The concept of "Health Systems Strengthening" has received a great deal of attention yet not everyone knows what is meant by the term - let alone how to do it. In last month's PLoS Medicine a group of researchers have attempted to pull together a list of 10 guiding principles "necessary for effective HSS".
From their article, the 10 principles are:
From their article, the 10 principles are:
- HOLISM: Consider all systems components, processes, and relationships simultaneously. Include all health systems strengthening principles listed below.
- CONTEXT: Consider global, national, regional, and local culture and politics.
- SOCIAL MOBILIZATION: Mobilize and advocate for social and political change to strengthen health systems and address the social determinants of health.
- COLLABORATION: Develop long-term, equal, and respectful partnerships between donors and recipients within the health sector and among other sectors. Develop and commit to a shared vision among partners by challenging underlying beliefs and assumptions. Ensure frequent communication among actors.
- CAPACITY ENHANCEMENT: Enhance capacity and ownership at all levels, from individuals and households to ministries of health, including leadership, management, institutional strengthening, and problem solving.
- EFFICIENCY: Train and supervise the most appropriate personnel to meet health needs. Utilize appropriate technology. Coordinate external aid and activities. Minimize waste. Allocate funds where they are needed most.
- EVIDENCE-INFORMED ACTION: Strengthen structure, systems, and processes to gather, analyze, and apply data locally. Make decisions, whenever possible, based on evidence. Monitor progress of programs, and adjust accordingly. Ensure transparency and accountability.
- EQUITY: Target those who are disenfranchised. Plan for equity by empowering the disenfranchised, with a particular emphasis on gender. Disaggregate indicators to track disenfranchised groups.
- FINANCIAL PROTECTION: Ensure that funding streams are predictable. Consider insurance schemes to protect from financial catastrophes.
- SATISFACTION: Respond to needs and concerns of all stakeholders. Demonstrate accountability to constituents. Implement and respond to feedback mechanisms measuring quality and provider/client relationships.
Lots of buzzwords here - but lists and frameworks can be helpful and it appears to be based on a great deal of analysis, so I think this might prove to be a useful tool for others as they embark on HSS activities in the coming years.
10 Guiding Principles for Health Systems Strengthening