Abstract
Weaknesses in health systems contribute to a failure to improve health outcomes in developing countries, despite increased official development assistance. Changes in the demands on health systems, as well as their scope to respond, mean that the situation is likely to become more problematic in the future. Diverse global initiatives seek to strengthen health systems, but progress will require better coordination between them, use of strategies based on the best available evidence obtained especially from evaluation of large scale programs, and improved global aid architecture that supports these processes. This paper sets out the case for global leadership to support health systems investments and help ensure the synergies between vertical and horizontal programs that are essential for effective functioning of health systems. At national level, it is essential to increase capacity to manage and deliver services, situate interventions firmly within national strategies, ensure effective implementation, and co-ordinate external support with local resources. Health systems performance should be monitored, with clear lines of accountability, and reforms should build on evidence of what works in what circumstances.
Highlights
Global Health Initiatives, such as the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM), the Global Alliance for Vaccines and Immunization (GAVI) have raised large sums of money for essential health care and have challenged previous notions of what is possible
The ability of countries to spend the new funds effectively is often constrained by fundamental weaknesses in their health systems [1,2,3]
Others have a normative role in addition to the technical assistance they provide at country level. These include the WHO and, in some respects, the World Bank. Their role should be to ensure that the best available evidence is used to inform the development and implementation of effective policies, activities that have recently been endorsed by the leaders of eight of the global health agencies, including the WHO, World Bank, GFATM, and GAVI [58]
Summary
Global Health Initiatives, such as the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM), the Global Alliance for Vaccines and Immunization (GAVI) have raised large sums of money for essential health care and have challenged previous notions of what is possible. One manifestation are the so-called 'diagonal programs'[53] being explored by the GFATM, where system-wide investment includes a degree of support to specialized disease functions [54] These involve a "strategy in which we use explicit intervention priorities to drive the required improvements into the health system, dealing with such generic issues as human resource development, financing, facility planning, drug supply, rational prescription, and quality assurance." [55]. Their role should be to ensure that the best available evidence is used to inform the development and implementation of effective policies, activities that have recently been endorsed by the leaders of eight of the global health agencies, including the WHO, World Bank, GFATM, and GAVI [58] These roles are clearly complementary but the increased global engagement in health systems strengthening is leading to considerable fragmentation in priorities and strategies [47,59]. They are not immune from public opinion, especially when a light is shone on their activities by non-governmental agencies, such as Global Health Watch [68]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
