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

Exploring a diagonal approach

Integrating antiretroviral treatment into primary health care

Programmes aimed at fighting single diseases have helped many, but they have also weakened public health systems. This does not have to be the case. Individual disease programmes can help to develop the capacity of primary health care systems.

Search Terms:: casestudies; africa

Changing 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/AID; (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.”

Tracking health workers in Botswana

18 August 2011

In June 2011, Botswana's Ministry of Health began partnering with CapacityPlus to implement iHRIS Manage, a free, open source software (OSS) designed to maintain information on health worker deployment and attrition. CapacityPlus is a USAID-funded global project that focuses on strengthening human resources to achieve the Millennium Development Goals. The goal of the Botswana programme is to track all health workers in the country, what districts they work in, and what cadre they belong to, in order to ensure that the right provider is at the right place with the right skills.

Enhancing the development effectiveness of health systems funding

17 August 2011

Established in 2009, the Health Systems Funding Platform is one of the latest initiatives to improve coordination amongst the numerous external funding organizations working to support health care institutions in developing countries. It has advanced farthest in two countries, Ethiopia and Nepal, and is currently expanding to several others. A new Working Paper from the Center for Global Development analyses the role of the Platform as a case study of how to resolve tensions between the aid and development effectiveness agendas.

Resisting "vertical programming": The case of Lacor hospital in Northern Uganda

24 June 2011

nurses-training-gulu In Northern Uganda, a region that has been scarred by decades of conflict, there is only one doctor for every 25,000 persons. Before 2003, Lacor Mission Hospital in Gulu was among a handful of health care institutions serving an extremely vast area. The devastating conflict had also forced thousands of local residents - along with hospital staff - to seek shelter within the hospital compound. Dominique Corti, describes how the management struggled to offer a full range of health services at a time when almost all external support was earmarked to combating AIDS.

Case study: Strengthening district health systems in Karamoja

29 May 2011

Inside the district health system

In Karamoja in northern Uganda, many children do not live to see their fifth birthday. In an initiative to improve child survival, Doctors with Africa, Cuamm has formed a partnership with UNICEF to strengthen Karamoja’s district health systems.

Essential Readings

World Health Organization (2009) Maximizing Positive Synergies between Health Systems and Global Health Initiatives
World Health Organization (2010) Key components of a well functioning health system
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
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

Go to annotated bibliography

Related Blogs

Strengthening health systems: we can do better

May 27, 2011 - Heinz Greijn (Editor-in-Chief, Capacity.org)

Since the start of the millennium, annual development assistance for health has surged from US$10.5 billion to US$27 billion 2010. This has led to notable successes, such... read more »

August 19, 2011 8:51 AM - Wangu Mwangi:

In light of the continuing relevance of this topic, we have decided to keep this... read more »

July 4, 2011 6:00 PM - Dominique Corti:

We recognise the issues addressed in issue 42 of Capacity.org on strengthening health... read more »