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Health systems capacity

Health systems strengthening is a core area of interest for the HLSP Institute, and is founded on the experience of HLSP in this field in the last 20 years.

What is a health system?
A country’s health system can be seen as the set of inter-related services, processes and capacities that include:
  • direct service delivery to the population – including preventive and promotive services (such as immunisation or information on safe sex); primary level health services such as clinics or general practitioners; or hospital care. Services can be provided by the private and public sectors;
  • the supporting services that make service delivery possible - for example, drug procurement and storage; equipment maintenance; blood transfusion service; financial and accounting systems to get funds to where they are needed;
  • the health workforce and their development, including training of doctors and other health workers; keeping health workers up to date;
  • the physical infrastructure needed to deliver the health services, including hospitals, laboratories, medical and other equipment, training schools and transport;
  • the financing arrangements which might include health insurance, direct payments by patients, public funding and international aid;
  • the system for regulation and licensing that protects the public from unsafe products, ineffective medicines or inept treatment;
  • the overall stewardship function for the health system, which includes setting policy; planning and allocating resources; and monitoring performance. There are many ways of organising these functions - for example decentralisation.
Issues and challenges
The inter-dependence of these elements is complex, which makes it a challenge to assess the capacity of a health system and identify how best to strengthen it. The priorities for strengthening will depend on the country circumstances. The scale of the task is so daunting that it is tempting to by-pass the system and set up parallel arrangements for health care.

The publication in 2005 of the Millennium Project report (Investing in Development) and the Commission for Africa report signals a growing consensus on the case for more aid to improve health in low income countries. At the same time questions are raised about how well such aid can be used, especially where systems are weak.

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