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.
