Health Systems Strengthening
What is Health Systems Strengthening?
Well-functioning
health systems deliver the quality health care people need, when they
need it, where they need it, and at prices they can afford.
Strengthening health systems, however, is challenging given their
complexity.
As
this definition implies, health systems encompass many subsystems, such
as human resources, information systems, health finance, and health
governance, all of which can be weakened by different types of
constraints. For instance, health care may cost too much, causing people
to delay seeking care or forgo it altogether. A country’s health budget
may not cover all its population’s health needs, especially services
for tuberculosis, HIV/AIDS, malaria, maternal and child health,
reproductive health, and other priority issues. As a result, a country’s
health outcomes may suffer.
To
strengthen health systems and expand access to priority health
services, USAID has supported a variety of global and bilateral health
systems strengthening projects since 1989. They include Health Systems
20/20 and now the Health Finance and Governance (HFG) Project. HFG is
designed to fundamentally strengthen health systems, with a focus on
improving the health financing and governance functions, so the systems
more efficiently and equitably deliver the life-saving health services
that people, especially children, women, and poor and vulnerable
populations, need.
We
will not be successful in our efforts to end deaths from AIDS, malaria
and tuberculosis unless we do more to improve the health systems around
the world.
President Barack Obama, 2009
The
HFG team views health systems strengthening as a nonlinear process that
demands holistic systems thinking rather than a traditional, vertical
approach. The holistic approach pays attention to how individual
components of the overall system and subsystems interact and affect one
another. Working simultaneously on multiple components of the system,
such as governance and financing, yields greater impact than addressing
an individual constraint. Effective interventions should target
constraints that will have maximum benefit across multiple health
programs.
Put another way, supporting the
health system refers to any activity that improves services, from
upgrading facilities and equipment to distributing mosquito nets. In
contrast, strengthening the
health system requires more comprehensive changes to policies and
regulations, financing mechanisms, organizational structures, and
relationships across the entire system. Both supporting and
strengthening efforts are important and necessary, and the balance
between them should be driven by a country’s context and priorities.
Above all, country ownership is essential to building a health system’s
sustainability and its ability to promote universal health coverage
