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.
There is a growing recognition, even a consensus, that health systems must be strengthened to achieve long-term improvements in health, including reaching the MDGs, and that valid tools to assess health systems are needed. While increasing emphasis is being placed on these topics (see here, for example), many questions remain: How should health systems be defined? Which is the best framework? Which indicators should be used to assess health systems performance?, etc. For a more detailed discussion of this topic, see this World Bank health systems workshop.
While it seems likely that there will never be a consensus on health systems frameworks and indicators, it does seem clear that there are some underlying principles that should guide the process of assessing and strengthening health systems. I am not referring to abstract concepts that are difficult to define and apply. I am referring to concrete, widely-accepted principles that, when applied, will produce a health system that is robust, efficient, and equitable. Here are a couple examples of potential principles, based on conversations that I’ve had with Henry Mosley, David Sanders, Malcolm Bryant, and others:
1. The focus and structure of health systems should be appropriate for the underlying disease burden, anticipated disease burden, and most efficient interventions. For example, much of the disease burden in developing countries can be most efficiently addressed on a household level. As such, the focus and structure of the health system (and, therefore, health programs and initiatives) should reflect that reality (community health workers, household behavior change interventions, etc.)
2. Local health workers’ capacity to identify and solve problems independently should be a major component of health systems strengthening. The health needs of any given community is continuously in a state of flux due to emerging diseases, changing demographics, environmental change, drug resistance, etc.
A group has been formed to draft a consensus statement that outlines such principles, and we are planning on disseminating it widely. (See here, and here, for examples of consensus statements). Such a document could have a significant impact on global health planning and policy. I envision a team composed of 1-3 primary authors, a working group of 20-30 that revise drafts, and hundreds of other contributors. We will, I hope, publish it in a high profile journal, advertise it widely in the media, and use it to leverage health decision makers through out the globe. I am not aware of such a document. Does one already exist?
Your involvement in this project could range from occasional, brief comments, to assisting frequently with the writing and advertising. I will plan on organizing the contributors, working as the primary writer (unless someone else wants to), and advertising by attending several global health conferences in the next year. I personally view this as a very important project that can make a significant impact. I’m wiling to put in the work to make it happen.
About 15 experienced global health professionals and health systems experts have already volunteered to review the document. In addition, I will be attending a number of conferences in the coming year to advertise and seek guidance.
Please let me know what you think of this idea, and how you would like to contribute. Be specific; let me know even if you only want to be included on the discussion. Also, please forward this to any of your colleagues, especially those that have extensive “on the ground” experience. Comment below, or email: ghsias at gmail dot com.
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