What health system strengthening issues matter to you?
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Last week, Health Systems 20/20 put out a call to the health systems strengthening community to "tell the world about health system strengthening issues that matter to you" by contributing to our blog. We received a number of responses (thank you, HSS community!) and look forward to receiving more in the coming weeks.
Here is a small sample of the responses we received:
From Charles Mboineki of Uganda:
I would like to forward my contribution in reference to the health system in Uganda.
The health care system in Uganda works with the public sector which involves all health facilities set up by the government of Uganda; private practice which includes private for-profit and private not-for-profit providers; traditional and complementary medicine which includes herbal medicine, traditional birth attendants, bone setters and well as spiritual healers. The system also works with the community initiative referred to as the "Village Health Team" (VHT) concept.
The VHT concept refers to a team of selected community members who assist health professionals carry out health activities at the community level with close supervision by health professionals at a health centre level II which is a parish-level base facility. The country is unable to have a health facility at every village but will have one at the parish level.
The VHT concept is very good if actually implemented throughout the entire country. It can contribute quite a lot to provide services outlined below to communities:
- 1. Health promotion and education activities such as use of mosquito nets for prevention against malaria which is the number one killer in Uganda and mobilization of mothers for antenatal care, delivery at health facilities and postnatal care. This will promote health care seeking and thus improve maternal health and reduce maternal mortality.
- 2. Mobilization for and monitoring of immunization of children. About 70% of children who die in Uganda die due to preventable diseases. VHTs will help improve immunization coverage through mobilization.
Recommendations:
1. I recommend that the VHT concept spread across the entire country since it now operates in just few districts in Uganda.
2. The VHTs need to be well motivated.
3. The VHT concept could also be implemented by other countries in Africa and elsewhere.
From Dr. Eliudi Eliakimu of Tanzania:
Dear colleagues, interested in Health System Strengthening (HSS), To me what matters are the elements of HSS both from the Human Rights perspective and the Functional System-Blocks perspective.
{1} The Right to Health (RTH) underpins the importance of having an effective health system as one of the core social institutions just like the court or the political system. With the interpretations of the RTH provided in General Comment (GC) 14 - four aims (or you may call them dimensions) of an effective health system are captured. These aims are as follows:
(1) Availability - generally meaning that functions of public health: health facilities (HF), programmes, goods, and services should be available in sufficient quantities.
(2) Accessibility - defined in four types: non-discrimination, physical accessibility [geographical], economic accessibility [affordability], and access to information.
(3) Acceptability - respectful of medical ethics and culturally appropriate
(4) Quality - HF goods and services are scientifically and medically appropriate and of good quality, as well as culturally acceptable. This aim/dimension emphasizes key issues that are also included/implied in the six WHO health systems building blocks including skilled personnel, scientifically approved and non-expired drugs, and hospital equipment. Other aspects mentioned under quality are consistent with the RTH definition - safe and potable water and adequate sanitation.
Integrating these RTH-aims (dimensions) of an effective health system in comprehensive HSS is very crucial as it will ensure that the vulnerable and neglected groups are reached with health care services from an effective and strengthened health system.
{2} Functional System-Blocks Strengthening - Here it is very important to have:
- Comprehensive HSS (rather than selective approach)
- Support for strengthening primary health care from Global Health Initiatives and other vertical programmes
- Social and environmental determinants of health included in HSS directly or indirectly (e.g., as part of positive externalities/positive spillovers)
- Sustainability plans hand-in-hand with system’s capacity building
- Increased emphasis on "service provision" building block to address issues of ethical practices and behaviour change issues including building positive attitude for existing staff as well as fighting corruption and other bad habits among service providers.
From Elizabeth Elhassan of the UK:
The importance of strengthening health systems cannot be over emphasized, particularly in the developing world. There is inadequate information on the gaps by countries in the developing world. It is not that the information is unavailable but that documentation is poor. I feel we need to have baseline data to enable the assessment of impact so the health systems are strengthened.
The level of funding for HIV/AIDS, Malaria and TB should have some impact on the health system. This is also applicable to onchocerciaisis control and polio eradiciation.
Efforts should be made to document the process of strengthening health systems.
If you or your colleagues would like to contribute, please be sure to send us an email at info@healthsystems2020.org
From Gabriele Mallapaty on 29 July 2009, 04:27
Comprehensive Health System Strengthening efforts should also pay more attention to strengthening basic diagnostic laboratory services.