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.<<p>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.
World Health Organization Health Systems Web Portal
A good health system delivers quality services to all people, when and where they need them. The exact configuration of services varies from country to country, but in all cases requires a robust financing mechanism; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; well maintained facilities and logistics to deliver quality medicines and technologies. The WHO web portal provides access to a range of global reports and other resources related to health systems.
USAID Health Systems Strengthening Programme
The USAID Health Systems 20/20 is a global health project working to strengthen health systems in developing countries. Strong health systems are critical to the achievement of better health outcomes. Health Systems 20/20 uses an integrated approach to address the financing, governance, operational, and capacity constraints in a health system that impede access to and use of life-saving priority health services. The project's web portal provides access to a comprehensive manual on conducting country assessments and links to country assessments that have been carried out so far. A unique feature of the portal is a web-based tool that allows users to review country data and prepare an automated country profile as a first step to deciding whether a full assessment using the manual is needed.
This human resources for health dossier offers practical up to date information about how to address human resource problems and issues, drawing upon evidence about what works, and identifying innovations in approaches, policy and practice. The dossier includes a section on the most frequently discussed and examined areas of policy and practice in health human resource management including scaling-up production, nursing workforce, medical workforce and skill mix.
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