scholarly journals Institutionalizing Leadership Management and Governance for Health System Strengthening in Emerging Economies: Evidence from the Partnership for Health System Strengthening in Africa (PHSSA)Programme

2021 ◽  
Vol 6 (6) ◽  
pp. 47-52
Author(s):  
Jennifer Chepkorir ◽  
Naphtali Agata ◽  
Nicholas Kiambi ◽  
Brenda Nangehe
Keyword(s):  
Health System ◽  
Health Systems ◽  
Universal Coverage ◽  
Emerging Economy ◽  
Sub Saharan Africa ◽  
Health System Strengthening ◽  
Health Coverage ◽  
Leadership Management ◽  
Health System Governance ◽  
Universal Health

Health systems in an emerging economy, specifically Sub-Saharan Africa (SSA) are characterized as fragile with low implementation of Universal Health Coverage. While acknowledging that the cause of the inadequacy in emerging economies is multi-factorial, other arguments are that the root cause is inadequate political and technical leadership. Evidence reveals that visionary, imaginative, decisive, responsible, and responsive leadership is insufficient to persuade all stakeholders in low-income nations in Sub-Saharan Africa to work together to attain the constructive goal of universal coverage. On the contrary, other academics suggest that successful leadership would establish a clear national vision for universal coverage and a commitment to achieving that objective over time. These contrasting observations motivated an interrogation of the link between health system governance and Universal Health Coverage in an emerging economy taking evidence from the PHSSA programme. Through a meta-analysis of the existing literature as well as analysis of the findings from the programme, the paper explores experiences, critical success factors and recommendations for improvement of UHC through institutionalizing health system governance in an emerging economy. The research provides evidence that the governance linkages in health systems and the outcomes they produce are contingent rather than assured, due to the variety and complexity inherent in the health system governance paradigm. The situation-specific setting of a country's health system determines what can be accomplished through health governance strategy design and implementation efforts. The paper recommends a need to create a conducive environment for adoption of health systems programmes by contextualizing health governance with regard to the larger set of governance institutions that surround it. A competency framework should also be adopted in recruitment of competent health managers. The study also recommends a need for the countries in seeking to institutionalize health system governance to develop and support an organizational structure and context that sustains leadership practices through advocacy, create an enabling environment for health systems leadership, management and governance through the development of ethics and other competences specific to universal health care situations as well as provide proper financial support system so that institutionalization of leadership, management and governance can have maximum impact on the effectiveness and efficiency of health systems. There is also a need to institutionalize short courses, seminars and conferences in health leadership, management, and governance so as to entrench participatory leadership in health systems.

scholarly journals 31.F. Workshop: Health system (performance) assessment: working towards a common approach

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Health System ◽  
Performance Assessment ◽  
Health Systems ◽  
Universal Health Coverage ◽  
System Performance ◽  
Health System Performance ◽  
Health Coverage ◽  
Health System Performance Assessment ◽  
Health Systems Performance ◽  
Universal Health

Abstract Since the publication of the World Health Report 2000, which aimed at assessing health systems performance globally, a number of health systems performance assessment (HSPA) frameworks and tools, designed for various purposes, have emerged. In 2017, the joint Universal Health Coverage 2030 Technical Working Group on Health Systems Assessment (TWG), consisting of health policy makers and global actors, such as the WHO, World Bank, USAID, Unicef, European Commission, OECD, etc., was formed with the aim to align the existing tools and develop a common approach to understanding and measuring health systems performance globally. As part of this work, the European Observatory on Health Systems and Policies (OBS) has developed a Health Systems Performance Assessment framework for Universal Health Coverage (HSPA Framework for UHC), that allows to evaluate health system performance, largely by drawing on the information available in the existing tools or through global data collection initiatives. Suggested approach is based on the detailed assessment of the four health system functions (governance, financing, resource generation and service delivery) and their sub-functions, the interaction of which jointly leads to the successes and failures in the achievement of health system goals. We propose distinct assessment areas for specific functions and sub-functions as a way to identify potential strengths and weaknesses, which can then be related to actions or responsibilities of specific actors within a health system, or linkages to other sectors. The objective of the workshop is to introduce the background, rationale, methods and process of developing of the HSPA framework for UHC; present a systematic approach to assessing various functions of health system and their interactions; relate the assessment areas of specific functions and sub-functions to the final health system goals; and, finally, to test the use of the framework in practice. The workshop is structured as follows: the workshop will start from the four 10-minute presentations (outlined below), followed by an interactive session with the audience to discuss the content of the framework and elaborate on its potential use for HSPA and applications globally. Key messages The HSPA framework for UHC is an approach that allows to bring together existing HSPA efforts and moves towards a more systematic and universally applicable health system performance assessment. The approach assesses performance through attribution of various health system outcomes to specific functions and sub-functions, allowing to identify strengths and weaknesses that affect performance.

Universal Health Coverage

2021 ◽  
pp. 134-153
Author(s):  
Joia S. Mukherjee
Keyword(s):  
Health Systems ◽  
Universal Health Coverage ◽  
Quality Care ◽  
Universal Coverage ◽  
Health Coverage ◽  
Quality Health Care ◽  
The Sustainable Development ◽  
Quality Health ◽  
The Right ◽  
Universal Health

As part of the Sustainable Development Goals the right to health is captured under the rubric of universal health coverage (UHC). That is that all people should have access to the high quality care they need without suffering financial hardship. This chapter explores this seminal topic reviewing the theory of universal coverage and definitions that shape the current conversation about UHC. This chapter also highlights some important steps taken by countries to expand access to quality health care but challenges the rhetoric that financing care through insurance schemes, a common approach to UHC) is sufficient when the inputs into the health systems do not match the disease burden. Finally, the chapter investigates the theory and practice behind a morbidity-based approach to strengthening health systems and achieving UHC.

scholarly journals How Clinical Research Can Contribute to Strengthening Health Systems in Low Resource Countries

2020 ◽  
Vol 5 (2) ◽  
pp. 48
Author(s):  
Florent Mbo ◽  
Wilfried Mutombo ◽  
Digas Ngolo ◽  
Patrice Kabangu ◽  
Olaf Valverde Mordt ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Research ◽  
Health System ◽  
Health Systems ◽  
Neglected Tropical Diseases ◽  
Information Provision ◽  
International Standards ◽  
Sub Saharan Africa ◽  
Health System Strengthening ◽  
Low Resource

Clinical research on neglected tropical diseases is a challenge in low-resource countries, and the contribution of clinical and operational research to health system strengthening is poorly documented. Developing new, simple, safe, and effective treatments may improve the effectiveness of health systems, and conducting research directly in health structures may have an additional impact. This study describes the process of conducting clinical trials in the Democratic Republic of Congo (DRC) in compliance with international standards, and the role of the trials in strengthening health system functions, including governance, human resources, health information, provision of care, and the equipping of health services with the necessary supplies and infrastructure. We conclude that conducting clinical trials in endemic areas has not only reinforced and supported the aim of conducting high-level clinical research in endemic countries, but has also brought lasting benefits to researchers, staff, and hospitals, as well as to broader health systems, which have positive knock-on effect on patients outside of the clinical trials and their communities. Sustainability, however, remains a challenge in an underfunded health system, especially with respect to specialized equipment. Clinical research in most of sub-Saharan Africa is highly dependent on international input and external technical support; there are areas of weaknesses in trial design and documentation, as well as in data management and analysis. Financing remains a critical issue, as African investigators have difficulties in directly accessing sources of international research funding.

scholarly journals Prevention of Congenital Transmission of Malaria in Sub-Saharan African Countries: Challenges and Implications for Health System Strengthening

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Kayode O. Osungbade ◽  
Olubunmi O. Oladunjoye
Keyword(s):  
Health System ◽  
Health Systems ◽  
Preventive Measures ◽  
Sub Saharan Africa ◽  
Health System Strengthening ◽  
African Countries ◽  
Congenital Transmission ◽  
Public Health Burden ◽  
Sub Saharan ◽  
Congenital Malaria

Objectives. Review of burden of congenital transmission of malaria, challenges of preventive measures, and implications for health system strengthening in sub-Saharan Africa.Methods. Literature from Pubmed (MEDLINE), Biomed central, Google Scholar, and Cochrane Database were reviewed.Results. The prevalence of congenital malaria in sub-Saharan Africa ranges from 0 to 23%. Diagnosis and existing preventive measures are constantly hindered by weak health systems and sociocultural issues. WHO strategic framework for prevention: intermittent preventive therapy (IPT), insecticide-treated nets (ITNs), and case management of malaria illness and anaemia remain highly promising; though, specific interventions are required to strengthen the health systems in order to improve the effectiveness of these measures.Conclusion. Congenital malaria remains a public health burden in sub-Saharan Africa. Overcoming the challenges of the preventive measures hinges on the ability of national governments and development partners in responding to the weak health systems.

21.G. Round table: Strengthening national level health systems governance

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Health Care ◽  
Health System ◽  
Eastern Europe ◽  
Health Systems ◽  
Universal Health Coverage ◽  
National Level ◽  
Health Coverage ◽  
Policy Makers ◽  
Universal Health ◽  
Health Systems Governance

Abstract Very often, important health system reforms are delayed, rendered ineffective or they simply go badly wrong. All too often this happens not because of a lack of money, health workers or health care facilities but because we adopt unfit ideas and decision and/or implement them insufficiently. The incapacity to develop, adopt and implement good decision is quintessentially the definition of bad governance. If we are to develop our health systems towards Universal Health Coverage and health systems performance improvement, we will need to strengthen our health system governance. Governance is vitally important to health systems reform and refers to how decisions are made and implemented - everything from the ability of policy-makers to take evidence-based and relevant decisions to their ability to implement policies and create alignment between different actors. In this workshop we will share experiences from a governance spring course for policy makers from Eastern Europe and Central Asia. Connected to this we will also share preliminary results of a study on National Level Health Systems Governance. The panelists will address five key issues The contribution of governance to Universal Health Coverage. This contribution will focus on a) the concept of governance defined as the way societies make and implement collective decisions and b) its 5 main domains including transparency, accountability, participation, integrity and capacity. (S Greer)Governance improvement needs in Eastern Europe and Central Asia: experiences from working with policy makers including countries like Azerbaijan, Georgia, Kyrgyzstan, Moldova Tajikistan, Ukraine and Uzbekistan. For purpose of peer-learning and contrasting experiences we have paired these countries with policy makers from Austria, Finland and Ireland (G Pastorino)Stakeholder participation in decision making and implementation: Very often, powerful stakeholders, like the medical profession, is over-represented and exerts immense veto power, while the voice of other professions, patients, and citizens remained unheard. What are the governance strategies and instruments to harness those underrepresented stakeholders for Universal Health Coverage? (G Fattore)Governing centralized and decentralized budgets in primary, social and hospital care: population-based health care in larger countries requires decentralization of part of the health care budget. What are the accountability lines and instruments that ensure that regional and local budget holders aligning with national policies for Universal Health Coverage? (L Hawkins)Governance contribution addressing corruption: According to surveys health systems are perceived prone to corruption. What is the contribution of governance to heal corruption and make the system work according to rules? (D Clarke) Key messages If we are to make progress towards Universal Health Coverage, we will need to strengthen health systems governance. Without strengthening health systems governance we will fail to manage stakeholders, budgets and corruption.

scholarly journals The road to universal health coverage: an overview of global and Indian scenarios

2021 ◽  
Vol 8 (5) ◽  
pp. 2601
Author(s):  
Anugraha John ◽  
Hari Teja Avirneni ◽  
Sinthu Sarathamani Swaminathan
Keyword(s):  
Health Insurance ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Universal Coverage ◽  
World Health ◽  
Health Coverage ◽  
Health Care Workforce ◽  
The Road ◽  
Global Movement ◽  
Universal Health

The declaration of World Health Assembly in the year 2005 paved the way for all the member states to plan for the transition towards universal coverage to their respective citizens. This was underpinned by the notion that access to quality basic and essential health services has to be made available for everyone to combat poverty and to achieve the developmental goals worldwide. This global movement towards universal coverage is considered as one of the greatest transitions in health, the other being the demographic transition and epidemiological transition. Since the adoption of Universal Health Coverage (UHC), the road taken by each country to achieve UHC is diverse and unique to its culture, needs of people and health systems in the respective country. However, all these approaches have a commonality of promoting and providing health insurance as an important mechanism to achieve UHC. Providing health insurance to ensure health coverage for all the citizens has been well tested and proved to be a viable option. But, addressing other needs and requirements of health systems such as expansion of health infrastructure, reinforcement of the health care workforce and reorganization of the existing health systems in line with newer policies is also extremely important.

Health workers and health systems

2018 ◽  
pp. 40-43
Author(s):  
Kate Mandeville ◽  
Ingrid Wolfe
Keyword(s):  
Health System ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Health Workers ◽  
Critical Role ◽  
Good Health ◽  
Health Coverage ◽  
Historical Factors ◽  
Equity Of Access ◽  
Universal Health

This chapter describes the critical role that health workers and strong health systems play in improving maternal and child health. A strong health system should deliver improved health, financial protection, equity of access, and a responsive service. Delivering these goals relies on strengthening all parts of the health system, in the context of social, political, and historical factors. There are many lessons to be learned from country experiences, including the importance of universal health coverage and investment in health workers. Universal health coverage is vital for ensuring good health for all; however, both establishing and expanding such coverage is fraught with challenges. Health workforces need to be aligned to a country’s population and disease burden, with retention of health workers given as much priority as increased production. Strengthening health systems is an essential part of the global effort to safeguard health for mothers and children, now and in the future.

scholarly journals District-level health system strengthening for universal health coverage: evidence from a longitudinal cohort study in rural Madagascar, 2014-2018

2020 ◽  
Vol 5 (12) ◽  
pp. e003647
Author(s):  
Andres Garchitorena ◽  
Ann C Miller ◽  
Laura F Cordier ◽  
Marius Randriamanambintsoa ◽  
Hery-Tiana R Razanadrakato ◽  
...  
Keyword(s):  
Health System ◽  
Child Mortality ◽  
Universal Health Coverage ◽  
Mortality Rates ◽  
Health System Strengthening ◽  
Care Seeking ◽  
Health Coverage ◽  
Longitudinal Cohort ◽  
Geographical Inequalities ◽  
Universal Health

IntroductionDespite renewed commitment to universal health coverage and health system strengthening (HSS) to improve access to primary care, there is insufficient evidence to guide their design and implementation. To address this, we conducted an impact evaluation of an ongoing HSS initiative in rural Madagascar, combining data from a longitudinal cohort and primary health centres.MethodsWe carried out a district representative household survey at the start of the HSS intervention in 2014 in over 1500 households in Ifanadiana district, and conducted follow-up surveys at 2 and 4 years. At each time point, we estimated maternal, newborn and child health coverage; economic and geographical inequalities in coverage; and child mortality rates; both in the HSS intervention and control catchments. We used logistic regression models to evaluate changes associated with exposure to the HSS intervention. We also estimated changes in health centre per capita utilisation during 2013 to 2018.ResultsChild mortality rates decreased faster in the HSS than in the control catchment. We observed significant improvements in care seeking for children under 5 years of age (OR 1.23; 95% CI 1.05 to 1.44) and individuals of all ages (OR 1.37, 95% CI 1.19 to 1.58), but no significant differences in maternal care coverage. Economic inequalities in most coverage indicators were reduced, while geographical inequalities worsened in nearly half of the indicators.ConclusionThe results demonstrate improvements in care seeking and economic inequalities linked to the early stages of a HSS intervention in rural Madagascar. Additional improvements in this context of persistent geographical inequalities will require a stronger focus on community health.

scholarly journals Policy dialogue as a collaborative tool for multistakeholder health governance: a scoping study

2020 ◽  
Vol 4 (Suppl 7) ◽  
pp. e002161
Author(s):  
Emilie Robert ◽  
Dheepa Rajan ◽  
Kira Koch ◽  
Alyssa Muggleworth Weaver ◽  
Denis Porignon ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Low Income ◽  
Collaborative Governance ◽  
Development Aid ◽  
Policy Dialogue ◽  
Health Coverage ◽  
Scoping Study ◽  
Universal Health

IntroductionHealth system governance is the cornerstone of performant, equitable and sustainable health systems aiming towards universal health coverage. Global health actors have increasingly been using policy dialogue (PD) as a governance tool to engage with both state and non-state stakeholders. Despite attempts to frame PD practices, it remains a catch-all term for both health systems professionals and researchers.MethodWe conducted a scoping study on PD. We identified 25 articles published in English between 1985 and 2017 and 10 grey literature publications. The analysis was guided by the following questions: (1) How do the authors define PD? (2) What do we learn about PD practices and implementation factors? (3) What are the specificities of PD in low-income and middle-income countries?ResultsThe analysis highlighted three definitions of policy dialogue: a knowledge exchange and translation platform, a mode of governance and an instrument for negotiating international development aid. Success factors include the participants’ continued and sustained engagement throughout all the relevant stages, their ability to make a constructive contribution to the discussions while being truly representative of their organisation and their high interest and stake in the subject. Prerequisites to ensuring that participants remained engaged were a clear process, a shared understanding of the goals at all levels of the PD and a PD approach consistent with the PD objective. In the context of development aid, the main challenges lie in the balance of power between stakeholders, the organisational or technical capacity of recipient country stakeholders to drive or contribute effectively to the PD processes and the increasingly technocratic nature of PD.ConclusionPD requires a high level of collaborative governance expertise and needs constant, although not necessarily high, financial support. These conditions are crucial to make it a real driver of health system reform in countries’ paths towards universal health coverage.

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