Health Systems Strengthening

Health Systems Strengthening (HSS)

This blog post was co-written with Morsi Mansour. Joan and Morsi are leadership development specialists in MSH’s Center for Leadership and Management.

Students in Uganda participate in a leadership development program during their pre-service medical training.

How can we empower the front-line of health care managers and service providers in the developing world?

As the Leadership, Management and Sustainability Program completes five years, it is an important moment to sum up what we have learned about sustainability and to reflect on how local ownership of health improvement programs supports sustainability of health results.

Halida Akhter receiving the United Nations Population Award in 2006.

Bangladesh, which is situated in a resource poor setting with a population of over 150 million, faces the major health challenge of a high maternal mortality rate. In the 1970s, the maternal mortality rate was 700 deaths per 100,000, and now it is still at 320 per 100,000. Although Bangladesh has made progress in reducing its infant mortality, much progress needs to be made to reach the Millennium Development Goals for maternal mortality. Bangladesh will need more than five years to achieve the goals. The Global Health Initiative (GHI) will help address the major health challenges women face in Bangladesh. Bangladesh has successful models of collaboration and public-private partnerships to share with other countries.

There have been a collection of high-profile and well attended mobile health (mHealth) “summits” held around the world in the past few years, including last month’s second annual mHealth Summit in Washington, D.C. (headlined by Bill Gates and Ted Turner), but the really interesting conversations are happening on the African continent. While large providers in the “developed world” are talking about the need for business plans and analysis, the debate in Kenya and Nigeria and Ghana is on how country-based leadership can scale up proven programs, develop sustainability, and provide practical and integrated models for cooperation between the government, mobile service providers, the medical community and the private sector.

On this World AIDS Day, we reflect yet again on progress made toward global commitments to fight the HIV epidemic. According to UNAIDS, new infections have decreased this past year from 2.7 million to 2.6 million, but, 30 years into the epidemic, only 5.2 million people out of the estimated 15 million who need drugs have access to treatment. Stigma, discrimination and human rights violations against persons living with HIV still exist, even in countries with generalized epidemics.

Integrated HIV programming across the entire health system can minimize many of these barriers to HIV prevention, care and, treatment.

At this First Global Symposium on Health Systems Research there have been a number of concurrent sessions on how best to make the link between research and decision-making. How do we make research relevant and timely so that it can inform policy-making?

MSH served as a panelist on the panel “Health systems and national policy-making: Strengthening the Connection,” which provided good examples of studies from Nigeria and the Middle East and North Africa (MENA) Region that provided insight into this gap.

In Nigeria, a study focused on how the gap between policy makers and researchers could be bridged. How can research be made attractive so policy makers desire it? Through a cross-sectional survey, they set out to improve the skills of policy makers in evidence-informed policy making. A platform was created where the two met on neutral ground to develop the research agenda. What came out of this collaboration were five skill building workshops where pre/post data was collected. There was much participation and enthusiasm by both parties which culminated in six policy briefs to improve health systems operation in Nigeria.

Last year, the mHealth Alliance and the National Institute of Health (NIH) sponsored their first mobile health (mHealth) “Summit,” at the Ronald Reagan building in Washington, DC. The location was telling: it is the home of the US Agency for International Development (USAID). This year’s mHealth Summit has nearly doubled in size, moved its location to the Convention Center, and is being keynoted by Bill Gates and Ted Turner. It is safe to say that mHealth is certainly a topic de jour. The problem is that the big names---the global mobile phone network providers, manufacturers, pharma companies, and global consulting firms---are all jumping on the bandwagon, but they are late to the game. And the conversations in the plenary sessions highlight the fact that there’s a huge disconnect between the global companies and the on-the-ground implementers.

Blog post also appeared on Global Health Magazine.

PEPFAR Fellow in the field

As the country with the second highest maternal mortality rate in the world, outranked only by India, Nigeria loses one in every 18 women during child-birth. The country also has one of the highest infant mortality rates in the world, one of the lowest life expectancy rates---estimated at 47 years---and the second largest population of people living with HIV & AIDS, with only 30% of people eligible for anti-retroviral treatment able to access these life-saving drugs.

Fragile states such as Afghanistan, the Democratic Republic of Congo, Haiti, Liberia, and Southern Sudan have among the worst health statistics – especially for women and children.  For political, economic, security and other reasons they can be extremely challenging work environments. Despite this, I have been deeply inspired to see what local health leaders have achieved when they have created strong partnerships among government, donors,  non-governmental organizations and where possible the private sector.  The charismatic former minister of health from Afghanistan, the  medical director of an urban clinic in northern Haiti, and the director of Torit hospital in Southern Sudan stand out as examples of local leadership in action under circumstances that would immobilize many of us.

In fragile states, constraints on governments often prevent them from simultaneously building their stewardship role and immediately expanding service delivery. Supporting the Ministry of Health to establish a basic package of health services, train local organizations to implement those services, and provide incentives (such as through performance-based financing) is critical to success. Additionally, the goal should be to move from many plans and actors across districts to one health plan with committed partners. 

The Health Minister’s Conference for member countries of The East, Central and Southern Africa Health Community (ECSA HC) was opened by the Minister of Health, Zimbabwe in Harare on October 25. The theme, "Moving from Knowledge to Action: Harnessing Evidence to Transform Healthcare" is very relevant to the mission of Management Sciences for Health (MSH).

I’ll highlight two sessions from the first day that support the evolving global health field and the work of MSH.

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