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IAPB 9 th General Assembly Eye Health: Everyone’s Business Hyderabad, India September 17-20, 2012. Scaling up: Perspectives for VISION 2020. Prof. Don de Savigny Health Systems Research Department of Epidemiology and Public Health [email protected]. - PowerPoint PPT Presentation
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IAPB 9th General AssemblyEye Health: Everyone’s BusinessHyderabad, IndiaSeptember 17-20, 2012
Scaling up:
Perspectives for VISION 2020
Prof. Don de SavignyHealth Systems ResearchDepartment of Epidemiology and Public [email protected]
“VISION 2020: The Right to Sight aim to eliminate avoidable blindness by 2020…. will not be achieved by
eye care services acting in isolation.”
Karl Blanchet. Indian Journal of Ophthalmology 60: (2012)
“More authorities are becoming aware that campaigns for the control of diseases will have only temporary effects if they are not followed by the establishment of permanent health services to deal with day-to-day work in the control and prevention of disease and the promotion of health.”
Annual Report of the Director-General, WHO
Brock Chisholm
1951
Increasing fragmentation in Global Health
Many Global Health Alliances, Partnerships, Consortia, and Initiatives
Mobilizing substantial resources
Most with a single disease or single intervention focus
Huge potential to support or weaken fragile health systems
No obvious Global Health architecture or leadership
Vision 2020 strategy
cost effective disease control interventions; human resource development; and infrastructure development
Guiding principles (ISSE):
Integrated into existing health care systems
Sustainable in terms of money and other resources
Equitable care and services available to all
Excellence – a high standard of care throughout
Objectives:
increase awareness identify and secure the necessary resources facilitate national programmes
This requires a deliberate convergence of disease-specific programme managers with health system developers.
Not so easy….
Ooms et al. BMC Globalization and health (2008)
The problem of verticality & the difficulty of integration
Scaling up: a definition
‘‘The ambition or process of expanding the effective coverage of health interventions
through programmes, services or systems’’
Scaling up: Not just multiplication
Pilot Projects
National Programmes
Sustainable integration in health systems
Where we usually stop;
Where indicators stagnate and targets become elusive …
New way of thinking required
Scaling up assumptions Linear, pre-planned process;
Simplistic, deterministic;
Standardized methods for predicting human and financial resources;
What works in small scale and specific contexts will easily replicate elsewhere
Real world system behaviour Non-linear, not predictable, not
controllable;
Highly heterogeneous actors and contexts;
Complex dynamics with unexpected feedback loops, delays and unintended consequences
Systems integration of Vision 2020 programmes: some perspectives
Governance structure, leadership, policy dialogue, network analysis, stakeholder
engagement, & ownership
Going beyond programme “M&E” to routine information flows
In national strategic plans, NHA and MTEF with
performance management
Comprehensive, patient centered, effective coverage across a continuum of care
Recognize and respond to local contexts and emergent behaviours
Standards of care from inter-
professional teams
Quantification, procurement and supply
chains that work
Work at interfaces: E.g. Relate disease burden
information to financing
Understand dynamic health system relationships &
demand
India’s intervention targetable burden
in Shares of total DALYs
Success factors in scaling up…
strong leadership and governance with active stakeholder network analysis, management and ownership
choosing simple integrated packages widely agreed to be valuable,
active engagement of a range of implementers and of the target community,
flexibility in tailoring the scale-up approach to local contexts, and
incorporating research before and along with implementation.
Scaling up is not predictable or controlled Use theories of change to develop local organizational, functional & political
capacities; Identify constraints & complex pathways Learn by doing Apply systems thinking ………..
Lessons for integrating in systems
(Modified from Yamey. PLoSMed 2011)
Paradigm shift?:Why engage with systems, and why now…
“Systems Thinking” is the language, and
“Systems Science” is the discipline for such a shift.
Approaching 2020 will benefit from increasingly sophisticated approaches to tipping points in complex adaptive health systems.
Vertical funding is often necessary at the beginning, but as health systems develop, separate mini-health systems for each disease and problem is wasteful and inefficient.
Thank you