Overview of Health System Strengthening DLI HSS workshop Ann Lion August, 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 Access Drugs, supplies, and equipment in stock Equitable and efficient financing Health workers paid, supervised, motivated Rational planning, professional management based on data

2) Health Workforce A well performing health workforce consists of… HR Management; HR skills HR policies Adequate drugs and supplies for effective workforce Data tracking of human resources Financing to hire adequate staff in National budget

3) Health Information System Link use of data to resource allocation, measurement of health worker performance A well performing health information system Ensures the production, analysis, dissemination and use of timely an reliable information Share data with community National Health Financing information informing policy Photo: David Lubinski, HMN

4) Medical Products, Vaccines and Technologies Procurement and supply programs need to ensure… Equitable access Assured quality Cost-effective use. Pro-poor financing of essential products Local capacity to enforce regulations Health workers trained in cost-effective prescribing practices

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 Pro-poor financing of essential products Use data to allocate resources

6) Leadership and Governance Effective leadership and governance ensures… strategic policy frameworks exist effective oversight and coalition-building provision of appropriate incentives attention to system-design, and accountability. Availability of accruate data for policy and advocacy Regulation of health workers and medical products Accountability to patients Financing that empowers consumers

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 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

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

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