Roll Back Malaria: Plans

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HEALTH SECTOR DEVELOPMENT IN THE CONTEXT OF RBM

• Strengthening the health sector to better take
  care of malaria
• Dr. J.J.Banda RBM

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CRITICAL ISSUES

• Synergy between disease interventions and
  operational systems
• Synergy between operational system requirements
  for different priority disease interventions
• Implementation to scale for impact
• Investment in shared operational systems
• Involvement of non - Health sectors
• Involvement of informal health providers
• Empowerment of communities

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Past Health sector development (Reforms)

• Post Independence health service expansion.
• The PHC movement.
• DHS and NHS movement.
• Decentralisation and democratisation.
• Health care financing Reform.

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Current situation Strengths,

• Countries have internalised some capacity in and
  familiarity with,
• Discrete disease interventions.
• Discrete administrative systems.
• Policy and Strategy development.
• Community empowerment.
• Discrete private/public partnership mechanisms.
• Multi-sector activity.

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Current situation Weaknesses,

• Non targeting of impact.
• Patchy Coverage.
• Conflict between disease interventions and
  delivery systems.
• Competition between efforts against different
  diseases.
• Non implementation of prioritisation

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Causes of remaining weaknesses

• Dormancy of higher order programming processes

Processes for innovation of disease interventions
Processes for institutionalisation and
implementing to scale
Processes for innovation in health systems
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Underlying Causes

• Natural Developmental progression
• Shift in expectations
• need for building blocks
• Fragmentation of external support.
• Resource inadequacy.

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The way forward

• Building on existing strengths
• Investing in higher order programming
• Capacity building, Programming for impact,
  Investment in shared support systems.
• Systematising service design
• Disease and system interventions as template for
  service design.
• Use of tracer conditions to build various layers
  of the health sector.
• Going beyond the traditional health sector.

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The household as a layer

• Meeting the challenge of initiating care in the
  home

Complexity of technology
Magnitude of population to be covered
Rapidity of response
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Adding the immediate HH support level

• Adding professional competence to allow for
  clinical differential diagnosis

Complexity of technology
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The first institutional support

• Adding professional competence for bed side
  nursing, laboratory capacity.

Complexity of technology
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Added value of RBM

• Targeting of impact outcomes
• Link to health sector development,
• Link to sector wide approaches.
• Two tier global and country partnerships.
• Technical support networks
• Pathfinder concept.

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Summary

• Maintaining achievements
• Synergy of systems
• Implementing to scale