Posted by: shigman | 04/04/2009

Dr. Etienne on Health Systems Strengthening

On March 20, 2009, the Global Health Council held a Community Meeting with Dr. Carissa Etienne, Assistant Director-General for Health Systems and Services at the World Health Organization.

Dr. Etienne presented recent developments in health systems strengthening with a special focus on primary health care, financing, human resources for health and work with Global Health Initiatives (GHIs). She discussed the WHO Executive Board resolution on primary health care, including health systems strengthening and the agenda for implementation of the resolution; universal coverage and building and sustaining human resources for health.

Dr. Etienne highlighted several issues in her presentation:

  • Developing and developed countries are on different paths in terms of evolving health systems – developing countries are moving toward a hospital-centric health system while developed countries are moving away from this approach.
  • The WHO’s Primary Health Care 2008 report highlights four reforms related to universal coverage, leadership reforms, service delivery reforms, and public policy reforms. In all of these efforts, participation is key, as people-centered needs and expectations must be addressed. People are at the center of WHO’s six health system building blocks.
  • There is a convergence of primary health care and health systems strengthening.
  • The financial crisis is having an impact in several areas. Domestic spending (including out-of-pocket expenses), increased demand for public services, and decreased external support in the form of official development assistance may be compromising quality of care.
  • The health community needs to learn and use the language of economics to deal and communicate effectively with the Ministers of Finance.
  • When countries use a training model from developed countries, they are training people to operate in a developed country setting rather than in a developing country setting. Thus, the training sets them up for exporting experts.
  • IHP+ coordination and plans – partners commit to funding around the compact and common plan. The goal is to have basket funding, though some donors (including the Global Fund and PEPFAR) are not there yet. So far, the process has been rather cumbersome and there is disconnect between what happens in the field and at level where the plan is developed. The concept of national plan “validation” is opposed by some countries and favored by some donors.
  • Behavior change is needed by all players to deliver on commitments.
  • There is a logical framework for integrating the health system – a WHO report is due out in June. The framework needs to draw on the evidence base and needs a “new science” that looks at the complex interface and incorporates better indicators.
  • Health systems are very country specific – there is a need to know who should be engaged and how they should be engaged.
  • National development of health systems will hopefully reduce the competition that exists between players, so that they can work together to formulate a manageable and sustainable health system.

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