In an effort to focus this blog – and provide myself a bit of structure and sanity! – I’m devoting Tuesdays to “systems issues”. For today, let’s start with the basics: what is a health system? I know, this sounds patronizing, but in fact, the goal of defining and strengthening health systems has only recently become a strong component of global health aid programs.
Here is one theory as to why: global health and aid for global health arose out of epidemics and campaigns to eradicate them, first the Cholera epidemic in the 1940s, then the smallpox effort which culminated in the eradication of the disease in the 70s (this is still the only disease to have been eradicated in history – check out Larry Brilliant’s TED talk here). These campaigns were marked by massive mobilization of resources – financial and human – but were time-bound and focused on a single disease. Therefore, I believe that the global health system was (not unjustly) designed to be reactionary and emergency-led.
However, this design is simply not suited to the promotion of primary health or treatment of chronic diseases, such as HIV/AIDS. The recent awareness of building stronger health systems has been led by increased efforts on the part of the Global Fund to integrate health systems strengthening into its funding of programs, and even more recently, by the reauthorization of PEPFAR and its integration into the Obama administration’s Global Health Initiative.
The WHO defines a health system as all organizations, institutions, resources and people whose primary purpose is to improve health. The system is then further broken down into 6 building blocks:
1. Service delivery
2. Medical products, vaccines and technologies
3. Health workforce
4. Health systems financing
5. Health information system
6. Leadership and governance
Over the upcoming weeks, each Tuesday, we’ll focus on one of these building blocks, exploring the current international efforts to strengthen the global system supporting them.
