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Interactions between health systems and Global Health Initiatives – what we learnt to inform research methodology
Joseph Perriëns on behalf ofBadara Samb
Senior Adviser to Assistant Director-GeneralTeam Leader, Global Health Initiatives
Health Systems and ServicesWorld Health Organization
This talk
• Background on health systems• Findings of "Positive Synergies"
– By "Building Block"– Meaning for future research
The main goals are:
– Improving health and health equity– Responsiveness, financial fairness
and efficiency
The intermediate goals are:– Greater access and coverage– Quality and safety
A health system consist of all organisations, people and actions whose primary intent is
to promote, restore or maintain health
Sticking points:
Challenges to scale up services for HIV, TB, malaria, and immunization
HIV/UA assessment report
Global Plan to stop TB
World Malaria report
GAVI/Norad report
• Inadequate financing• HR crisis • Affordable commodities • Stigma, discrimination…• Accountability
• Partnership alignment • Inadequate financing • Laboratory capacity • HR crisis • Quality drugs
• Drug efficacy • Information system • Inadequate financing
• HRH and Community
services • M&E
• HR crisis • Inadequate financing • Leadership and
management • Inter-agency
coordination
Government health spending per capita(low, lower middle and upper middle income
countries)
0
50
100
150
200
250
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Government health spending per capita(low, lower middle and upper middle income
countries)
0
50
100
150
200
250
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
upper middle income lower middle income low income
Low Income
Lower Middle IncomeGovernment health spending per capita
(low, lower middle and upper middle income countries)
0
50
100
150
200
250
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
upper middle income lower middle income low income
Government health spending per capita(low, lower middle and upper middle income
countries)
0
50
100
150
200
250
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
upper middle income lower middle income low income
Upper Middle Income
Where too look
Global progress on MDG 4
Global progress on MDG 5
Findings of "Positive Synergies"
- 14 new studies
- Over 250 studies and reports
Financing
– Association of GHIs with overall increases in global resources for health
– No clear correlation between GHI resources and domestic health budgets or reallocation of resources
– GHIs have contributed to some improvements in health aid-effectiveness, particularly in the area of predictability of financing
– Indication that disease-specific funding may not be well enough aligned
GAVI and Health Systems Strengthening
Global Fund and Health Systems Strengthening
Health workforce
– Some potentially negative impacts on already overstretched human resources for health
– Measures to strengthen the health workforce ongoing
– Measures more on in-service training for disease-specific services, and task shifting
Governance
– Evidence of early lack of alignment
– More recent progress
– Enhanced community participation
Health information
– Focus on coverage, and surveillance for specific diseases
– Innovations in generation and use of new information and communication technologies
– Failure to invest in more rational, robust, efficient and independent common data architecture.
Supply management
– Improvements in availability and affordability of a number of commodities
– Growth in the volume of commodities not matched by improvements in the management of supplies
Service delivery
– Expanded access and uptake of targeted services (caution: attribution)
– Mixed evidence of expanded access and uptake of non targeted services
– Evidence on role of GHIs in fostering equity and quality of non targeted health services is weak and mixed
Pre-natal visits and polio vaccinations , Haiti
Research considerations
GHIs and country health systems are dynamic, complex entities.
» Studying their interactions defies over-simplistic, single variable, linear analysis and raises caution with respect to generalizations
» Implementation research should reflect this complexity, and include both quantitative and qualitative methods, from a variety of disciplines such as health, anthropology, systems engineering and economics, and include the input of all important stakeholders