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
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?