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

2. Session Objectives
Understand the WHO Building Blocks as a foundation for health systems strengthening
Understand the difference between supporting and strengthening the health system

3. 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.

4. 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.

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. When a patient is sick…
Treat patient’s symptoms?
Strengthen the patient’s health?

13. 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

14. 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

15. 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

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

17. 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

18. 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

19. Resources
WHO Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes.
USAID Sustaining Health Gains – Building Systems.
2010. Implementation of the Global Health Initiative: Consultation Document.

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