Transcript of "What is Different in Different Approaches to Health Systems Strengthening?: A Brief Review of Concepts and Semantics"
Whatisdifferent in differentapproaches<br />to HealthSystemsStrengthening? <br />A briefreview of concepts and semantics<br />George Shakarishvili<br />Senior Advisor, HealthSystemsStrengthening<br />The Global Fund to Fight AIDS, Tuberculosis and Malaria<br />Global Health Council Satellite Session<br />Health System Strengthening: What is Everyone Doing?<br />June 13, 2011<br />
HSS: A high priority on the global health agenda<br />MDGs: HSS is key for reaching the MDG health targets<br />Evidence:<br /> Research on GHIs<br />Political support: <br />G8, H8, HLTF, and other high-level forums <br />Increased demand and supply (2007-2010) <br />World Bank: USD 2.5 billion<br />GFATM: USD 1.7 billion<br />GAVI Alliance: USD 0.8 billion<br />
A (false) vertical vs. horizontal dichotomy<br />1940s-1950s: Disease eradication campaigns: cholera, smallpox, malaria<br />1960s: Paradigm shift: system strengthening approach<br />(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”<br />1970s -1980s: Primary health care<br /> (1978): Alma-Ata Declaration<br />1990s: Health financing reforms<br />(1993): “World Development Report: Investing in Health”<br />Early 2000s: Disease outbreak and GHIs <br />Global Fund, GAVI Alliance, Stop TB, UNAIDS, RBM, PEPFAR, PMI…<br />2010s: Integration<br /> (2009): Maximizing Positive Synergies between Health Systems and Global Health Initiatives<br />
HSS: overly explored, but vaguely defined?<br />An Illustrative List <br />of Health System Frameworks<br />- Actors framework (Evans, 1981)<br />- Fund flows framework (Hurst, 1991)<br />- Demand-supply framework (Cassels, 1995)<br />- Performance framework (WHO, 2000)<br />- Control knobs framework (Hsiao, 2003)<br />- Building blocks framework (WHO, 2007)<br />- Primarycare framework (WHO 2008)<br />- Systems framework (Atun, 2008)<br />“With the growth of interest in strengthening of health systems, the world now confronts a proliferation of models, strategies, and approaches.” <br />Lancet 2009, 373: 508–15<br />“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.” <br />PLoSMedicine 2009, Vol6, Issue 4 <br />“There is lack of consensus onwhat health-system strengthening means, and consequently on how it should be done and evaluated.” <br />Lancet 2010,377: 1222-23. 6736(10)60679-4<br />
Do definitionsmatter?<br /><ul><li>Health system strengthening
Performance assessment</li></li></ul><li> HSS: A single definition or multiple dimensions?<br /><ul><li>Interventions: inputs, processes, policies, etc. leading to</li></ul> outputs, outcomes, and impact<br />Programmatic<br /><ul><li>Overarching principles: equity, efficiency, sustainability…
Increasing customer satisfaction</li></li></ul><li>Common weaknesses of HSS funding applications<br />Dissociation of HSS: lack of linkages between proposed HSS interventions and HS goals<br />Fragmented approach to HSS: strengthening specific “building blocks” vs. strengthening the system <br />Verticalization of HSS: HSS is viewed as a separate entity<br />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<br />Lack of analytical foundation: addressing visible symptoms vs. underlying causes of poor health system performance (how vs. why)<br />
Access via common<br /> proposal form (GF/GAVI)<br />Access via jointly assessed national health strategy (WB/GF/GAVI)<br /> “Existing<br />financing”<br />Harmonization of existing HSS support<br />Health systems fundingplatform(GAVI-GFATM-WB-WHO)<br />Harmonized grant/credit management<br />“New<br /> financing”<br />Opt 1<br />Opt 2<br />
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