1. 21 July 2005 UNDG Policy Network On the MDGs UNDG Policy Network on the MDGs

2. 21 July 2005 UNDG Policy Network On the MDGs Why and How scaling up health systems Strategies By Dr. Paolo Piva UNDG Policy Network on the MDGs

3. 21 July 2005 UNDG Policy Network On the MDGs Why health systems? Strong health systems are not an end in itself A means to achieve better health outcomes An absolute requirement for achieving the MDG Universal access to broad based HS could meet –60-70 % of child mortality –70-80% of the maternal mortality –HIV/AIDS pandemic Essential –To spend well increase aid for health –To sustain health gains in the future Learning Event

4. 21 July 2005 UNDG Policy Network On the MDGs Learning Event Why Human Resources for health? Health workers are dying They are leaving public service Health workers live below the poverty line; Migrating from rural to urban areas Migrating to countries that rewards them better Shortage of health staff is a serious constraint –To scaling up –To respond to HIV/AIDS – TB –Achieve health MDGs

5. 21 July 2005 UNDG Policy Network On the MDGs Learning Event

6. 21 July 2005 UNDG Policy Network On the MDGs Learning Event Human Resources Challenges Improve pay and supplements, Incentives for those working in poorer areas Upgrade the skill-mix of health workers To strengthen essential emergency and surgical skills and knowledge of PHC Better partnerships with private providers, NGOs and community partners

7. 21 July 2005 UNDG Policy Network On the MDGs Learning Event How to scale up Increase the number of health service providers –Increased volume of services –different providers better suited for different groups –Competition Increase the capacity of existing health providers –By increasing human resources –Financial (drugs, supplies, equipment etc.)

8. 21 July 2005 UNDG Policy Network On the MDGs Learning Event Factors affecting the performance of health systems Amount of resources invested in the health system - minimum threshold level of resources necessary for an essential package The way the health systems are designed and organized –Health systems perform better with the contribution of all players –Roles and functions clearly defined - stewardship, financing and service provision –Capability to manage structural and operational transitions, –Capability to resolve problem –Sustain motivation to enhance efficiency and improve performance

9. 21 July 2005 UNDG Policy Network On the MDGs Learning Event Selected Innovative Strategies 1/2 Contracting: NGOs, private sector providers - focus on service delivery Performance-related pay and incentives: –improving workforce performance –benchmarks to determine the level of pay and incentives to be provided Subsidies for the poor: –user fee exemptions –risk pooling –vouchers Decentralization: changing authority to the district/local level, –priority setting, resource allocation and other key decisions –capacity building for decentralization Hospital autonomy: de-linking hospitals from central control

10. 21 July 2005 UNDG Policy Network On the MDGs Learning Event Selected Innovative Strategies 2/2 Reorganizing outreach workers - change –Use of home-based and health post workers, –Their professional requirements or volunteer status Accreditation of institutions providing services, –Means of setting, monitoring and enforcing standards Social marketing: influence health behavior - use of health products –Condoms, bednets, ORS, essential drugs, or contraceptives Community engagement, –Communities involved in HS oversight, planning or operations –Voice to community concerns, –Hold providers accountable for their performance