Abstract
BackgroundThis paper argues that the global health agenda tends to privilege short-term global interests at the expense of long-term capacity building within national and community health systems. The Health Systems Strengthening (HSS) movement needs to focus on developing the capacity of local organizations and the institutions that influence how such organizations interact with local and international stakeholders.DiscussionWhile institutions can enable organizations, they too often apply requirements to follow paths that can stifle learning and development. Global health actors have recognized the importance of supporting local organizations in HSS activities. However, this recognition has yet to translate adequately into actual policies to influence funding and practice. While there is not a single approach to HSS that can be uniformly applied to all contexts, several messages emerge from the experience of successful health systems presented in this paper using case studies through a complex adaptive systems lens. Two key messages deserve special attention: the need for donors and recipient organizations to work as equal partners, and the need for strong and diffuse leadership in low-income countries.SummaryAn increasingly dynamic and interdependent post-Millennium Development Goals (post-MDG) world requires new ways of working to improve global health, underpinned by a complex adaptive systems lens and approaches that build local organizational capacity.
Highlights
This paper argues that the global health agenda tends to privilege short-term global interests at the expense of long-term capacity building within national and community health systems
The current interest in health systems strengthening (HSS) provides an opportunity for the global health community to focus on building organizational capacity by improving institutions in low-income countries [1]
Institutions in low-income countries are often focused on short-term, disease specific interventions that lack the sustainability required for strengthening health systems
Summary
How do institutions influence local organizations and health systems in low-income countries? While institutions can enable organizations to realize their potential to strengthen health systems, all too often they force organizations to adopt inefficient behaviours, which stifle learning and development. A recent study of health systems that have achieved ‘good health at low cost’ identified several lessons in relation to factors that improved the success of HSS efforts [21] These lessons include the articulation of a vision and long-term strategy; consideration of the constraints imposed by path dependency; building consensus at a societal level; allowing flexibility and autonomy in decision making; resilience – learning from experiences, feeding back into the policy cycle; support from the broader governance and socioeconomic context in the country; being in harmony with culture and population preferences; achieving synergies among sectors and actors; and demonstrating openness to dialogue and collaboration between public and private sectors, with effective government oversight [21].
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