Health system strengthening approaches

While the humanitarian approach centres around the immediate delivery of health services, health systems strengthening supports the building of sustainable public health systems. The World Health Organization has developed a common Framework for Action for health system strengthening that consists of six building blocks (see the section of this dossier entitled “WHO Health Systems Building Blocks”). WHO defines health system strengthening as improving these six health system building blocks and managing their interactions in ways that achieve more equitable and sustained improvements across health services and health outcomes.

Health system strengthening typically starts getting more attention if a country enters a post-conflict transitional state. Activities tend to commence in an (early) recovery phase, when there is an indication that a government is able to resume responsibility for the implementation of key services. In the health sector, this approach tends to follow the principles of Primary Health Care, which focuses on issues such as universal access, equity and community participation. It generally involves the development of a cost-effective Essential Package of Health Services as a cornerstone to roll out equitable health services to the great majority of the population. Various novel tri-partite arrangements between fledgling governments, donors and non-governmental organisations to get the services to the population have emerged over the past few years.

These donors, along with Global Health Initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Global Alliance for Vaccines and Immunisation (GAVI), will also finance institution-building activities in the health sector such as the implementation of priority-setting activities, and the development of planning and financing mechanisms, health information strategies, and human resources strategies.

The types of implementing agencies associated with health systems strengthening differ from the humanitarian context. Where governments assume a stewardship role, humanitarian agencies (which are often hesitant about government collaboration) tend to make way for NGOs with a stronger development mandate, and a host of (international) technical consultancy agencies which all support the governance structure.