Global Health
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Health Systems Interventions The Basics In recent years, the global community has achieved an unprecedented level of dedication to and investment in global public health; concurrently, the topic of health systems has gained a much larger profile. Defined by the World Health Organization (WHO) as “all the activities whose primary purpose is to promote, restore, or maintain health,” health systems strengthening aims to improve health by responding to people’s needs and expectations, and by providing services in a fair and equitable manner.1 ◗
Fragile health systems have impeded the progress of disease-specific initiatives, such as those for HIV/AIDS, underscoring the idea that improved health infrastructure is critical for the effective control of many diseases.2
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More broadly, well-functioning health systems are recognized as a prerequisite to achieving the Millennium Development Goals by 2015. Leaders at the Group of 8 industrialized countries have called for increasing the capacity of weak health systems, particularly those in sub-Saharan Africa.
Interventions The WHO and the World Bank, among other institutions, have elucidated the different elements of health systems – Leadership and Governance, Financing, Health Workforce, Health Information Systems, Service Delivery and Medical Products and Technologies – which serve to provide a spectrum of needed services, universal access to those services, and universal coverage of all health care benefits.
Selected Interventions for Health Systems by Building Block Leadership & Governance*2 - Impose regulations on standards of care or medicines; - Develop a plan for health systems with supportive policies and laws with monitoring and evaluation mechanisms.3 - Ensure that managers have the necessary training and skills for the job; hold accountable for successes or failures. - Leaders should ensure that the Ministry of Finance releases money in time for health systems to pay salaries, bills and purchase necessary pharmaceuticals; Financing* - Developing risk-pooling insurance schemes, such as community-based health financing. - Develop payment and other incentives for providers, e.g. reimburse private facilities for care for the poorest citizens. Health Workforce* - Develop a plan for human resources; standardize job descriptions, ensure that job duties are clear to employees. - Train workers properly on basic medical and nursing skills; assess knowledge, review performance. - Create incentives to retain workers and grant certifications that aren’t easily transferable to other countries. - Train nurses, midwives to provide services normally provided by doctors, e.g. caesarean sections, to save more lives. Health Information Systems* - Track information and analyze data to implement effective interventions and measure outcomes. - Link patient databases of records to all departments to avoid duplication; keep information up-to-date and accessible. - Effective public communications to mitigate local epidemics, e.g. AIDS and pandemic avian influenza. Medical Products & Technologies* - Policies and guidelines appropriate to populations served their resources and health infrastructure. - Ensure that supplies of blood, antibiotics, diagnostics, gloves, and other necessary commodities are always in stock. Service Delivery* - Mass drug administration campaigns; social-marketing methods or free government provision of goods. - Training and equipping village health teams to provide home-based care where no facilities exist. *Please see companion brief Understanding Health Systems for definitions of elements of health systems
Linkages to Broader Development Goals A health system encompasses more than just the health care system – income, infrastructure, clean water, education, and environmental sustainability also play a role.3 Some health system interventions extend beyond the scope of the health sector; e.g., building or repairing roads and improving transportation methods so that people can travel to hospitals. ◗
Leadership and Governance. Form coalitions in local governments comprised of representatives from health, agricultural and other development sectors that can enforce government accountability to it’s people.2. Create crosssectoral public policies for development by starting with communities.4.
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Financing. Coordinate financing of health with other development issues. Fifty countries have begun to implement National Health Accounts, which manage all public expenditures on health and development.
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Service Delivery. Implement clean water and sanitation, environmental safety and health-related education programs, e.g. collaborate with schools to improve access to health and education jointly.4 Emphasize the importance of building capacity for local ownership of service delivery in communities.5
Research Needs Select Research Needs for Health Systems by Building Block - On a national level, develop health priorities to guide investment and research. - At the hospital and clinic levels, examine successful interventions for management and leadership. - Conduct long-term tests of the financial sustainability of interventions. 4, 6 - Research ways to provide medical coverage for those who cannot pay out of pocket.7, 8 - Test ways to provide accurate, reliable health information in a sustainable manner. - Research how information systems and technology investments will facilitate the management of information in all aspects of the health system and will improve the capacity for surveillance. - Train researchers across all health areas to build local capacity for research, teaching and training. - Research the impact of task shifting skills of doctors to lower-level workers on quality of care.9 - Research to develop effective forecasting and distribution systems for drugs and other commodities to avoid stock-outs and shortages of essential medicines.10 - Research to identify and disseminate findings about affordable, safe and effective interventions that are widely available and to make access to health care more equitable. Service Delivery - Engage communities in the design of delivery mechanisms and measure results.6
Leadership & Governance Financing Health Care Health Information Systems Health Workforce Medical Products/Tech.
A Call to Action The Global Health Council supports comprehensive prevention, care and treatment policies that are evidence-based and locally appropriate. The Council supports strategic investments in health systems, including research that identifies clear and measurable outcomes, effective interventions and the impact of disease-specific initiatives and achievement of the MDGs. The Council also calls for the United States, developing country governments and other public and private donors to continue their leadership role in strengthening health systems.
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World Health Organization. 2000. The world health report 2000: health systems: improving performance. Geneva: World Health Organization. Available from: http://www.who.int/whr/2000/en/index.html Mills A, et al. Strengthening health systems. In: Jamison D, et al, editors. Disease Control Priorities. 2nd ed, 2006. World Bank. 2007. What is a health system? The World Bank Strategy for HNP Results. Available from: http://www.worldbank.org/ Holveck JC. 2007. Prevention, control, and elimination of neglected diseases in the Americas. BMC Public Health 7(6). Global Health Council. Using research to meet the needs of health systems and communities. Research Symposium at the 35th annual international health conference. May 28, 2008. Omni Shoreham Hotel. Akogun O, et al. 2001. Community-directed treatment of onchocerciasis with ivermectin in Takum, Nigeria. Trop Med & Intl Health 6(3):232-43. Global Health Council. Follow-up interview with Dr. Ahbay Bang. July 18, 2008. (accessed October 6, 2008), Available from: http://groups.google.com/group/ghc-research-symposium?hl=en&lnk=srg Ooms G, et al. 2006. Do we need a world health insurance to realise the right to health? PLoS Med 3(12):2171-6. Huicho L, Scherpbier RW, Nkowane AM, Victora CG, the Multi-Country Evaluation of IMCI Study Group. 2008. How much does quality of child care vary between health workers of different durations of training? An observational multi-country study. Lancet 372:910-6. Miralles M, Brock T. 2008. The pillbox: where does pharmaceutical management fit into the health system? Presentation at USAID Global Health Mini University. September 12, 2008. George Washington University.
Updated September 2008