Health Systems Strengthening

RECOMMENDATIONS FOR CONGRESS

Encourage the U.S. Agency for International Development (USAID), the State Department, and the Department of Health and Human Services, including the Centers for Disease Control and Prevention, to:

• DevelopacomprehensiveHSSstrategythatidentifies

andadvancesmeasurableobjectivesforallsixWorld

HealthOrganization(WHO)BuildingBlocks(seebelow)

andincludesspecificsupportforfrontlinehealthworkers

andcommunity-basedhealthservicedeliveryandaccess.

EachagencyimplementingU.S.globalhealthprograms

shouldidentifyanHSSleadaspartofthestrategy.

• DevelopandregularlyupdateHSStechnicalguidanceto

helpinformtheworkofcountry-basedU.S.government

teams.Relevantagenciesshouldprovidesubstantive

guidancetotheirfieldstaffthatincludespracticaladvice

onhowtodesign,implement,andassessHSSprograms.

• Defineandapplyclearmetricstoassesstheimpact

ofU.S.investmentsinHSS.Inearly2013,U.S.agencies

begantheprocessofdeterminingindicatorstomeasure

theimpactofitsHSSefforts.Monitoringandmanaging

progressareessentialforensuringprogramsare

achievingdesiredresults.

• Investinglobalhealthresearchandprofessional

trainingforstudentsfromdevelopingcountriestobuild

asustainablehealthworkforcecapableofeffectively

addressingpopulationneedsandrespondingtopublic

healththreats(seebriefonFrontlineHealthWorkers).

WHAT YOU SHOULD KNOW

The goal of health systems strengthening (HSS) is to improve health outcomes, save lives, and make investments in health more efficient.

Health systems consist of all the institutions, resources, and people whose primary purpose is to improve health.Theseincludehospitals,clinics,healthworkers,pharmacies,financing

andpharmaceuticals,informationandcommunicationssystems,

andpoliciesandbusinesspractices.

HSS refers to activities that improve a health system’s efficiency, quality, access, and effectiveness and lead to better health outcomes for everyone regardlessofethnicity;gender;religion;income;oranyothereconomic,political,orsocialstatus.

Weak health systems make it difficult for people to receive proper or sufficient care, especially among those who need it most (i.e.,women,children,theruralpoor,themarginalized

The Collective Voice of the Global Health Community

andstigmatized,andreligiousandethnicminorities).These

weaknessesarefarmoreacuteinfragilestatesandareasof

conflict.

Functioning public and private health systems are essential to the success of disease-specific health initiatives and to meeting the U.S. global health goals ofendingpreventablechildandmaternaldeaths,ensuringglobalhealthsecurity,andachievingan

AIDS-freegeneration.Strengtheninghealthsystemsensuresthat

U.S.investmentsinglobalhealtharesustainable.

Strong health and community systems are key to preventing and responding to epidemics, new diseases, or unexpected events,suchastheZikaepidemicinLatinAmerica,theEbola

epidemicinWestAfrica,ornaturaldisasters.

Ensure funds are allocated to health systems strengthening in all future global health-related legislation toensurethatcapacityisbuiltwithinacountry’ssystemandthroughotherprovidersofhealthservices,suchasfaith-basedinstitutionsandcommunity-

basedorganizations,tomaximizeefficienciesintacklingdiseasesandhealthissues.Futureprogrammingshouldemphasizetechnical

cooperationandcountryownershipinhealthsystemsoveralongtimeperiod.

Local communities, including faith communities, should be integrated into the U.S. government approach to HSS. Communityinvolvementandparticipationarekeyingredients

towell-functioninghealthsystems.TheU.S.governmentshould

activelyincludelocalcommunitiesindecidingthedirectionof

itshealth-improvingactivitiesandthedeliveryofhealthservices,

particularlythroughsocialaccountabilitymechanisms.

The U.S. government should work with nongovernmental organizations (NGOs), faith-based organizations (FBOs), and others who implement HSS assistance programs to find the most effective means for optimizing its partnerships. TheU.S.governmentshouldtakeadvantageoftheHSSknowledge

thatalreadyexistsintheNGO,FBO,anddonorcommunityand

incorporatethatexpertiseintoitsHSSprogramming.

IntegratedHealthProjectintheDRCCredit:WarrenZelman

Citations1. “WHO Health Systems Framework,” The World Health Organization. http://bit.ly/2hpzvoe.

2. Tracking Universal Health Coverage: First Global Monitoring Report, World Health Organization and the World Bank, 2015. http://bit.ly/2hAxdR2.

3. Global strategy on human resources for health: Workforce 2030, World Health Organization, 2016. http://bit.ly/1PQqoCG.

4. Working for health and growth: investing in the health workforce. High-Level Commission on Health Employment and Economic Growth, United Nations, 2016. http://bit.ly/2cPWjLr.

The WHO defines six “Building Blocks” that are essential to strong health systems:1

Resources WHOHealthSystemsFrameworkhttp://bit.ly/2hpzvoe

Contributers Vince Blaser,IntraHealthInternational,vblaser@intrahealth.org

Marielle Hart,InternationalHIV/AIDSAlliance,mhart@stopsaidsalliance.org

Filmona Haliemichael, ManagementSciencesforHealth

WHY THIS INVESTMENT IS IMPORTANT

Thesebuildingblocksrepresentthestructuresandresources

neededtoprovideefficientandeffectivehealthservicesto

ensurehealthyoutcomes.Yet,manycountrieshavesevere

inequitiesinaccesstohealthservices;2facecriticalhealth

workforceshortages;3andsufferfromweakinformationsystems,

irregularsupplychains,inefficientuseofresources,andweak

governanceandaccountabilitymechanisms.Thesevulnerabilities

posefinancial,political,andhealthrisksnotjusttodeveloping

countries,butalsotothewholeworld.

Ultimately,healthsystemsstrengtheningisabouthelping

countriesimprovehealthandsavethelivesofalltheircitizens,

includingthemostmarginalizedandvulnerable.Dueto

improvedbiomedicaltechnologies,increaseduseofinformation

technologies,andsustainedpublicandprivateinvestments,

significanteffortshavebeenmadetostrengthenhealthsystems.

Asaresult,deathsduetopreventablecauseshavedecreased,

equitableaccesstoqualityhealthcarehasimproved,and

populationsarehealthierandmorestable.

SERVICE DELIVERY

ACCESS TO ESSENTIAL PRODUCTS

HUMAN RESOURCES

FINANCING

HEALTH INFORMATION SYSTEMS

LEADERSHIP & GOVERNANCE(medicines,vaccines,etc.)

HSSiskeyastheU.S.governmentcontinuestopromotecountry

ownershipandsustainability.USAIDiscommittedtoHSSand

seesitasacentralgoalofallU.S.globalhealthprogramming.

USAID’sOfficeofHealthSystemsleadstheagency’swork

onHSS,ensuringaccesstosafeandgoodqualitymedicines;

strengtheningcapacitytodetectandcontaininfectiousdisease

threats;trainingandequippingafrontlinehealthworkforce

todeliveressentialserviceswheretheyareneededmost;and

strengtheningfinancialmanagementsystems.

HSSisevenmoreimportantinthecurrentU.S.fiscalclimate;

everydollarinvestedinglobalhealthmustaddsustainablevalue

anddemonstrateprogresstowardachievingpriorityhealth

outcomes.Newevidenceshowsinvestmentsinhealthsystems

alsohavemultipliereffectsthatenhanceinclusiveeconomic

growth.4Stronghealthsystemsareimperativeformaximizing

theimpactofU.S.globalhealthinvestments.

IntegratedHealthProjectintheDRCCredit:WarrenZelmanIntegratedHealthProjectintheDRCCredit:WarrenZelman