Health system strengthening-Reflections on its meaning, assessment, and our state of knowledge.
health system strengthening
low- and middle-income countries
Journal
The International journal of health planning and management
ISSN: 1099-1751
Titre abrégé: Int J Health Plann Manage
Pays: England
ID NLM: 8605825
Informations de publication
Date de publication:
Oct 2019
Oct 2019
Historique:
received:
01
07
2019
revised:
29
07
2019
accepted:
30
07
2019
pubmed:
7
8
2019
medline:
29
5
2020
entrez:
7
8
2019
Statut:
ppublish
Résumé
Comprehensive reviews of health system strengthening (HSS) interventions are rare, partly because of lack of clarity on definitions of the term but also the potentially huge scale of the evidence. We reflect on the process of undertaking such an evidence review recently, drawing out suggestions on definitions of HSS and approaches to assessment, as well as summarising some key conclusions from the current evidence base. The key elements of a clear definition include, in our view, consideration of scope (with effects cutting across building blocks in practice, even if not in intervention design, and also tackling more than one disease), scale (having national reach and cutting across levels of the system), sustainability (effects being sustained over time and addressing systemic blockages), and effects (impacting on health outcomes, equity, financial risk protection, and responsiveness). We also argue that agreeing a framework for design and evaluation of HSS is urgent. Most HSS interventions have theories of change relating to specific system blocks, but more work is needed on capturing their spillover effects and their contribution to meeting overarching health system process goals. We make some initial suggestions about such goals, to reflect the features that characterise a "strong health system." We highlight that current findings on "what works" are just indicative, given the limitations and biases in what has been studied and how, and argue that there is need to rethink evaluation methods for HSS beyond finite interventions and narrow outcomes. Clearer concepts, frameworks, and methods can support more coherent HSS investment.
Types de publication
Journal Article
Langues
eng
Pagination
e1980-e1989Subventions
Organisme : Department for International Development
ID : Supported by the ReBUILD and ReSYST RPCs
Informations de copyright
© 2019 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.
Références
Witter S, Palmer N, Balabanova D, et al. Evidence review of what works for health system strengthening, where and when? Prepared by the ReBUILD and ReSYST research consortia for DFID. 2019.
Reich M, Takemi K, Roberts M, Hsiao WC. Global action on health systems: a proposal for the Tokyo G8 summit. Lancet. 2008;371(9615):865-869.
Balabanova M, McKee M, Mills A, Walt G, Haines A. What can global health institutions do to help strengthen health systems in low income countries? Health Res Policy Syst. 2010;29(8):22.
Marchal B, Cavalli A, Kegels G. Global health actors claim to support health system strengthening-is this reality or rhetoric? PLoS Med. 2009;6(4):e1000059.
World Health Organisation. Health Systems Strengthening Glossary; 2019. Retrieved online. https://www.who.int/healthsystems/hss_glossary/en/index5.html
Chee G, PIelemeier N, Lion A, Gonnor C. Why differentiating between health system support and health system strengthening is needed. Int J Health Plann Manage. 2013;28(1):85-94.
WHO. Monitoring the Building Blocks of Health Systems: A Handbook of Indicators and Their Measurement Strategies. Geneva: World Health Organisation; 2010.
Adam T, De Savigny D. Systems thinking for strengthening health systems in LMICs: Need for a paradigm shift. Health Policy Plan. 2012;27(4):iv1-iv3.
Ager A, Saleh S, Wurie H, Witter S. Health in situations of fragility: a systems for health approach. WHO Bull. 2019;97:378-378A.
Hatt L, Johns B, Connor C, Meline M, Kukia M, Moat K. Impact of Health Systems Strengthening on Health. Bethesda, MD: Health Finance & Governance Project, Abt Associates; 2015.
Balabanova D, McKee M, Mills A. ‘Good Health at Low Cost' 25 years on: What Makes a Successful Health System? London: London School of Hygiene & Tropical Medicine; 2011.
Balabanova D, Mills A, Conteh L, et al. Good health at low cost 25 years on: lessons for the future of health systems strengthening. Lancet. 2013;381(9883):2118-2133.
Watt N, Sigfrid L, Legido-Quigley H, et al. Health systems facilitators and barriers to the integration of HIV and chronic disease services: a systematic review. Health Policy Plan. 2017;32(4):iv13-iv26.
Mutale W, Vardoy-Mutale AT, Kachemba A, Mukendi R, Clarke K, Mulenga D. Leadership and management training as a catalyst to health system strengthening in low-income settings: evidence from implementation of the Zambia Management and Leadership course for district health managers in Zambia. PLoS One. 2017;12(7):e0174536.
Samuels F, Amaya AB, Balabanova D. Drivers of health system strengthening: Learning from implementation of maternal and child health programmes in Mozambique, Nepal and Rwanda. Health Policy Plan. 2017;32(7):1015-1031.
Ciccone DK, Vian T, Maurer L, Bradley EH. Linking governance mechanisms to health outcomes: a review of the literature in low- and middle-income countries. Soc Sci Med. 2014;117:86-95.
Panda B, Thakur HP. Decentralization and health system performance-a focused review of dimensions, difficulties, and derivatives in India. BMC Health Serv Res. 2016;16(6):561.
Buchan J, Couper ID, Tangcharoensathien V, et al. Early implementation of WHO recommendations for the retention of health workers in remote and rural areas. Bull World Health Organ. 2013;91(11):834-840.
Behera MR, Prutipinyo C, Sirichotiratana N, Viwatwongkasem C. Interventions for improved retention of skilled health workers in rural and remote areas. Ann Trop Med Public Health. 2017;10(1):16.
Koot J, Martineau T. Zambian Health Workers Retention Scheme (ZHWRS) 2003-2004. Lusaka: Ministry of Health; 2005.
Gow J, George G, Mwamba S, Ingombe L, Mutinta G. An evaluation of the effectiveness of the Zambian Health Worker Retention Scheme (ZHWRS) for rural areas. Afr Health Sci. 2013;13(3):800.
Dawson AJ, Buchan J, Duffield C, Homer CS, Wijewardena K. Task shifting and sharing in maternal and reproductive health in low-income countries: a narrative synthesis of current evidence. Health Policy Plan. 2014;29(3):396-408.
Scott K, Beckham SW, Gross M, et al. What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Hum Resour Health. 2018;16(1):39.
McCollum R, Gomez W, Theobald S, Taegtmeyer M. How equitable are community health worker programmes and which programme features influence equity of community health worker services? A systematic review. BMC Public Health. 2016;16(1):419.
Witter S, Fretheim A, Kessy FL, Lindahl AK. Paying for performance to improve the delivery of health interventions in low- and middle-income countries. Cochrane Database Syst Rev. 2012;2:CD007899.
Tambulasi RI. Reforming the Malawian Public Sector: Retrospectives and Prospectives. Dakar: Council for the Development of Social Science Research in Africa; 2010.
Vasan A, Mabey DC, Chaudhri S, Epstein HAB, Lawn SD. Support and performance improvement for primary health care workers in low- and middle-income countries: a scoping review of intervention design and methods. Health Policy Plan. 2017;32(3):437-452.
Rowe AK, Labadie G, Jackson D, Vivas-Torrealba C, Simon J. Improving health worker performance: an ongoing challenge for meeting the sustainable development goals. BMJ. 2018;362:k2813.
Makuta I, O'Hare B. Quality of governance, public spending on health and health status in Sub Saharan Africa: a panel data regression analysis. BMC Public Health. 2015;21(15):932.
Marchal B, Dedzo M, Kegels G. A realist evaluation of the management of a well-performing regional hospital in Ghana. BMC Health Serv Res. 2010;10(1):24.
Farag M, Nandakumar AK, Wallack S, Hodgkin D, Gaumer G, Erbil C. Health expenditures, health outcomes and the role of good governance. Int J Health Care Finance Econ. 2013;13(1):33-52.
Negeri KG, Halemariam D. Effect of health development assistance on health status in sub-Saharan Africa. Risk Manag Healthcare Policy. 2016;9:33-42.
Gyimah-Brempong K. Do African Countries get Health from Health aid? Tampa, FL: University of South Florida, Department of Economics; 2015.
Commins S, Davies F, Gordon A, Hodson E, Hughes J, Lister S. Pooled funding to support service delivery: lessons of experience from fragile and conflict-affected states. London: DFID; 2013. Retrieved online. https://assets.publishing.service.gov.uk/media/57a08a10ed915d622c00053d/61050-PFs-Full_Volume_May2013_.pdf
Odendaal W, Ward K, Uneke J, et al. Contracting out to improve the use of clinical health services and health outcomes in low- and middle-income countries (Review). Cochrane Database Syst Rev. 2018;4:CD008133.
Briggs CJ, Garner P. Strategies for integrating primary health services in middle- and low-income countries at the point of delivery. Cochrane Database Syst Rev. 2006;19(2):CD003318.
Schiffman J, Darmstadt GL, Agarwal S, Baqui AH. Community-based intervention packages for improving perinatal health in developing countries: a review of the evidence. Semin Perinatol. 2010;34(6):462-476.
Kalyango JN, Alfven T, Peterson S, Mugenyi K, Karamagi C, Rutebemberwa E. Integrated community case management of malaria and pneumonia increases prompt and appropriate treatment for pneumonia symptoms in children under five years in Eastern Uganda. Malar J. 2013;12(1):1.
Ratnayake R, Ratto J, Hardy C, et al. The effects of an integrated community case management strategy on the appropriate treatment of children and child mortality in Kono District, Sierra Leone: a program evaluation. Am J Trop Med Hyg. 2017;97(3):964-973.
Graven M, Allen P, Smith I, MacDonald NE. Decline in mortality with the Belize integrated patient-centred country wide health information system (BHIS) with embedded program management. Int J Med Inform. 2013;82(10):954-963.
Rahman A, Moran A, Pervin J, et al. Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh. BMC Public Health. 2011;11(1):914.
Lindegren ML, Kennedy CE, Bain-Brickley D, et al. Integration of HIV/AIDS services with maternal, neonatal and child health, nutrition, and family planning services. Cochrane Database Syst Rev. 2012;9:CD010119.
Gera T, Shah D, Garner P, Richardson M, Sachdev HS. Integrated management of childhood illness (IMCI) strategy for children under five. Cochrane Database Syst Rev. 2016;6:CD010123.
Arifeen SE, Blum LS, Hoque DM, et al. Integrated Management of Childhood Illness (IMCI) in Bangladesh: early findings from a cluster-randomised study. Lancet. 2004;364(9445):1595-1602.
Bryce J, Victora CG, Habicht JP, Black RE, Scherpbier RW. Programmatic pathways to child survival: results of a multi-country evaluation of integrated management of childhood illness. Health Policy Plan. 2005;20(1):i5-i17.
Barasa E, Mbau R, Gilson L. What is resilience and how can it be nurtured? A systematic review of empirical literature on organizational resilience. Int J Health Policy Manag. 2018;7(6):491-503.
Witter S, Jensen C. Learning health systems in low and middle income countries: background paper for alliance for health policy and systems research, Geneva; 2019.
Alameddine M, Fouad FM, Diaconu K, et al. Resilience capacities of health systems: accommodating the needs of Palestinian refugees from Syria. Soc Sci Med. 2019;220:22-30.
Workie NW, Shroff E, Yazbeck AS, Nguyen SN, Karamagi H. Who needs big health sector reforms anyway? Seychelles' road to UHC provides lessons for sub-Saharan Africa and island nations. Health Syst Reform. 2018;4(4):362-371.
Cleary S, Erasmus E, Gilson L, et al. The everyday practice of supporting health system development: learning from how an externally-led intervention was implemented in Mozambique. Health Policy Plan. 2018;33(7):801-810.
Gilson L, Barasa E, Nxumalo N, et al. Everyday resilience in district health systems: emerging insights from the front lines in Kenya and South Africa. BMJ Glob Health. 2017;2(2):e000224.