Health Systems Strengthening: 2015 and Beyond

Health Systems Strengthening: 2015 and Beyond

The strengthening of health systems in low and middle income countries is central to the global effort to promote economic and social development through universal health coverage, reduce mortality, and improve health and sustainability of health care over the next 15 to 25 years. ("Health Systems Strengthening: 2015 and Beyond")

MSH has released a new information brief, "Health Systems Strengthening: 2015 and Beyond." The brief looks at lessons learned from working at all levels of the health system for over 40 years, outlines problems that must still be addressed and identifies specific ways to address them.

The strongest health systems provide universal health coverage: all people can access health care when they need it without being impoverished by the costs. Services are distributed equitably so that people in even the most remote areas can reach them and services meet the needs of all residents, including women, youth, and minorities. A strong health system is embedded inextricably within the communities that it serves, and with them is able to learn, adapt, and adjust to changing circumstances, including crises, while continuing to ensure that all of the following six pillars work in concert:

  1. Governance structures develop, implement, and monitor the basic legal framework required for effective operation of both public and private health services and protection of patients’ health and rights. Effective governance ensures that standards of care and targets for coverage are set, monitored and maintained and that services are cost effective.
  2. Information is collected from service delivery points to inform local and national level decision-making regarding key public health interests, such vaccination coverage, drug availability, and health worker performance.
  3. Human resources are sufficient in number and effectively trained, deployed, supervised, and supported. Providers are licensed and motivated and incentivized to deliver the highest quality of care possible to targeted populations so that opportunities for care are not lost.
  4. Finances for health services are generated, pooled, allocated, and managed to ensure equitable access to care at all income levels. Strong health systems use resources appropriately and wisely to incentivize better performance of health workers and health institutions.
  5. Pharmaceuticals, diagnostic tests, vaccines, and other key supplies and commodities are procured and delivered to points of service to ensure consistent supply at all times in a condition that maximizes their effectiveness and affordability.
  6. The delivery of preventive and curative health services is coordinated to provide a full continuum of care. Clients are treated with dignity and respect and access to services that prevent or treat the most common causes of illness is ensured.

It is clear how one weak pillar in this very complex system could negatively affect all the others. If a health system has well-trained human resources, but constant stock outs of medicines, it cannot deliver effective care. If services are of a high quality, but clients cannot afford them, they will not receive them when in need. If all services are free, but facilities are understaffed and providers are not skilled, people will continue to die from preventable causes. If the quality of care is good, but no system exists to alert authorities to respond to disease outbreaks, the country, its neighbors, and the world are left vulnerable to deadly epidemics. Stronger health systems are essential for us all.

What are the problems?

For almost three decades, international development assistance for health has focused mainly on specific diseases or aspects of health care, such as HIV, TB, malaria, family planning, and immunization programs. These programs provided important and significant injections of funding, commodities, new technologies, and technical assistance, and their sharp focus enabled rapid gains in performance. However, they were largely implemented in situations with weak infrastructure and poor public management, undermining their chances of long-term success and even weakening the very health systems they were expected to support. These vertical programs have all made impressive gains: since 1990, maternal and child mortality have decreased by almost half; the number of people on regular and routine treatment for AIDS has increased from 400,000 in 2003 to 9.7 million in 2012. These programs are reaching the limits of their effectiveness, however, and it is systemic weaknesses within each of the six pillars of most health systems that present the greatest barriers to continued progress. Better health, prosperity, and security for the most vulnerable will not be possible using the methods of the 1990s and 2000s. Building stronger and better functioning health systems that are locally owned and managed is imperative and will permit these remarkable gains to continue without bankrupting the economies that support them.

Download the “Health Systems Strengthening: 2015 and Beyond” information brief to find out what we’ve learned and what remains to be done.