Health Systems Strengthening

Health Systems Strengthening (HSS)

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).

Global Health TV visits Ethiopia’s capital, Addis Ababa, to see how MSH’s  systems approach at the community level results in better lives for people living with HIV & AIDS. Management Sciences for Health, an international nonprofit organization, uses proven approaches developed over four decades to help leaders, health managers, and communities in over 60 countries build stronger health systems for greater health impact.

Watch the video.

In fragile states, constraints on governments often prevent them from simultaneously building their stewardship role and immediately expanding service delivery. National and local governments must ultimately lead the process and work together with NGOs and the private sector to successfully strengthen their own health systems.

In Haiti, a two-pronged approach was successfully developed and implemented prior to the earthquake by a four-way partnership between the Government of Haiti, the United States Government, a network of Haitian and international NGOs  (Santé pour le Développement et la Stabilité d’Haíïti) (SDSH), and Management Sciences for Health.

The two-pronged approach included:

Today, the 37th annual Global Health Council Conference “Goals and Metrics” begins in Washington, DC. MSH is pleased to be a Silver Sponsor of the conference.

MSH is sponsoring two auxiliary events:

“Can Country Ownership Work?  Field Perspectives on Health Systems Strengthening”
Today, June 14, 2-4pm, Governors Room, Omni Shoreham Hotel, Washington, DC
A panel discussion co-hosted by MSH and Oxfam on how “country ownership”—the management of donor funds by a national government—works in practice. The panel will feature first-hand perspectives from government and civil society health providers from Cambodia, Mozambique, and Nigeria.
The event is open and free to the public.
A live webcast will also be available:  http://www.ustream.tv/channel/can-country-ownership-work

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