Transcript Slide 1
Interactions between health systems and
Global Health Initiatives – what we learnt to
inform research methodology
Joseph Perriëns on behalf of
Badara Samb
Senior Adviser to Assistant Director-General
Team Leader, Global Health Initiatives
Health Systems and Services
World Health Organization
This talk
• Background on health systems
• Findings of "Positive Synergies"
– By "Building Block"
– Meaning for future research
A health system consist of all organisations, people and
actions whose primary intent is
to promote, restore or maintain health
The main goals are:
– Improving health and health equity
– Responsiveness, financial fairness
and efficiency
The intermediate goals are:
– Greater access and coverage
– Quality and safety
Sticking points:
Challenges to scale up services for HIV, TB, malaria, and
immunization
HIV/UA assessment
report
Global Plan to stop
TB
• Inadequate financing
• HR crisis
• Affordable commodities
• Stigma, discrimination…
• Accountability
• Partnership alignment
• Inadequate financing
• Laboratory capacity
• HR crisis
• Quality drugs
World Malaria
report
• Drug efficacy
• Information system
• Inadequate financing
• HRH and Community
services
• M&E
GAVI/Norad
report
• HR crisis
• Inadequate financing
• Leadership and
management
• Inter-agency
coordination
Government health spending per ca
capita
spending
Government health(low,
and upper middle in
middle
lower per
per capita
spending
middle income
upper
and
lower middle
ow,
countries)
Where
too look
income
d upper middle
countries)
health spending per capita
Government
ntries) 250(low, lower middle and upper middle income
countries)
200
250
200
150
150
100
100
50
50
0
0
2002
199920032000
199619991997
2005 2006
2004 2001
2001 2002
2000 1998
1997 1998
1995 1996 1995
2003
2006
2003
2002
2001
1999
96 1997 1998upper
income
low2005
income 2004
middle
lower
income
middle2000
Upper
Middle
Income
income
middle
lower
income
middle
upper
2006
2005
2003 2004
2002
00 2001
Lower
Middle
Income
low income
income
middle
lower
income
middle
upper
ower middle income
Lowincome
Income
low
Global progress on MDG 4
Global progress on MDG 5
Findings of "Positive Synergies"
- 14 new studies
- Over 250 studies and reports
Financing
– Association of GHIs with overall increases in
global resources for health
– No clear correlation between GHI resources and
domestic health budgets or reallocation of
resources
– GHIs have contributed to some improvements in
health aid-effectiveness, particularly in the area of
predictability of financing
– Indication that disease-specific funding may not
be well enough aligned
GAVI and Health Systems Strengthening
Global Fund and Health Systems Strengthening
Health workforce
– Some potentially
negative impacts on
already overstretched
human resources for
health
– Measures to strengthen
the health workforce
ongoing
– Measures more on inservice training for
disease-specific services,
and task shifting
Governance
– Evidence of early lack of
alignment
– More recent progress
– Enhanced community
participation
Health information
– Focus on coverage, and surveillance
for specific diseases
– Innovations in generation and use of
new information and communication
technologies
– Failure to invest in more rational,
robust, efficient and independent
common data architecture.
Supply management
– Improvements in
availability and
affordability of a number
of commodities
– Growth in the volume
of commodities not
matched by
improvements in the
management of
supplies
Service delivery
– Expanded access and uptake
of targeted services (caution:
attribution)
– Mixed evidence of expanded
access and uptake of non
targeted services
– Evidence on role of GHIs in
fostering equity and quality of
non targeted health services is
weak and mixed
Pre-natal visits and polio vaccinations , Haiti
Research considerations
GHIs and country health systems are dynamic,
complex entities.
» Studying their interactions defies oversimplistic, single variable, linear analysis
and raises caution with respect to
generalizations
» Implementation research should reflect this
complexity, and include both quantitative
and qualitative methods, from a variety of
disciplines such as health, anthropology,
systems engineering and economics, and
include the input of all important
stakeholders