Health Systems: Speakout
Ronald Waldman
1. Is strengthening health systems a top priority to prevent and cure illness and extend life in developing countries?
Yes, it is.
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?
Management, management, management. Specifically, I would say that health systems need to be more accommodating, in every way, to their clients. They need to encourage people to use the system and, in order to do so, they need to provide appropriate services of high quality at an affordable cost, preferably at no cost to the consumer. In short, they need to be accountable to the client.
3. Are Global Health Initiatives such as GAVI, the Global Fund, Roll Back Malaria and Stop TB strengthening health systems (or undermining them)?
For the most part they are undermining them. This is certainly the case for polio eradication. The idea that vertical programs could strengthen health systems is not laughable, though. It's really a question of going from lip service to objective, measurable indicators. A "health systems impact statement" should be de rigeur for all disease-specific global initiatives, and for local ones as well.
4. How could an entity such as the Health Systems Action Network help to ensure a more coordinated approach to health systems strengthening?
By forging consensus on a clear action plan that includes a step-wise approach to strengthening health systems, and a set of objective, measurable indicators that would inform as to when progress is being made. Disease outcomes should be part of the equation; health system strengthening may not always be the best way to bring about the most desirable results. Just as vertical programs should be accountable for system strengthening, so too should system strengtheners be accountable for reducing morbidity and mortality.