Disease specific efforts and health systems strengthening

The past trend for a focus on disease specific approaches has raised concerns that funding for health system development has received less resources and attention - for instance addressing human resources constraints, service organisation issues or problems of access.

It is increasingly being highlighted that disease specific interventions rely upon the health system for delivery and population reach. Health system weaknesses or constraints can therefore limit service delivery and reach. . For example, whilst donors may provide sufficient funding for medicines for AIDS, tuberculosis and malaria, there may not be the doctors or nurses available to prescribe these medicines adequately.

Conversely, if a significant proportion of the time of health service staff is allocated to specific areas of the health service (e.g. AIDS, tuberculosis and malaria services) then other parts of the service may suffer (e.g. antenatal care). Additionally, competition for skilled staff has impacts too. For example, evidence from Malawi suggests health workers are being drawn away from working in public sector services towards better paying non-governmental organisations and aid agencies.

Another challenge that disease orientated approaches wrestle with is the linkage or integration with other related parts of the health services. For example, HIV and AIDS services with family planning and sexual and reproductive health care.