scholarly journals The Global Health System: Strengthening National Health Systems as the Next Step for Global Progress

PLoS Medicine ◽  
2010 ◽  
Vol 7 (1) ◽  
pp. e1000089 ◽  
Author(s):  
Julio Frenk
Keyword(s):  
Global Health ◽  
Health System ◽  
Health Systems ◽  
National Health ◽  
Health System Strengthening

Harnessing instability as an opportunity for health system strengthening: A review of health system resilience

2019 ◽  
Vol 32 (3) ◽  
pp. 128-135 ◽  
Author(s):  
Caroline Chamberland-Rowe ◽  
François Chiocchio ◽  
Ivy Lynn Bourgeault
Keyword(s):  
Global Health ◽  
Health System ◽  
Health Systems ◽  
Health System Strengthening ◽  
Operational Model ◽  
Academic Literature ◽  
System Resilience

In recent years, resilience has emerged as a prominent topic in global health systems discourse as a result of the increasing variety and volume of sources of instability inflicting strain on systems. In line with this study’s intent to bring together existing literature on health system resilience as a means to understand the process through which systems achieve resilience, a review of academic literature related to health system resilience was conducted. Emerging from this review is an operational model of resilience that builds on existing health systems frameworks. The model highlights health system resilience as a process through which leaders in all sectors need to be mobilized in order to harness instability as an opportunity for health system strengthening rather than a threat to the system’s sustainability and integrity.

Norm diffusion and health system strengthening: The persistent relevance of national leadership in global health governance

2014 ◽  
Vol 40 (5) ◽  
pp. 877-896 ◽  
Author(s):  
GARRETT WALLACE BROWN
Keyword(s):  
Global Health ◽  
Health System ◽  
Health Systems ◽  
Central Element ◽  
Health System Strengthening ◽  
Local Health ◽  
Governance Mechanisms ◽  
Health Governance ◽  
Norm Diffusion ◽  
National Leadership

AbstractAcademics and policymakers often argue that global health policy greatly affects and influences national health systems because these policies transfer and implant ‘best practice’ norms and accountability techniques into local health systems. On the whole these arguments about the ‘diffusion of norms’ have merit since there is considerable evidence to suggest the existence of a positive correlation between global norms and national behaviour. Nevertheless, this article argues that traditional analytical frameworks to explain norm diffusion underplay the fact that norms are significantly ‘glocalised’ by national actors and further discount the role that national leadership plays in strengthening health systems. In response, this article presents a ten-year comparative paired study of the participatory governance mechanisms of the South African health system and its health strengthening measures. In doing so, the role of the national government in their relations with the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) will be examined and how key ‘partnership’ norms were amalgamated into health governance mechanisms. It will be argued that although global policy plays an important guiding role, health norms are never transcribed straightforwardly and a central element to successful health governance remains vested in the nation and the leadership role it exerts.

scholarly journals 22.F. Workshop: What makes for resilient health systems? Evidence from the State of Health in the EU country profiles

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Building Blocks ◽  
The State ◽  
Lessons Learned ◽  
Three Dimensions ◽  
Health System Strengthening ◽  
New Work ◽  
State Of Health ◽  
The Eu

Abstract The European Commission's State of Health in the EU (SoHEU) initiative aims to provide factual, comparative data and insights into health and health systems in EU countries. The resulting Country Health Profiles, published every two years (current editions: November 2019) are the joint work of the European Observatory on Health Systems and Policies and the OECD, in cooperation with the European Commission. They are designed to support the efforts of Member States in their evidence-based policy making and to contribute to health care systems' strengthening. In addition to short syntheses of population health status, determinants of health and the organisation of the health system, the Country Profiles provide an assessment of the health system, looking at its effectiveness, accessibility and resilience. The idea of resilient health systems has been gaining traction among policy makers. The framework developed for the Country Profiles template sets out three dimensions and associated policy strategies and indicators as building blocks for assessing resilience. The framework adopts a broader definition of resilience, covering the ability to respond to extreme shocks as well as measures to address more predictable and chronic health system strains, such as population ageing or multimorbidity. However, the current framework predates the onset of the novel coronavirus pandemic as well as new work on resilience being done by the SoHEU project partners. This workshop aims to present resilience-enhancing strategies and challenges to a wide audience and to explore how using the evidence from the Country Profiles can contribute to strengthening health systems and improving their performance. A brief introduction on the SoHEU initiative will be followed by the main presentation on the analytical framework on resilience used for the Country Profiles. Along with country examples, we will present the wider results of an audit of the most common health system resilience strategies and challenges emerging from the 30 Country Profiles in 2019. A roundtable discussion will follow, incorporating audience contributions online. The Panel will discuss the results on resilience actions from the 2019 Country Profiles evidence, including: Why is resilience important as a practical objective and how is it related to health system strengthening and performance? How can countries use their resilience-related findings to steer national reform efforts? In addition, panellists will outline how lessons learned from country responses to the Covid-19 pandemic and new work on resilience by the Observatory (resilience policy briefs), OECD (2020 Health at a Glance) and the EC (Expert Group on Health Systems Performance Assessment (HSPA) Report on Resilience) can feed in and improve the resilience framework that will be used in the 2021 Country Profiles. Key messages Knowing what makes health systems resilient can improve their performance and ability to meet the current and future needs of their populations. The State of Health in the EU country profiles generate EU-wide evidence on the common resilience challenges facing countries’ health systems and the strategies being employed to address them.

scholarly journals Health system gaps in cardiovascular disease prevention and management in Nepal

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Archana Shrestha ◽  
Rashmi Maharjan ◽  
Biraj Man Karmacharya ◽  
Swornim Bajracharya ◽  
Niharika Jha ◽  
...  
Keyword(s):  
Human Resources ◽  
Health System ◽  
Health Systems ◽  
National Health ◽  
Task Force ◽  
Health Spending ◽  
Building Blocks ◽  
Critical System ◽  
Government Organizations ◽  
The Government

Abstract Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.

scholarly journals Resilience Testing of Health Systems: How Can It Be Done?

2021 ◽  
Vol 18 (9) ◽  
pp. 4742
Author(s):  
Heather L. Rogers ◽  
Pedro Pita Barros ◽  
Jan De Maeseneer ◽  
Lasse Lehtonen ◽  
Christos Lionis ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Phase 1 ◽  
Action Planning ◽  
Health System Strengthening ◽  
System Transformation ◽  
Traffic Light ◽  
Phase 0 ◽  
Five Phases ◽  
Quantitative Indicators

The resilience of health systems has received considerable attention as of late, yet little is known about what a resilience test might look like. We develop a resilience test concept and methodology. We describe key components of a toolkit and a 5-phased approach to implementation of resilience testing that can be adapted to individual health systems. We develop a methodology for a test that is balanced in terms of standardization and system-specific characteristics/needs. We specify how to work with diverse stakeholders from the health ecosystem via participatory processes to assess and identify recommendations for health system strengthening. The proposed resilience test toolkit consists of “what if” adverse scenarios, a menu of health system performance elements and indicators based on an input-output-outcomes framework, a discussion guide for each adverse scenario, and a traffic light scorecard template. The five phases of implementation include Phase 0, a preparatory phase to adapt the toolkit materials; Phase 1: facilitated discussion groups with stakeholders regarding the adverse scenarios; Phase 2: supplemental data collection of relevant quantitative indicators; Phase 3: summarization of results; Phase 4: action planning and health system transformation. The toolkit and 5-phased approach can support countries to test resilience of health systems, and provides a concrete roadmap to its implementation.

scholarly journals What Makes Health Systems Resilient? A Qualitative Analysis of The Perspectives of Swiss NGOs

2021 ◽  
Author(s):  
Pauline Yongeun Grimm ◽  
Kaspar Wyss
Keyword(s):  
Global Health ◽  
Health System ◽  
Human Resource Development ◽  
Health Systems ◽  
Knowledge Exchange ◽  
Innovative Solutions ◽  
System Resilience ◽  
State Actors

Abstract Background: Resilience has become relevant than ever before with the advent of increasing and intensifying shocks on the health system and its amplified effects due to globalization. Using the example of non-state actors based in Switzerland, the aim of this study is to explore how and to what extent NGOs with an interest in global health have dealt with unexpected shocks on the health systems of their partner countries and to reflect on the practical implications of resilience for the multiple actors involved. Consequently, this paper analyses the key attributes of resilience that targeted investments may influence, and the different roles key stakeholders may assume to build resilience. Methods: This is a descriptive and exploratory qualitative study analysing the perspectives on health system resilience of Swiss-based NGOs through 20 in-depth interviews. Analysis proceeded using a data-driven thematic analysis closely following the framework method. An analytical framework was developed and applied systematically resulting in a complete framework matrix. The results are categorised into the expected role of the governments, the role of the NGOs, and practical future steps for building health system resilience. Results: The following four key ‘foundations of resilience’ were found to be dominant for unleashing greater resilience attributes regardless of the nature of shocks: ‘realigned relationships,’ ‘foresight,’ ‘motivation,’ and ‘emergency preparedness.’ The attribute to ‘integrate’ was shown to be one of the most crucial characteristics of resilience expected of the national governments from the NGOs, which points to the heightened role of governance. Meanwhile, as a key stakeholder group that is becoming inevitably more powerful in international development cooperation and global health governance, non-state actors namely the NGOs saw themselves in a unique position to facilitate knowledge exchange and to support long-term adaptations of innovative solutions that are increasing in demand. The strongest determinant of resilience in the health system was the degree of investments made for building long-term infrastructures and human resource development which are well-functioning prior to any potential crisis. Conclusions: Health system resilience is a collective endeavour and a result of many stakeholders’ consistent and targeted investments. These investments open up new opportunities to seek innovative solutions and to keep diverse actors in global health accountable. Strong governance, a bi-directional knowledge exchange, and the focus on leveraging science for impact can draw greater potential of resilience in the health systems. Governments and the NGOs have unique points of contribution in this journey towards resilience and may support governments to prioritise investing in the key ‘foundations of resilience’ in order to activate greater attributes of resilience.

scholarly journals The “Sustainability Doctrine” in Donor-Driven Maternal Health Programs in Tanzania

2022 ◽  
pp. 73-91
Author(s):  
Meredith G. Marten
Keyword(s):  
Health System ◽  
Health Systems ◽  
Newborn Care ◽  
Health System Strengthening ◽  
Respectful Maternity Care ◽  
Health Issues ◽  
The Public ◽  
Governmental Organizations ◽  
Non Governmental Organizations ◽  
Sustainable Health

AbstractStrengthening health systems to provide equitable, sustainable health care has been identified as essential for improving maternal and reproductive health. Many donors and non-governmental organizations (NGOs) have contributed to undermining health system strengthening, however, through adhering to what Swidler and Watkins call the “sustainability doctrine,” policies that prioritize time-limited, targeted interventions best suited for short-term funding streams, rather than the long-term needs of local populations. This chapter presents ethnographic data from semi-structured and key informant interviews with 16 policymakers and NGO directors in Dar es Salaam, Tanzania from 2011 to 2012. I illustrate how sustainability doctrine policies were put into practice, and how they have persisted, despite their shortcomings, using examples of donor-prioritized maternal healthcare initiatives in Tanzania rolled-out several years apart: prevention of mother-to-child transmission of HIV (PMTCT) and basic emergency obstetric and newborn care (BEmONC) programs in the late 2000s, and more recent efforts to implement respectful maternity care (RMC) programs. I focus on several issues informants identified as crippling efforts to build strong health systems, particularly the internal brain drain of healthcare workers from the public sector to higher-paying NGO jobs, and the prioritization of types of programs donors believed could be sustained after the funding period ended, specifically trainings and workshops. I describe how despite these issues, international organizations still design and implement less effective programs that often fail to account for local circumstances in their efforts to solve some of the more intractable health issues facing Tanzania today, in particular, the country’s stagnating maternal mortality rate. In this chapter, I argue that practices promoted and implemented under the guise of “sustainability” in policy papers and reports generated by donors paradoxically contribute to health system precarity in Tanzania.

scholarly journals Strengthening mental health systems in low- and middle-income countries: recommendations from the Emerald programme

BJPsych Open ◽  
2019 ◽  
Vol 5 (5) ◽  
Author(s):  
Maya Semrau ◽  
Atalay Alem ◽  
Jose L. Ayuso-Mateos ◽  
Dan Chisholm ◽  
Oye Gureje ◽  
...  
Keyword(s):  
Mental Health ◽  
Health System ◽  
Human Resource Development ◽  
Health Systems ◽  
Building Blocks ◽  
Health System Strengthening ◽  
Mental Health Systems ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

BackgroundThere is a large treatment gap for mental, neurological or substance use (MNS) disorders. The ‘Emerging mental health systems in low- and middle-income countries (LMICs)’ (Emerald) research programme attempted to identify strategies to work towards reducing this gap through the strengthening of mental health systems.AimsTo provide a set of proposed recommendations for mental health system strengthening in LMICs.MethodThe Emerald programme was implemented in six LMICs in Africa and Asia (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda) over a 5-year period (2012–2017), and aimed to improve mental health outcomes in the six countries by building capacity and generating evidence to enhance health system strengthening.ResultsThe proposed recommendations align closely with the World Health Organization's key health system strengthening ‘building blocks’ of governance, financing, human resource development, service provision and information systems; knowledge transfer is included as an additional cross-cutting component. Specific recommendations are made in the paper for each of these building blocks based on the body of data that were collected and analysed during Emerald.ConclusionsThese recommendations are relevant not only to the six countries in which their evidential basis was generated, but to other LMICs as well; they may also be generalisable to other non-communicable diseases beyond MNS disorders.Declaration of interestNone.

Rights of access to healthcare for undocumented migrants: understanding the Italian and British national health systems

2018 ◽  
Vol 11 (4) ◽  
pp. 232-243 ◽  
Author(s):  
Danielle da Costa Leite Borges ◽  
Caterina Francesca Guidi
Keyword(s):  
Health System ◽  
Health Systems ◽  
National Health ◽  
Universal Access ◽  
Research Question ◽  
Access To Healthcare ◽  
Health Policies ◽  
Undocumented Migrants ◽  
Content Type ◽  
British Health

Purpose The purpose of this paper is to analyse the levels of access to healthcare available to undocumented migrants in the Italian and British health systems through a comparative analysis of health policies for this population in these two national health systems. Design/methodology/approach It builds on textual and legal analysis to explore the different meanings that the principle of universal access to healthcare might have according to literature and legal documents in the field, especially those from the human rights domain. Then, the concept of universal access, in theory, is contrasted with actual health policies in each of the selected countries to establish its meaning in practice and according to the social context. The analysis relies on policy papers, data on health expenditure, legal statutes and administrative regulations and is informed by one research question: What background conditions better explain more universal and comprehensive health systems for undocumented migrants? Findings By answering this research question the paper concludes that the Italian health system is more comprehensive than the British health system insofar it guarantees access free of charge to different levels of care, including primary, emergency, preventive and maternity care, while the rule in the British health system is the recovering of charges for the provision of services, with few exceptions. One possible legal explanation for the differences in access between Italy and UK is the fact that the right to health is not recognised as a fundamental constitutional right in the latter as it is in the former. Originality/value The paper contributes to ongoing debates on Universal Health Coverage and migration, and dialogues with recent discussions on social justice and welfare state typologies.

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