Health Systems Strengthening

Health Systems Strengthening (HSS)

Dr. Ronald O'Connor, Founder of MSH, and Marcia Herrera, Director of Talent Management at MSH, co-authored this blog post.

Dr. David Sencer died on Monday, May 2, 2011 in Atlanta, Georgia at age 86. He died at Emory University Hospital, due to complications of heart disease.

Dr. Sencer, one of the major twentieth century public health thought leaders, was also one of the rarest: a warm-hearted, modest man of great accomplishments and lifelong dedication to Management Sciences for Health's mission of closing the gap between what is known and what is done to solve important public health problems around the world.

From 1986 until his retirement in 1993, Dr. Sencer was a valued MSH colleague and advisor; he served in the roles of Chief Operating Officer and Senior Fellow. Dr. Sencer led by empowering others; he believed that more could and would be done when leaders put the action, and often the visibility, in the hands of those most directly on the front lines of practical public health action.

Indeed, Dr. Sencer was doing it long before MSH was conceived, in a career that spanned many personal and professional challenges: Dr. Sencer overcame tuberculosis as a young physician and went on to lead many important health initiatives and institutions.

It’s common sense that a mother who is on treatment for AIDS, pregnant, has a sick child, and is accompanying a sister debilitated by Tuberculosis should not have to visit four separate service delivery points to receive care. Integrated health services not only make the world a healthier place, but also decrease the burden on health systems.

Integration is a comprehensive approach to service delivery. It is the transition from a vertical or horizontal approach to a diagonal, synergistic approach at all levels of a health system. Smart integration means coordinating disease specific programs (such as HIV and AIDS) with other health programs that have operated independently in the past (for example, family planning) to deliver services at the same time or, more importantly, with the same funding. Integration helps organizations maximize the impact of their health investments while allowing people, information, and funding to flow more easily among collaborating groups and stakeholders. Equally important, integration enables providers to treat the health needs of individuals and families more efficiently---regardless of the initial reason a person seeks care.

My recent field visit has given me a great perspective on one of MSH’s major activities - the costing of health services. MSH has extensive costing experience in East Asia & Pacific, Latin America & the Caribbean, Southern Africa, and West Africa.

MSH developed and has helped manage multiple applications of the CORE Plus (Cost and Revenue Analysis Tool Plus). CORE Plus is a tool that helps managers and planners estimate the costs of individual services and packages of services in primary health care facilities as well as total costs for the facilities. The cost estimates are based on norms and can be used to determine the funding needs for services and can be compared with actual costs to measure efficiency.

Costing of health care services is a powerful exercise whose data and results can be used for a number of things. When the cost of a package of services is determined, the analysis can be used for practical purposes, such as planning and prioritization or allocation of funds based on known cost figures. Results from a costing study can also be used to set appropriate user fees or other prices linked to provision of services. Finally, results of a costing study can be used as an advocacy tool to ensure that appropriate funds are allocated for the package of services.

Malawi has some of the worst health statistics in the world, ranking 166 out of 177 countries. This is the result of HIV & AIDS, food insecurity, weak governance, and many human resources challenges. Health care vacancies range anywhere from 30-80%, and Malawi only has 252 doctors in the entire country. The health system is regularly plagued with stock outs of key medicines and supplies, as a result of poor procurement and distribution practices. Malawi has one of the highest HIV prevalence rates in the world; the average prevalence for sub-Saharan Africa is 7.5%, Malawi has 12% prevalence in the adult population.

More than 50% of Malawi’s population lives further than 5 km from a health center.  Health care workers in the community, who are capable of providing essential health care services to those living in ‘hard to reach areas,’ are essential.  Meet the HSAs – Health Surveillance Assistants.

In March 2011, the CSIS Global Health Policy Center asked bloggers around the world: What should the key priority of the upcoming UN High Level Meeting on Non-Communicable Diseases be and why? We had a number of great submissions.  Dr. Jonathan D. Quick was one of our four finalists.  Read his entry below and look out in the days and weeks ahead for other finalist's blogs and another blog contest on NCDs. 

This was originally posted on smartglobalhealth.org.

The most common NCDs are diabetes, heart disease, cancers, and chronic lung diseases. According to the World Health Organization, about 36 million people die each year due to NCDs, and a quarter of NCD deaths are of people aged under 60; 9 in 10 of these people are from developing countries. Breast cancer kills over 270,000 women in the developing world each year.

Political and social momentum has been building, as the United Nations High Level Meeting on NCDs approaches, for a change from emergency, disease specific responses to an integrated systems-strengthening response.

Drug Therapeutic Committee training course in Kampala, Uganda.

As we celebrate World Health Day on April 7, 2011, the global health community is focusing on an increasingly dangerous health challenge---drug resistance. Antimicrobial resistance (AMR)---defined by the World Health Organization (WHO) as the resistance of a microorganism to an antimicrobial medicine to which it was previously sensitive---is a global public health threat that is rapidly wiping out the effectiveness of many first-line treatments. It undermines major public health achievements in treating infectious diseases such as HIV & AIDS, tuberculosis, malaria, and sexually transmitted infections. Not only is AMR a complex, cross-cutting problem affecting a wide variety of sectors, but it has crossed all national, geographical, and ethnic boundaries and is spreading globally.

Strong leadership, governance, and management are the cornerstones of successful global, national, and local efforts to save lives and achieve the  maximum impact from health investments. Yet effective leadership, management, and governance skills and practices too often are the vital missing elements in public, civil society and even private health organizations. Fortunately, these skills can be developed. They are best developed working in teams, in one’s own setting, over time, while facing real challenges.

With our partners, MSH works to build capacity at all levels within public and private organizations to improve leadership and management practices. Improved capacity ensures sound governance policies, creates a work climate that supports staff motivation, increases flexibility, and realigns staff to focus on common, achievable objectives.

I recently visited Haiti and had the opportunity to meet with some local Haitian non-governmental organizations supported by MSH’s Santé pour le Développement et la Stabilité d’Haíïti (SDSH) project, as well as the central Ministry of Health, and departmental Ministry of Health offices. I was searching for information in an effort to learn more about how Performance-Based Financing (PBF) has affected service delivery in Haiti. The SDSH-supported facilities produce monthly service utilization reports that capture the important information, but I’ve been working to obtain comparable information on other facilities. My first thought was the Health Information System (HIS) Unit at the Ministry of Health (MoH).

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