Investing in Health Systems Strengthening- Taking Stock of the Evolving Global Landscape
George Shakarishvili, Bob Emrey, and Rifat Atun
Health systems strengthening (HSS) has long been one of the major areas of international health practice and a multi-billion annual investment in low- and middle-income countries resourced by local means and international donors. During the last decade important developments took place in the conceptual, policy, and programmatic approaches to HSS, alongside substantial changes in the global health funding architecture, which have influenced both—theoretical interpretation and practical implementation of HSS at the country and global levels. These developments provide a timely opportunity to take stock and analyze evolving landscape of international HSS support in order to better inform further advancements in the field, and particularly to maximize the impact of investments. This commentary briefly explores important dynamics in the global HSS setting, which occurred during the last 5-7 years, and are essential for considering by international health community while setting the future HSS agenda and investment frameworks.
This is a nice concise report on health system strengthening (HSS). But your analysis like most health development programs looks only at a top down approach. To truly make HSS work on the ground where diseases need treatment while prevention and public health programs ramp up, we must consider the bottom up approach as well, that is the end point of a health system, the patient. Where this bottom up approach occurs, in a village clinic, a district hospital or a referral hospital does not matter. What matters is a health system must deliver education and treatment interventions to patients and their families and data or feedback to the sector on how it is doing. To withhold endpoint treatment while putting in place the administration of a health system is akin to withholding ART for HIV/AIDS patients or surgery for a young adult suffering from a perforated appendix. Creating a hybrid approach toward health system strengthening where development aid focuses on top down management, finance and administrative issues while bottom up measures keep the country’s population healthy and happy make sense. Combined with a commitment to listening to what developing country health providers tell us they need, the next 5-7 years of health system strengthening might be more successful than the first 5-7 years.