identifying which lessons are most applicable under what circumstances
- By training health personnel in planning and financial dialogue
- By identifying experiences and expertise that can be shared between countries
- By mobilizing resources to undertake the above tasks