Guidelines

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Health Systems Strengthening - Why and
how?
Anders Nordström Assistant Director
General Health Systems and Services WHO
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(No Transcript)
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The challenges to scale up services for HIV, TB,
and malaria
World Malaria report
Global Plan to stop TB
HIV/UA assessment report

• Inadequate financing
• HR crisis
• Affordable commodities
• Stigma, discrimination
• - Accountability

• Drug efficacy
• Information system
• Inadequate financing
• Community services
• - ME

• Partnership alignment
• Inadequate financing
• Laboratory capacity
• HR crisis
• Quality drugs

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Major challenges and gaps inequalities, lack of
integration and efficiency, lack of financial and
human resources..
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Big picture lessons

• Commitments and specific results have been
  achieved, partly through GHP
• The focus has on discrete health outcomes, on the
  need for financial resources and/or a specific
  part of a health system
• Now an understanding of that unless there are
  well functioning and comprehensive health
  systems, it is not possible to sustain the
  desired outcomes

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Systems and programmes getting results
NCD strategies National plans Surveillance Healthy
lifestyles Clinical preventionand
treatment Continuing care
HIV strategies National plans Surveillance Safe
sex Treatment Continuing care
Connecting common agenda? Is it more
efficient? Are there better outcomes?
Source adapted from WPRO/NCD
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The approach a combination of vertical and
horizontal the "diagonal"

• Taking the desired health outcomes as the
  starting point for identifying the health systems
  constraints that "stops" effective scaling up of
  services
• Addressing the systems bottlenecks in such away
  that system-wide effects are achieved benefiting
  also other programmes
• Addressing primarily health systems policy,
  systems and capacity issues
• Do not invest in specific and isolated health
  systems plans with exception for possibly in
  infrastructure and human resources

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A coherent framework for strengthening health
systems to improve health outcomes "Everybody's
business"

• " A health system consist of all organisations,
  people and actions whose primary intent is to
  promote, restore or maintain health"
• The main health systems goals are
• Improving health and health equity
• Responsiveness, financial fairness and efficiency
• Intermediate goals
• Greater access and coverage
• Quality and safety

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A Framework for Action

• Service delivery
• Package of integrated services
• Public and private providers
• Community engagement
• Management, infrastructure and logistics
• Inter-sectoral action for better health
• Health workforce
• HR strategies plans
• Education scale-up
• Retention and return of health workers
• Migration
• Information
• Data and surveillance systems
• Health System Metrics
• Synthesis and analysis of data disaggregated by
  age and sex

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A Framework for Action

• Medical products and technologies
• Policies for medicines and technologies
• Procurement and distribution systems
• Rational use of drugs
• Monitor of quality
• Financing
• Social health protection and increase
  pre-payment risk pooling reduce OOPS
• Increased and more predictable financing
• Equitable and efficient allocation of funds
• Expenditure tracking - National Health Accounts
• Leadership and governance
• Sector policies, strategies, plans and MTEF
• Regulation, oversight and accountability
• Generation and use of research and knowledge

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Improving health systems performance and scaling
upfor better health
HN 14 June 2007
Unclear Health systems and disease
programmes?? One health systems
everything? Specific health systems bottle necks

• A common agenda for Scaling up for Health
• Integration of service
• A "diagonal approach addressing health systems
  bottlenecks
• National frameworks for investments
• Coordination between country needs, the key
  global health actors and bilateral commitments

Concept
WB
National Development Plan
WHO
National Health Plan
WHO WB GAVI GF UNAIDS UNICEF UNFPA UK
,Norway, US Canada Gates
Addressing the key health systems bottlenecks
with the desired health outcomes as the entry
point
Global Fund
GAVI
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Success story Central Plateau, HaitiIntegrated
HIV/TB programme strengthens primary health care
Patient Visits 7/200211/2003
Prenatal Care Visits 7/200212/2003
Vaccine Administration 1/200312/2003
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Well resourced system a key to ART coverage
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The reality check prioritization of systems
elements by countries
(as reflected in 30 GFATM round 5 health system
strengthening proposals
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Thank you