Posted by: ihfgeneva | April 30, 2014

IHF Geneva Health Forum: Special Report: The difficult road towards comprehensive Health Systems Strengthening: closing the gap between theory and practice

The objective of this session was to explain why opportunities for   strengthening health systems were being missed despite the targeted aims of the global health sector.  Experts concentrated on different sub-topics, yet all of the presentations acknowledged that despite inflows of millions of dollars, health systems are struggling and experiencing marginal progress.

The topics of disease control programs (DCPs) and the tensions that they have generated within broader health systems, were addressed.  An argument presented was that DCPs are currently being overemphasized to the point that they are undermining the overall efficacy of general health access and delivery.  By diverting attention away from general care, they also receive substantial funding by donors compared to other programs.  Thus, specific programs combatting AIDS or TB have good intentions, yet are creating “islands of efficiency” in low resource health systems.

Another subject of discussion was on the problems concerning targeted policies, focusing on their intricate complexities as reasons for their low rates of effectiveness.  There is need not only for their proper adoption by managers and implemented by providers, but recognition that they also have the potential to act on non-targeted populations.  In addition, decision-making regarding targeted policies is too centralized, and the formulation of these policies is not clear at local levels.

The presentation on health systems in Sub-Sahara Africa, highlighted how several factors are propelling a vicious circle to exclude initiatives for reform.  Firstly, individuals have poor perceptions of what a health systems entail, perceiving the term as vague and ambiguous.  Next, there are various functional factors such as low resources, skewed priorities, and limited margins for manoeuver.  Organizational contributors centralize decision-making and inhibit coordination, and structural factors subordinate interventions to lower district levels and prevent them from being adopted on wider scales.

During discussions, the audience articulated such sentiments that:

–          Health systems appear to be concentrating too much on “hardware”, items like money or legislation.

–          It is the people who are overriding and exploiting health system policies with their own interests and networks.

–          Regarding the over-prevalence of DCPs, external factors like the WHO and Global Fund are pushing developing nations too vigorously for specific programs in which they have a stake.

–          Officials from developing countries are complying with these demands since they lack understanding of health systems; for them, it is easier to implement interventions with limited scopes.

In sum, the session proposed that a lack of management capacity by individuals is the reason that health systems continue to suffer.  Leadership at national and global levels has failed to ease tensions between actors and monitor the effective implementation of policies.

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