Sustaining Health Gains – Building Systems
Health Systems Report to Congress
Strengthening the health systems of developing countries is a central goal of USAID health programming. Achieving this goal is critical to sustaining improvements in outcomes in health- or disease-specific areas, and is a significant factor in supporting overall development in partner countries. The Omnibus Appropriations Act for 2009 (HR1005, 2009) requested that USAID “provide a report … on current efforts to strengthen health systems, include spending by program, and progress made.” In October 2009, USAID released Sustaining Health Gains – Building Systems: Health Systems Report to Congress [PDF, 3.2MB].
According to the World Health Organization (WHO), a health system consists of all organizations, people, and actions whose primary intent is to promote, restore, or maintain health. WHO has defined six core functions of a working health system. They are service delivery; human resources; information; medical supplies, vaccines, and technology; health financing; and governance and leadership. Health systems strengthening is defined by WHO as any array of initiatives and strategies that leads to better health through improvements in one or more of the health system’s functions, measured by increased access, coverage, quality, or efficiency, and that implies a measurable and sustainable improvement in performance.
While many kinds of activities can contribute to strengthening health systems, USAID uses a strategic approach that is based on extensive evidence and experience to target the most critical health systems function needs and elements. USAID helps countries move toward sustainability through continued integration of disease-specific interventions and information to promote health and prevent disease into the broader health system – increasing efficiency while protecting progress on disease-specific interventions.
The report highlights USAID activities to:
- Strengthen Health Systems in Low-Income Countries
Even in countries with low resources, strained human capital, and weak infrastructure, USAID has worked to find solutions to health systems problems that result in public health impact. The work described in Rwanda, Ethiopia, Kenya, Kyrgyzstan, Haiti, and Yemen shows USAID’s contribution to the development of health systems and the impact these contributions have had on the health of these countries’ citizens.
- Strengthen Health Systems in Post-Conflict and Conflict Countries
As countries transition from relief to development, to make an impact on health status, the basic elements of a health system must be built or rebuilt. The work described in Southern Sudan, Liberia, and Afghanistan shows USAID’s contribution to ensuring that basic health services are delivered to the people of post-conflict settings under national policy frameworks that legitimize the government, improve health outcomes, and put the country on the path toward development.
- Strengthen Health Systems in More Advanced Developing Countries
Health systems in more advanced developing countries are typically able to provide basic preventive, promotive, and curative care to a large portion of their population, while also making progress with quality improvement and equitable financing. The work described in Peru, Honduras, Armenia, Egypt, South Africa, Nicaragua, and Georgia shows USAID’s contribution to the development of these countries’ health systems and the impact these contributions have had on sustained improvements in health outcomes, especially those for poor and underserved populations.
- Promote Best Practices in Research and International Technical Collaboration
USAID conducts health systems research and evaluation to identify, test, and facilitate partner country introduction and scale-up of best practices that reduce the burden of disease due to the major causes of mortality and severe morbidity. USAID Missions help strengthen the capacity of ministries of health to employ evidence-based approaches and build the capacity of partner country researchers to contribute to improved health.
- Measure Progress in Health Systems Strengthening
Given the complexity of health system strengthening interventions and the need to tailor interventions based on country situations, the global community has yet to reach a consensus on internationally approved indicators and benchmarks to measure health systems strengthening. USAID currently collaborates with the Health Metrics Network, WHO, and other research centers in the United States and overseas that are devoted to the development of better consensus health systems indicators and progress measurement tools.
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