Interactions between health systems and Global Health Initiatives: a WHO/Italy collaborative effortCarissa EtienneAssistant Director-GeneralHealth Systems and ServicesWorld Health Organization
The context: Global progress on MDG 4
The context: Global progress on MDG 5
The context: Global progress on ART
The diagnostic: the challenges to scale up services for HIV, TB, malaria, and immunizationHIV/UA assessment report Global Plan to stop TBWorld Malaria report GAVI/Norad report Inadequate financing HR crisis Affordable commodities Stigma, discrimination Accountability Partnership alignment Inadequate financing Laboratory capacity HR crisis Quality drugs Drug efficacy Information system Inadequate financing HRH and Community services M&E HR crisis Inadequate financing Leadership and management Inter-agency coordination
The challenge: How do many consider health systems?An eminent economist a riddle, wrapped in a mystery, inside an enigmaquoting Churchill
An eminent Health Systems expert- Black hole- Black box- Shopping list
An initial answer: WHO defines health systems The main goals are:Improving health and health equityResponsiveness, financial fairness and efficiency
The intermediate goals are:Greater access and coverageQuality and safety A health system consist of all organisations, people and actions whose primary intent is to promote, restore or maintain health
The inevitable debate
Disease specific programmes vs. health systems
but the wrong question
What fuels the debate: Government Health spending per capita
What fuels the debate: Total annual resources available for AIDS 1986 - 2005
The reality check: Life Expectancy vs. Spending
The reality check: Health outcomes and health spending
deprived suburb YEARS But money is not all: Life expectancy in Glasgow, UK WHR, 2006100 5482affluent suburb
The right questionHow can global health initiatives and country health systems optimize their interactions to achieve their common goal of improving health outcomes?
In other words: we need to look at the big picture
The good signals: GAVI and Health Systems Strengthening
The good signals: Global Fund and Health Systems Strengthening
The good signals: PEPFAR and Health Systems Strengthening
Normative work and wide implementation of Task ShiftingCommitment to produce 140,000 health care workers in PEPFAR2Importance of broad health systens strenthening in PEPFAR 2
Make the slide nicer -- Add here a PEPFAR photo or logo (Francesca)
TimeTimeTime
The big challenge 1: not to miss the opportunity
The big challenge 2: do it right
The process: a broad multi-stakeholder collaborationAcademiaCivil SocietyImplementers and GHIs
Make the slide nice and add a photo (Francesca)
The products: a broad multi-stakeholder collaborationAn academic in a peer-review journalA case libraryA set of recommendationsA declaration
Findings Known sources
- 14 new studies - Over 250 studies and reports- 22 country case studies
Two emerging points
- GHIs and country health systems are not independent - GHIs and country health systems are dynamic, complex entities
studying their interactions defies over-simplistic, single variable, linear analysis and raises caution with respect to generalizations.
Findings: service delivery Expanded access and uptake of targeted services (caution: attribution)
Expanded access and uptake of non targeted services
Evidence on role of GHIs or health systems on equity and quality of health services is weak and mixed
Polio vaccination, Haiti
Chart1
17311887
24013120
275717072
Pre-GHI
Post-GHI
Sheet1
LCSt.MarcHinche4th Qtr
Pre-GHI1731240275720.4
Post-GHI1887131201707231.6
North45.946.94543.9
Prenatal visits, Rwanda
Chart1
11881303
13292490
14144065
17073714
Pre-GHI
Post-GHI
Sheet1
KabarondoMulindiRukaraRusumo
Pre-GHI1188132914141707
Post-GHI1303249040653714
Findings: finance 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
Government spending on HIV
Findings: governance Evidence of early lack of alignment
More recent progress
Enhanced community participation
Findings: health workforce Some potentially negative impacts on already overstretched human resources for health
Measures to strengthen the health workforce ongoing
Measures more on in-service training for disease-specific services, and task shifting
Findings: 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.
Findings: 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
The recommendations Be Bold Set targetsEnhance leadership Engage communities Improve evidence
Thank you
**55% of people live in urban areas but 75% of doctors, 60% of nurses and 58% of other health workers live in urban areas
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