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.
To sign onto this call, comment below with the following: Your name, affiliation, and location. If you have questions or comments, email firstname.lastname@example.org. You can see the Lancet article here, or the body of the article here.
Call to Action
Those engaged in global health should hold governments and other affiliated organisations accountable for the effect of global health activities on existing health systems
• take the lead in development and dissemination of HSIAs that can be used by all groups associated with global health, and
• include prominent section for development and dissemination of HSIAs on their website
All donors, led by major donors such as the Bill & Melinda Gates Foundation, the US President’s Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank should:
• require that all global health initiatives and programmes that they fund take into account the effect on the existing health system, and
• fund activities to develop and implement effective evidence-based HSIAs
Government leaders and ministry of health personnel, particularly in developing countries, should assess and document effect of global health initiatives and programmes on their existing health system, irrespective of who funds the programme
Academic institutions and researchers should prioritise research for development of HSIAs that are evidence-based and take into account local realities
Non-governmental organisations and staff who participate in humanitarian work should:
• participate in development of and sign onto codes of conduct, such as the NGO Code of Conduct
• take into account effect of their programmes on existing health system, and
• work with academic and other institutions to develop HSIAs that are appropriate to their specific situation
The Alliance for Health Policy and Systems Research, the Health Systems Action Network, the Countdown Working Group on Health Policy and Health Systems, the International Health Impact Assessment Consortium, the Institute for Health Metrics and Evaluation, and others involved in health systems advocacy and research should:
• support development of HSIAs and indicators that are evidence-based, easy to use, and appropriate to the implementing organisation’s capacity and situation
• Collaborate to establish a website where methods and expertise in the conduct of HSIAs are displayed
R. Chad Swanson, DO, Johns Hopkins School of Public Health
Baltimore, MD, USA
Henry Mosley, MD, MPH, Johns Hopkins School of Public Health
Baltimore, MD, USA
David Sanders, MBChB, University of Western Cape
Bellville, Western Cape, South Africa
David Egilman, MD, MPH, Brown University
Providence, RI, USA
Jan De Maeseneer, MD, PhD, Ghent University
Mushtaque Chowdhury, PhD, BRAC University
Claudio F. Lanata, MD, MPH, Nutritional Research Institute
Kirk Dearden, PhD, Boston University
Boston, MA, USA
Malcolm Bryant, MBBS., MPH, Innovative Development Expertise and Advisory Services, Inc
Boston, MA, USA
The idea behind Global Health Systems Impact Assessments is actually quite simple: all global health activities should consider the impact that they have on the underlying health system before their activity begins. The need for these assessments stems from three facts:
1. Millions suffer and die needlessly around the world, mostly in developing countries. This blog will assume that there is agreement on this point. (If needed, however, see here, here, here, here, or here)
2. Functional, vibrant health systems are needed to ensure health. This blog will discuss some of the evidence and rational behind that claim. However, much information can be found on the “Health Systems Links” on the right side of this blog’s home page.
3. Targeted health programs have significant impacts on the underlying health systems, both positively and negatively, sometimes with disastrous consequences. While this blog will likely discuss examples of such programs, documentation can also be found here, here, and here.
We request, then, that all global health program planners in all organizations – from multimillion dollar donors like the global fund and the Gates foundation to district health leaders in Africa – consider the impact that their respective activities will have on health systems building blocks like service delivery mechanisms, the health workforce, and health technologies. This planning, we predict, will lead to systems in developing countries that are less dependent on developed countries’ funds and technical support, and better prepared to respond to future health challenges.