In this month’s Health Policy & Planning, Tamara Hafner and Jeremy Shiffman have a new article that I think should be on everyone’s reading list (and since it is open access, it can be). Their abstract:

After a period of proliferation of disease-specific initiatives, over the past decade and especially since 2005 many organizations involved in global health have come to direct attention and resources to the issue of health systems strengthening. We explore how and why such attention emerged. A qualitative methodology, process-tracing, was used to construct a case history and analyse the factors shaping and inhibiting global political attention for health systems strengthening. We find that the critical factors behind the recent burst of attention include fears among global health actors that health systems problems threaten the achievement of the health-related Millennium Development Goals, concern about the adverse effects of global health initiatives on national health systems, and the realization among global health initiatives that weak health systems present bottlenecks to the achievement of their organizational objectives. While a variety of actors now embrace health systems strengthening, they do not constitute a cohesive policy community. Moreover, the concept of health systems strengthening remains vague and there is a weak evidence base for informing policies and programmes for strengthening health systems. There are several reasons to question the sustainability of the agenda. Among these are the global financial crisis, the history of pendulum swings in global health and the instrumental embrace of the issue by some actors.

Basically their research finds that health system strengthening (HSS) became sexy due the the fact that there was a big push for disease-specific programs and addressing the MDGs and health systems were seen as a big barrier to achieving goals on other fronts. But since no one has ever really figured out what HSS is, nor how one actually strengthens a health system, it risks falling off the global health radar, especially as we take our foot off the pedal on other global health fronts. To that I would add (as suggested to me by Rob Yates on Twitter) it has been pushed out by the embrace of another related, but sometimes as nebulous, concept – Universal Health Coverage.

Don’t get me wrong, this might not be a bad thing, and current efforts might be more realistic than pushing an agenda that involves transforming so many aspects of a health system rather than focusing on what might be a more manageable piece of the puzzle. But in this time with so much up in the air in global health, it is worth asking if it is worth bringing this issue back as a central effort, in particular in the context of post-MDG discussions. Is this an idea worth saving?

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1 Response » to “♫ Are we bringing HSSexyBack? ♫”

  1. April Harding says:

    Interesting analysis. And thanks for the “heads up”.
    While I agree with Jeremy S and his co-author that, at the global level, a trend towards growing attention and support for HSS has taken place, it’s important not to mistake this as representing what is happening on the ground.
    On the ground, I don’t think HSS activities have really grown. Rather, as Grace Chee and her co-authors pointed out in their paper “Why differentiating between health system support and health system strengthening is needed” (2012), many activities currently undertaken and labeled as HSS are actually merely supporting the system, but do little to strengthen it.
    They make a strong case that most of the increased attention manifests itself in assistance which alleviates input constraints to service delivery – rather than on “more comprehensive changes to performance drivers such as policies and regulations, organizational structures, and relationships across the health system to motivate changes in behavior and/or allow more effective use of resources to improve multiple health services.” I think they have nailed what is happening.
    The trend Jeremy and his co-author are explaining is more one of wording and presentation than substance.I think what has undermined the shift to actual HSS support is that it would require real changes in time horizons (e.g. longer) and goals. That is, donor agencies wouldn’t be able to track their aid dollar to a bednet, an HIV/AIDS patient treated and the like, nor claim to have have contributed to whatever reduction happened in a particular disease incidence/ prevalence.
    But hey, that is just speculation. Since the change didn’t happen!

    Here is a link to Chee et al http://dx.doi.org/10.1002/hpm.2122

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