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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