Overview of Health System Strengthening DLI HSS workshop Ann Lion August, 2011

Overview of Health System Strengthening

DLI HSS workshop

Ann LionAugust, 2011

Session Objectives

Understand the WHO Building Blocks as a foundation for health systems strengthening

Understand the difference between supporting and strengthening the health system

What is a Health System?

A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health.

WHO Health System Framework

Source: World Health Organization. Everybody’s Business: Strengthening health systems to improve health outcomes—WHO’s Framework for Action. Geneva: WHO, 2007, page 3.

1) Service Delivery

Good health services delivery…

Quality

Health workers paid, supervised, motivated

Drugs, supplies, andequipment in stock

Equitable and efficientfinancing

Rational planning, professional management based on data

Access

2) Health Workforce

A well performing health workforce consists of…

HR Management;

HR skills

HR policies

Adequate drugs and supplies for effective workforce

Financing to hire adequate staff in National budget

Data tracking of human resources

3) Health Information System

A well performing health information system

Ensures the production, analysis, dissemination and use of timely an reliable information

Photo: David Lubinski, HMN

Link use of data to resource allocation, measurement of health worker performance

Share data with community

National Health Financing information informing policy

4) Medical Products, Vaccines and Technologies

Procurement and supply programs need to ensure…Equitable access Assured qualityCost-effective use.

Pro-poor financing of essential products

Health workers trained in cost-effective prescribing practices

Local capacity to enforce regulations

5) Financing

A good health financing system… Raises adequate funds for health Protects people from financial

catastrophe Allocates resources and

purchases good and services in ways that improve quality, equity, and efficiency.

Payment systems to reward health worker distribution and retention

Use data to allocate resources

Pro-poor financing of essential products

6) Leadership and Governance

Effective leadership and governance ensures…strategic policy frameworks exist effective oversight and coalition-buildingprovision of appropriate incentivesattention to system-design, and accountability.

Accountability to patientsFinancing that empowers consumers

Regulation of health workers and medical products

Availability of accruate data for policy and advocacy

The 7th Building Block – People

Individuals, households, and communities as:

Civil society Consumers Patients Payers Producers of health through

knowledge, attitudes, behaviors, and practices

Graphic: Bob Emrey, USAID

When a patient is sick…

Treat patient’s symptoms?

Strengthen the patient’s health?

What is Health Systems Strengthening?

improving [the] six health system building blocks and managing their interactions in ways that achieve more equitable and sustained improvements across health services and health outcomes

Beyond a single disease Beyond a single building block - harness the

interactions between the building blocks Beyond the life of the intervention -

sustained improvements Country ownership

Support vs. Strengthening - Examples

Support Training

Net distribution

Immunizing babies

ART distribution

Strengthening Add technical content to

nursing school curricula Add nets to national

health budget and procurement plans

Add immunization and ART training to pre-service curricula, ensure available supplies

3. Obstacle: Weak governance

Disease/Service Specific Response

Health System Strengthening

• Short term training workshops and tools to plan and manage focal programs

• Parallel governance structures and information systems for focal services

•Community oversight of health facilities•Rational allocation of health funds based on need, not politics•Policymaker accountability to constituents

A way forward: Harness earmarked health funds to strengthen health systems to sustain results

0

1

2

3

4

5

6

2004 2005 2006 2007

$US

Billi

ons

(200

8 Pr

ices

)

Infectious Diseases

Health Systems

Basic Health

Reproductive Health

The truth about health system strengthening

Not prescriptive Objective, evidence-based and

tailored to the country Indirect link between HSS and

health outcomes Attribution difficult Few photo ops

Donor coordination REALLY matters

Long-term process

Group Exercise – Systems Thinking

Scenario: US NGO distributes condoms at the community level.

Task: At your table, discuss whether this program supports

or strengthens the health system, and why. Propose ways the condom distribution activity can be

developed as a systems strengthening program You have 10 minutes

Report-out

Resources

WHO. 2007. Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes. http://www.who.int/healthsystems/strategy/everybodys_business.pdf

USAID. 2009. Sustaining Health Gains – Building Systems. http://pdf.usaid.gov/pdf_docs/PDACN511.pdf

2010. Implementation of the Global Health Initiative: Consultation Document. http://www.pepfar.gov/documents/organization/136504.pdf

Thank you

Reports related to this presentation are available at www.HS2020.org