Beyond scaling up Bloom at the Global Symposium

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Beyond scaling up Bloom at the Global Symposium

  1. 1. Beyond Scaling Up Pathways to Universal Access to Health Services Gerald Bloom
  2. 2. The challenge of rapid scaling up • Political commitments to increases in access, increases in funding for health systems and creation of new global organisations • Path dependency and the management of change in a dynamic and complex context (emergence of complex health systems and shift from absolute scarcity to problems with safety, quality and cost) • Meeting the needs of the poor in contexts of changing patterns of inequality • Unexpected outcomes, unintended consequences and the need for systematic knowledge and shared understandings
  3. 3. Taking management systems to scale • Financial commitments and absorption capacity • Creation and rapid spread of effective arrangements in large public or private organisations • Embody learning in institutions and avoid reinventing the wheel • Simple-to-understand accountability arrangements • Difficulties in transferring institutional arrangements between contexts (risk of failure or of unintended consequences)
  4. 4. Spreading learning from pilots • The importance of political and management leadership • Building management capacity and management systems • Incentives and local institutions (formal and informal) • Local adaptations for local contexts • The importance of learning approaches
  5. 5. Public Sector Reform • Strategies for reform and revitalisation of the public sector (islands of excellence, strengthening accountability) • Can the health sector lead public sector reform (the need for a learning approach)?
  6. 6. Innovation systems for health • Emergence, diffusion and adaptation of innovations (technological and organisational) • Producers of innovation (R&D centres, local service providers, informal entrepreneurs) • Innovative organisations (local innovators, government agencies, social entrepreneurs, private companies) • level of organisational innovation (micro, macro and meso) • Geographical location of centres of innovation
  7. 7. Discontinuity, disruption and transition -1 • Sustaining and disruptive innovations • New niches for public and private providers of health-related goods and services - growth in demand for inexpensive and effective health care associated with economic growth, demographic change and spread of knowledge • Spread of the informal economy, emergence of problems with cost, quality and safety and the disruption of existing institutional arrangements for service delivery and distribution of pharmaceuticals
  8. 8. Discontinuity, disruption and transition -2 • Low cost information and communication technologies are creating new opportunities for spreading access to expert knowledge to providers and users of services and new regulatory challenges to prevent excessive influence by interest groups • Locality and disease-specific social responses to health- related problems • Construction of new types of partnership for safe, effective and affordable health services
  9. 9. Objectives of panel • To explore approaches that have fostered innovation, rapid learning and large scale impact in the health sector that incorporate context and social arrangements as central to learning and change • To identify practical approaches for collaboration between innovators, researchers, governments and funding agencies to strengthen the capacity of health systems to meet the needs of the poor
  10. 10. Objectives of panel • To explore approaches that have fostered innovation, rapid learning and large scale impact in the health sector that incorporate context and social arrangements as central to learning and change • To identify practical approaches for collaboration between innovators, researchers, governments and funding agencies to strengthen the capacity of health systems to meet the needs of the poor

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