Utah Valley Global Health Group

A blog about global health for those living in Utah Valley and their friends.

Archive for July, 2007

Health Systems Development: An Introduction

Posted by chads on July 14, 2007

I am convinced that, ultimately, health systems will need to be strengthened before global health disparities are decreased long-term. Defining “health system” is a challenge. It is (relatively!) easy, on the other hand, to define, communicate, implement, and measure, for example, the treatment of AIDS, or the distribution of mosquito nets, or the eradication of polo through mass immunization campaigns. Those focused interventions in and of themselves, however, may not improve health. Indeed, it is possible that the opposite may happen. While mortality from specific diseases may decrease, the intervention may have unintended consequences. For example:

-Sudden increased funding in response to a particular disease (AIDS) can lead to health workers leaving established programs (child health) for the new programs.

-If eradication of specific diseases (small pox, polio) don’t lead to the improvement of local capacity to respond to new diseases (AIDS, SARS, Avian Influenza), then health will not likely improve long-term.

-Short-term funding for programs meant to further only political ambitions or humanitarian means are not likely to include evaluation and monitoring mechanisms that will allow local public health practitioners to learn to make necessary adjustments in programs.

In order for the health of people in developing countries to improve, I am convinced that the health system must be strengthened. What, then, is a health system?

It is the capacity of locals to respond effectively to their own health problems.

In the words of the WHO, a health system


is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health.

A CDC paper published in 1999 outlined four components of health systems:

  • health policy, regulatory and strategic planning functions; — definition and development of institutions/organizational arrangements;
  • mobilization and allocation of financial resources;
  • mobilization and allocation of human resources; and
  • management and delivery of health services.

What does all of this mean? That’s a complicated question that I hope to tease out in future posts and reading. For funders, it might mean providing long enough time, as well as provisions in the proposals to allow human capacity development. For researchers and universities, it might mean evaluating how interventions affect health systems. For humanitarian organizations and NGOs, it might mean always considering the impact that their interventions have on the health system – on the local workers, on the often fragile existing state-sponsored health programs, and on the ability to respond to future global health challenges. In short, I believe that everyone involved in global health should ask themselves the following question:

Does my involvement add to or take away from the current health programs, and what affect will my involvement have on their ability to respond to future health challenges?

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Book Review: Millions Saved

Posted by chads on July 12, 2007

There are few books that I would recommend everyone interested in global health have on their bookshelves. “Millions Saved: Proven Successes in Global Health” by Ruth Levine and the What Works Working Group is one such book.

You see, my experience in global health suggests that the main barrier to success in combating needless suffering and early death in developing countries lies not so much in identifying the need. It seems to me that most people recognize at least superficially the disparities in health globally. The main barrier lies in convincing funders that the cause is worth funding, and in reaching a consensus among those that implement global health programs. A first step in breaking those barriers is to identify prior successes and examine why they were successful. “Millions Saved” does just that.

Ruth Levine and her colleagues at the Center for Global Development have identified a series of 17 successful global health cases – interventions that have actually saved lives. From eradicating small pox world-wide to eliminating measles in Southern Africa, they give us a brief introduction to the scope of the problem, share how the intervention was implemented, and show how and why it was successful. They then share six common characteristics, lessons learned:

  1. Success is possible even in the poorest countries
  2. Governments in poor countries can do the job – and in some cases are the chief funders
  3. Technology, yes – but behavior change, too
  4. International coalitions have worked
  5. Attribution is possible
  6. Success comes in all shapes

The book is a short, easy read at about 150 pages. Each chapter explains a case, and both qualitative and quantitative aspects (with limitations) of the successes are discussed. There is currently a new edition out (I have not yet read it) which is being used in college courses.

“Millions Saved” answers critics, inspires idealists, and reminds those working in the often frustrating field of global health that a healthier world is, in fact, possible. I highly recommend this book.

Posted in Book Reviews, Evidence-based Global Health | 4 Comments »