We believe that systems thinking and complexity science can be transformational in global health by increasing local capacity and shared learning, and minimizing unintended consequences.
Three scientific journal articles were recently published (within just a few months of each other) that review the impact of global health initiatives (mostly HIV related) on underlying health systems:
1. “An assessment of interactions between global health initiatives and country health systems” was published in the Lancet on June 20, 2009. This review is the most comprehensive of the three, and includes action points for all global health players. I was especially struck by their first of 5 recommendations: “Infuse the health systems strengthening agenda with the sense of ambition and speed that has characterized the GHIs.” Health Systems activism is needed!
2. “The effects of global health initiatives on country health systems: a review of the evidence from HIV/AIDS control” was published by the journal “Health Policy and Planning.” The authors found both positive and negative effects: “Positive effects have included a rapid scale-up in HIV/AIDS service delivery, greater stakeholder participation, and channelling of funds to non-governmental stakeholders, mainly NGOs and faith-based bodies. Negative effects include distortion of recipient countries’ national policies, notably through distracting governments from coordinated efforts to strengthen health systems and re-verticalization of planning, management and monitoring and evaluation systems.”
3. The authors of “Global Health Actors Claim To Support Health System Strengthening—Is This Reality or Rhetoric?” discussed the various uses for the term “health systems strengthening”, and found that “most current HSS strategies are in fact selective, disease-specific interventions, and their effects may undermine progress towards the long-term goal of an effective, high-quality, inclusive health system.”
4. (A fourth article, “Investment in HIV/AIDS programs: Does it help strengthen health systems in developing countries?” was published in late 2008).