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Health systems
A health system comprises all public and private organizations, institutions and resources that are geared towards improving, maintaining or restoring health. There has been growing attention paid to the strengthening of entire health systems in recent years. This is driven, in part, by the need to undo some of the damage caused by a focus on donor-specified priorities in recent years - for instance HIV/AIDS and Tuberculosis, which has negatively impacted on other neglected diseases and even reversed gains from earlier investments in building a solid health infrastructure in developing countries.
The need for a more integrated approach to health issues was one of the key topics discussed at a high-level international forum on health research held in Mexico City in 2004. The summit called for strong national health systems as a pre-requisite for achieving the health-related Millennium Development Goals (MDGs).
According to the World Health Organization (WHO) development assistance for health increased from US$ 2.5 billion in 1990 to over US$ 13 billion in 2005. While this increase in funding was laudable, most of the funds were channelled through donor-driven programmes that targeted specific diseases to the detriment other diseases and different health priorities within countries. WHO estimates, for example, that the percentage of donor funding allocated to HIV/AIDS out of total funding for the health sector rose from 10 percent in the 1990s to approximately 30 percent today.This vertical top-down programming approach thus contributed to a skewed development of health systems. Of particular concern has been the drawing away of resources from critical elements of the health system associated with horizontal programming including preventive measures, primary care services, and health workforce development.
Despite widespread recognition of the magnitude of problems facing the health sector in developing countries, and a growing body of knowledge that suggests that linking services at the primary health care level contributes to higher-quality health services for the poor, there has been little progress in integrating vertical and horizontal programming at the national and sub-national level in most developing countries.By focusing on capacity strengthening for primary health care provision at the meso (sub-national) and local levels, this section aims to highlight some of the latest analysis on issues related to integration of vertical and horizontal programming and share practical tools and experiences on how to achieve greater synergies between donor-funded programmes, national planning and community initiatives on health.
Featured Article
Capacity development toolkit for health systems strengthening
This
UNDP-Global Fund Partnership toolkit provides practical advice, tools, templates and process
guidance covering five key steps in the transition from UNDP management towards full national
responsibility for implementing response programmes for HIV&AIDS, TB and Malaria.
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Recent Articles
Global fund announces new cooperation model to strengthen domestic accountability
11 January 2013
The Global Fund has launched a transition phase towards a new funding model that is set to become fully operational in 2014. According to the Fund ".... The new model will increase country focus and provide implementers with more flexible timing, better alignment with national strategies, greater predictability on the process and the level of funding available, early feedback on grant applications, and an ability to elicit full expressions of demand."
MoreBarefoot Guide 3: Mobilizing religious health assets for transformation
16 November 2012
Health, freedom and social justice cannot be
separated. In Africa, anything between 20-70% of public healthcare is delivered through religious
institutions or groups. The latest "Barefoot Guide" to organizational learning and social change
takes as its point of departure the notion that "Religious assets for health are everywhere, they
matter to a lot of people, and they can be mobilized for the health of all." Among topics covered
in the guide are: thinking differently about public health; working with and mobilizing religious
health assets; supporting the ‘leading causes of life’; understanding ‘healthworlds’ and the
strengths of ‘people who come together’; boundary leadership; thinking about systems; and ‘deep
accountability.’
Capacity development toolkit for health systems strengthening
09 November 2012
This
UNDP-Global Fund Partnership toolkit provides practical advice, tools, templates and process
guidance covering five key steps in the transition from UNDP management towards full national
responsibility for implementing response programmes for HIV&AIDS, TB and Malaria.
Towards universal health coverage in Cambodia
27 August 2012
There is widespread support in Cambodia for greater integration of demand-side health financing schemes for the poor and the informal sector to improve access to health care and reduce the burden of health expenditure. Operation of these schemes by government, donor bodies and various international and local non-government organisations has resulted in a fragmented system with high overhead costs, high monitoring and evaluation costs and complex reporting requirements. Institutional and operational barriers to strengthening universal coverage in Cambodia: options for policy development, a Working Paper published by the Nossal Institute for Global Health at the University of Melbourne, identifies institutional and health financing design barriers to establishing a national agency, as well as policy solutions.
MoreChanging minds: A guide to facilitated participatory planning
26 August 2011
This book draws on the work of thinkers and doers throughout the world who have grappled with
the challenge of planning complex institutions, especially health systems and development
projects. Their problem: Conventional planning methods often do not work. The solution:
Involve all the key stakeholders in making the plan. The challenge: Devise a planning system that
the principals and stakeholders can trust, and that is inclusive, balanced, and dynamic.
The Capacity Project: final report
18 August 2011
Human resources for health (HRH) first attracted global attention when it became evident that
the health workforce in the developing world was facing a crisis, and that this was affecting
health service delivery and health outcomes. The Joint Learning Initiative on Human Resources for
Health and Development (JLI), a consortium of more than 100 health leaders from around the world,
undertook an exploration of the HRH landscape during 2002-2004 and identified three major aspects
of an accelerating global HRH crisis: (i) the devastation of HIV/AIDS; (ii) an accelerated level of
out-migration of health professionals from developing countries; and (iii) chronic underinvestment
in human resources. The study concluded that “mobilization and strengthening of the health
workforce is central to combating health crises in some of the world’s poorest countries and for
building sustainable health systems.”
Other Topics
Essential Readings
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World Health Organization (2009) Maximizing Positive Synergies between Health Systems and Global Health Initiatives
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World Health Organization (2010) Key components of a well functioning health system
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Rifat A. Atun, Sara Bennett, Antonio Duran (2008) When do vertical programmes have a place in health systems?” World Health Organization/European Observatory on Health Systems and Policies
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Centre for Health, Science and Social Research and Wemos Amsterdam (2008) Human Resources for the Delivery of Health Services in Zambia: External Influences and Domestic Policies and Practices: A case study of four districts in Zambia
