Health Systems Strengthening

Health Systems Strengthening (HSS)

This article originally appeared on The Huffington Post.

As world leaders gather next week at the U.N. to review progress on the Millennium Development Goals (MDGs) to eradicate poverty, hunger, and disease by 2015, a new integrated approach to funding and delivering health services in developing countries is critical if the UN's global health targets -- especially for women and children -- are to be met. Currently, the health goals are competing with each other for money, people, and other scarce resources. How can we get back on track?

There is much to celebrate next week: over four million people are currently receiving antiretroviral drugs to treat AIDS; eliminating mother to child transmission of HIV is within reach by 2015; malaria deaths have been reduced by over half in some countries; the global burden of TB is falling; and more than 500 million people are now treated for one or more neglected tropical diseases.

Earlier this summer, the Center for Global Development hosted a guest lecture by the Ministry of Health of Ethiopia Dr.Tedros Adhanom Ghebreyesus with a panel of experts from Zambia, Mozambique and Uganda and representatives from United States Government (USG) agencies to discuss one of the most challenging concepts to define right now - Country Ownership.

For the last two years, the USG has tried to find a way to partner with developing country governments while they balance their accountability to Congress.  In recent development reform plans like the Global Health Initiative and Feed the Future, there are numerous references to country ownership, country driven, country-led, and country guided but neither actually come out and define the term “country ownership.”

So, what is country ownership? How will we know when we achieve it? It is an end in itself or the best way to ensure long-term sustainability?

At a time when many are looking for examples of lasting local success in international development and sustainable approaches to healthcare for low income populations, PROSALUD, Bolivia’s largest health nongovernmental organization (NGO), embodies this success.  PROSALUD just celebrated its 25th anniversary last week – and MSH was there to help celebrate. For over two decades, PROSALUD has contributed to the unmet health needs of low-income populations in Bolivia, working with the active participation of the communities it serves.

It is always very special to witness an idea blossom, a theory carried out in practice, a vision becoming a reality. Such occasions are all too rare and when you’re in one, you really feel like you are living a special moment in history.

Ron O’Connor, Founder of Management Sciences for Health (MSH) and I had this very distinct opportunity two weeks ago in Santa Cruz, Bolivia as we were honored to attend the 25th Anniversary Celebration of PROSALUD.  Over the last 25 years, MSH has been privileged to accompany PROSALUD in its successful journey from one small clinic dependent on outside donations to become one of Bolivia’s primer health care providers with 23 health centers and 5 clinics in 9 cities across the country. And, PROSALUD is financially independent and governed by its own Bolivian Board of Directors.

At the International AIDS Conference in Vienna, Austria, my colleagues and I gathered to discuss the principles of smart integration and its challenges, successes, and recommendations for implementation. 

Smart integration means coordinating HIV & AIDS programs with other health programs that have operated independently in the past; providing comprehensive services at all levels of the health system – from households to health facilities and across the continuum of prevention, treatment, and care; and building stronger partnerships between public and private sectors.

There are three perspectives of integration that must be kept in mind when discussing integration – the client, provider, and the efficiency. Smart integration is important now because AIDS has become a chronic disease and we need to move away from the emergency response interventions.

As we have heard, Haiti is the poorest country in Western Hemisphere and has some of the worst health statistics. Many things did not work well before the earthquake and the recovery effort has not progressed as many had hoped.

There is a perception among some, though, that nothing was working before the January 12th earthquake and that nothing has happened since.

Certainly in the health sector, and specifically in AIDS, this perception is simply wrong. The earthquake has been devastating for Haiti and its people, but in the health sector there were many good things going on before the earthquake and some real strengths to build upon. The government of Haiti, at both the national and department level, has been playing a strong leadership role.

MSH first began working in Haiti over 30 years ago. Over the last decade our nearly all-Haitian staff has worked intensively to develop leadership, management, planning, and service delivery skills within the Ministry of Health and Population, nationally and at the departmental and local levels. We also work to strengthen over two dozen service delivery NGOs.

The Group of Eight (G-8), holding their annual summit last weekend in Muskoka,Canada, announced a Canadian-led Muskoka Initiative on Maternal, Newborn and Under-Five Child Health (Muskoka Initiative). The Group of 20 (G-20) summit held immediately after in Toronto, resulted in no additional commitments to maternal and child health. MSH believes the G-20 missed an opportunity to support global health when the group did not endorse the G-8’s maternal and child health initiative announced the day before. The G-20 is a group of key finance ministers and central bank governors that meets semi-annually on matters relating to the international financial system.

Next month in Vienna, Austria, thousands of activists, community workers, donors, health leaders, and government officials will gather for the VVIII International AIDS Conference.  This year’s theme is Rights here, right now: a mandate on the importance of health as a human right for all.  While it is easy to talk about health as a human right, it is much more difficult to deliver to diverse communities in some of the poorest countries around the world. 

Last year when President Obama announced his Global Health Initiative (GHI), he spoke about meeting the health needs of the world by leveraging current resources and integrating programs for greater health impact. Integrating HIV & AIDS services with other health services such as reproductive health (including family planning), TB, malaria, or maternal and child health increases effectiveness and ultimately sustainability. 

“Songs brought by foreigners do not last long at the dance.”  So goes a Kenyan proverb that supports the concept that countries should own their development. The development community knows this, but we aren’t yet making it happen on a broad scale. On the opening day of the Global Health Council conference last week, Management Sciences for Health (MSH) teamed up with Oxfam America to host a panel on country ownership and how to successfully achieve it.

To a standing room only audience the panelists from civil society, NGOs, local government, and US government discussed country ownership models from a varied perspectives. Highlights from the interesting conversation are below:

Just over five months ago, Haiti suffered a devastating earthquake that displaced more than 700,000 people.  Addressing the health needs of such a large population in a post-disaster situation is a complex challenge, one Management Sciences for Health (MSH) is supporting through its many programs including our Leadership, Management and Sustainability Program (LMS).

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