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Strengthening Health Systems: From Global to Local

Sara Bennett, Associate Professor Johns Hopkins School of Public Health

Global Health Council Satellite SessionHealth System Strengthening:

What is Everyone Doing?June 13, 2011

Key points

There is both conceptual confusion and multiple approaches to HSS

Conceptual confusion is problematic – but it may be premature to fix conceptual frames

Multiplicity of approaches is a good thing, if it reflects responsiveness to differing contexts

Need to embrace more nationally driven HSS agendas and support the development of national-level capacity to drive such agendas

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Different current approaches to HSS

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Problems of lack of conceptual clarity

Too much time spent explaining things to each other and to outsiders!

Fragmentation and lack community across a small field

Lack of agreed standards to track commitments and achievements

Cyclical trends in priority for health systems

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Oh, but how do you accommodate system dynamics

and emergent behaviors?

I support a diagonal

approach to HSS with positive

synergies

Intrinsic features of field that promote cyclical policy (source: Rochefort 1988)

Complexity of field and heterogeneous problems

Exaggerated ideologies – over-confidence, disillusionment

Incomplete development of scientific basis Mismatch of goals and means Linked to social and economic cycles Not sexy!

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From global to local

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• Context specificity of HSS• Cycles leave insufficient

time for country implementation

• National commitment to HSS may be more important than global funding

• Need for local research to build global evidence base

Future health systems – DFID-supported research consortium

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Philosophy Country-driven research, focus on local capacity development

Countries Afghanistan, Bangladesh, China, India, Uganda and neighbours

X-cutting themes

Unlocking community capabilities, stimulating innovation, understanding intervening in complex adaptive systems

Interventions • M-health schemes to better link informal providers to formal health care system

• Vouchers for transport to facilities• New approaches to regulation• Community scorecards for health

Reflections Diversity of proposed interventions reflects local

contexts and histories Country leadership motivates and empowers

country researchers Responsiveness to local concerns facilitates links

to policymakers and other research users Planned research processes incorporate learning

and adaptation Relinquishing leadership can be frustrating for

northern researchers and challenging for generalizable findings

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