1 / 9

What is d ifferent in d ifferent a pproaches to Health Systems Strengthening ?

What is d ifferent in d ifferent a pproaches to Health Systems Strengthening ? A brief review of concepts and semantics. George Shakarishvili Senior Advisor , Health Systems Strengthening The Global Fund to Fight AIDS, Tuberculosis and Malaria.

hammett-livingston
Download Presentation

What is d ifferent in d ifferent a pproaches to Health Systems Strengthening ?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Whatisdifferent in differentapproaches to HealthSystemsStrengthening? A briefreview of concepts and semantics George Shakarishvili Senior Advisor, HealthSystemsStrengthening The Global Fund to Fight AIDS, Tuberculosis and Malaria Global Health Council Satellite Session Health System Strengthening: What is Everyone Doing? June 13, 2011

  2. HSS: A high priority on the global health agenda MDGs: HSS is key for reaching the MDG health targets Evidence: Research on GHIs Political support: G8, H8, HLTF, and other high-level forums Increased demand and supply (2007-2010) World Bank: USD 2.5 billion GFATM: USD 1.7 billion GAVI Alliance: USD 0.8 billion

  3. A (false) vertical vs. horizontal dichotomy • 1940s-1950s: Disease eradication campaigns: cholera, smallpox, malaria • 1960s: Paradigm shift: system strengthening approach • (1969): “the most serious health needs can not be met by teams with spraying guns and vaccination syringes.” John Bryant, “Health and the Developing World” • 1970s -1980s: Primary health care • (1978): Alma-Ata Declaration • 1990s: Health financing reforms • (1993): “World Development Report: Investing in Health” • Early 2000s: Disease outbreak and GHIs • Global Fund, GAVI Alliance, Stop TB, UNAIDS, RBM, PEPFAR, PMI… • 2010s: Integration • (2009): Maximizing Positive Synergies between Health Systems and Global Health Initiatives

  4. HSS: overly explored, but vaguely defined? • An Illustrative List • of Health System Frameworks • - Actors framework (Evans, 1981) • - Fund flows framework (Hurst, 1991) • - Demand-supply framework (Cassels, 1995) • - Performance framework (WHO, 2000) • - Control knobs framework (Hsiao, 2003) • - Building blocks framework (WHO, 2007) • - Primarycare framework (WHO 2008) • - Systems framework (Atun, 2008) • “With the growth of interest in strengthening of health systems, the world now confronts a proliferation of models, strategies, and approaches.” • Lancet 2009, 373: 508–15 • “Health system strengthening, the new buzzwordin discussions about international health, is in danger of becoming a container conceptthat is used to label very different interventions.” • PLoSMedicine 2009, Vol6, Issue 4 • “There is lack of consensus onwhat health-system strengthening means, and consequently on how it should be done and evaluated.” • Lancet 2010,377: 1222-23. 6736(10)60679-4

  5. Do definitionsmatter? Health system strengthening Operational research, implementation research Quality of care Performance assessment

  6. HSS: A single definition or multiple dimensions? Programmatic • Interventions: inputs, processes, policies, etc. leading to • outputs, outcomes, and impact • Overarching principles: equity, efficiency, sustainability… • External factors: epidemiology, demography, polit-economy... • Systems thinking Conceptual Operational • Coordination • Harmonization • Alignment HealthSystemsStrengthening

  7. The Global Fund’s HSS portfolio: a means to an end • Health system goals: • Improving health outcomes (HIV, TB, malaria and also MNCH) • Reducing health-related financial risks • Increasing customer satisfaction

  8. Common weaknesses of HSS funding applications • Dissociation of HSS: lack of linkages between proposed HSS interventions and HS goals • Fragmented approach to HSS: strengthening specific “building blocks” vs. strengthening the system • Verticalization of HSS: HSS is viewed as a separate entity • Dis-balanced request for HSS support: over 75% of cross-cutting HSS support was requested for strengthening the service delivery function of the health system vs. 1% for strengthening health financing system • Lack of analytical foundation: addressing visible symptoms vs. underlying causes of poor health system performance (how vs. why)

  9. Access via common proposal form (GF/GAVI) Access via jointly assessed national health strategy (WB/GF/GAVI) Health systems fundingplatform(GAVI-GFATM-WB-WHO) “Existing financing” Harmonization of existing HSS support Harmonized grant/credit management “New financing” Opt 1 Opt 2

More Related