Abt Associates  In collaboration with:I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health

Strengthening Health SystemsMoving Beyond Supporting the Health System

Ann Lion Health Systems 20/20 Project Director, Abt Associates

Global Health Council Satellite SessionHealth Systems Strengthening: What is Everyone Doing?June 13, 2011

Goal of this presentation

Clarify existing HSS definition Supporting vs. strengthening health systems

Propose criteria to distinguish what activities are HSS interventions (support vs. strengthen) Scope Longevity Approach

What is health system strengthening?

Strengthening health systems goes beyond supporting the systemSupporting focuses on filling gaps to

produce better short-term outcomesStrengthening is about making the system

function better in the long term

Strengthening vs. supporting health systems

Parameter Health System Support

Health System Strengthening

Scope May be focused on a single disease or intervention

Activities have impact across health services and outcomes

Longevity Effects limited to period of activity

Effects will continue after activities end

Approach Provide inputs to address identified system gaps

Revise policies and institutional relationships to change behaviors and resource use to address identified constraints

What is not health system strengthening

Most common misunderstanding of HSS is that it is any activity that supports a HS building block Focus tends to be on increasing inputs Often covers only one HS block or disease area Tends to be short-term solution

Misconception of HSS often leads to investment in activities that, in effect, only support the system temporarily but posture as HSS

The 3 dimensions of health systems

1) Health system building blocks2) Program/disease areas3) Performance drivers

Inputs Policies and regulations Organizational structures Behaviors of HS actors

A “cube” view of the health system

© Abt Associates, 2001

The 3 dimensions of health systems

But focus on performance driver tends to be on inputs, while the remaining drivers are often overlooked by HSS programs

Inputs vs. other key HSS performance drivers

© Abt Associates, 2001

© Abt Associates, 2001

How to design HSS interventions?

There is no “menu” of HSS interventions Design will be affected by a number of factors specific to

country context and system constraints A health system strengthening intervention should:

Include all 3 dimensions shown in the HS cube illustration Affect more than one program/disease area Address country-specific constraints

Guidance for identifying HSS interventions

Is it Health System Strengthening? Does the intervention have cross-cutting benefits beyond a

single disease? Does the intervention address policy and organizational

constraints or strengthen relationships between the building blocks?

Will the intervention produce long-term systemic impact beyond the term of the project?

Is the intervention tailored to country-specific constraints and opportunities with clearly defined roles for country institutions?

Acknowledgements

Grace Chee** Nancy Pielemeier Catherine Connor Mark McEuen Sheila O’Dougherty Hong Wang

** lead drafter

Slavea Chankova Joe Kutzin Marty Makinen David Evans Tahgreed Adams Abdo Yazbeck

Abt Associates  In collaboration with:I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health

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