WHO health systems building blocks
Improving health services and strengthening health systems: adopting and implementing innovative strategies - an exploratory review in twelve countries
Reviewing health service implementation
Authors:
J. Janovsky; D. Peters
Publisher:
World Health Organization , 2006
In recent years, a number of specific strategies for improving health services and strengthening health systems have been consistently advocated. In order to advise governments, the World Health Organization(WHO) commissioned this exploratory study to examine more closely the track record of these strategies in twelve low-income countries. A review of implementation and impact of eight strategies is provided. These include contracting with NGOs, the delegation of authority, user fees exemptions, and subsidies for the poor. In addition performance related pay and incentives, reorganising outreach workers and social marketing are considered. The review includes three fragile states: Cambodia, Myanmar and Papua New Guinea.
In addition to analysing the role of the selected strategies in specific countries over the last five years, the study examines salient features and dynamics of each national health system and the broader context within which it operates. The document also highlights developments and events that are likely to have had a bearing on decisions made in the health sectors. Trends in key health service delivery outputs are also mapped as part of the context. Based largely on desk reviews the study reveals that documentation of how well strategies have been implemented is particularly poor. This is especially the case for strategies that cut across programmes where monitoring is organised around those programmes. The authors find that many low-income countries are pursuing new ways of delivering health services but frequently without plans for taking successful small scale projects to national level. The study also reveals that although community engagement policies and strategies are frequently adopted they are not achieving national coverage.
