DfID is developing a framework for health systems strengthening. This roundtable discussion in June 2015 brought together HEART members to draw on their research findings to inform the framework. It was a response to an enquiry into DFID funded work to inform DFID programmes in a review. This HEART talks includes the presentations from three DFID funded research programme consortia on ReBUILD, COMDIS-HSD, and Future Health Systems.
Tim Martineau on ReBUILD: Research for Building pro-poor health systems during recovery from conflict
Tim Martineau is a Research Director for the ReBUILD programme. ReBUILD is a 6-year research programme which started in 2011. In his presentation he describes the research which focuses on health systems as they emerge from conflict. They take a historical lens to try to understand key decisions that have been made in the areas of health financing and human resources.
The research contributes to the health systems strengthening framework in five areas: 1) a historical perspective on the policy context; 2) actors and power; 3) health systems resilience; 4) gender and equity; and 5) the social contract, the relationship between the state and users and how this contributes to the effectiveness of health services. The ReBUILD approach focuses on building local capacity to carry out health service reform and research uptake. This includes using in-country researchers. It aims to benefit from multi-project and multi-partner programmes.
John Walley on the COMDIS-HSD approach to health systems and services strengthening
COMDIS-HSD research looks at service delivery for communicable diseases and non-communicable diseases (NCDs). In this presentations John Walley, the COMDIS co-research director, focuses on the health systems and services strengthening areas that they work on.
COMDIS-HSD are looking to ensure the right drugs are included on the WHO essential drugs list. They work on human resources – the right kind of training and performance management. They also look at health financing, particularly aiming to influence governments to finance preventive treatment for communicable and non-communicable diseases. John presents a model from their findings on Tuberculosis (TB) care which they apply to the components of service delivery for NCDs and multi-drug resistant TB.
With Health Management Information Systems they have been looking not at creating something new but looking at ways to work with what already exists. The work of COMDIS-HSD emphasises understanding, working with, and strengthening the district health system and not by-passing it.
David Peters on lessons for health systems strengthening from Future Health Systems research
David Peters is a professor at Johns Hopkins Bloomberg School of Public Health and one of the research directors for the Future Health Systems (FHS) research consortium. In this presentation he speaks about the lessons FHS have learned about health systems strengthening.
The first lesson is that they are beyond the stage of simply picking cost-effective interventions and moving away from funding WHO “building blocks”, the inputs of a health system. Their research has found that even the simplest intervention involves complex social interactions which needs to be recognised. They also highlight that reaching the poor and marginalised requires particular effort.
FHS emphasises the need to focus on implementation. Successful interventions to strengthen health have been identified but there is no single blue-print. Rather there are some universal principles and processes: 1) a “learning and doing” approach underlies successful implementation of many different strategies; and 2) flexibility, data, and involvement of key stakeholders and implementation support are all needed to address complex and changing conditions.
David discusses learning from the Ebola outbreak. He concludes with recommendations for how DFID should intervene in health systems in low- and middle-income countries:
- Listen to the voice of the disadvantaged
- Find the best evidence – “evidence-informed public health” + implementation evidence
- Use a “systems lens” to look across the health system for resources and effects
- Customise interventions to address local capabilities and constraints
- Adapt and experiment, focus on implementation for sustainable systems
- Pay attention to governance and institution-building
- Measure, disclose results, learn – especially to see that the poor are benefiting and that constraints are being addressed