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Strengthening Health Systems: From Global to Local

Strengthening Health Systems: From Global to Local. Sara Bennett, Associate Professor Johns Hopkins School of Public Health Global Health Council Satellite Session Health System Strengthening: What is Everyone Doing? June 13, 2011. Key points.

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Strengthening Health Systems: From Global to Local

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  1. Strengthening Health Systems: From Global to Local Sara Bennett, Associate Professor Johns Hopkins School of Public Health Global Health Council Satellite Session Health System Strengthening: What is Everyone Doing? June 13, 2011

  2. Key points • There is both conceptual confusion and multiple approaches to HSS • Conceptual confusion is problematic – but it may be premature to fix conceptual frames • Multiplicity of approaches is a good thing, if it reflects responsiveness to differing contexts • Need to embrace more nationally driven HSS agendas and support the development of national-level capacity to drive such agendas

  3. Different current approaches to HSS

  4. Problems of lack of conceptual clarity • Too much time spent explaining things to each other and to outsiders! • Fragmentation and lack community across a small field • Lack of agreed standards to track commitments and achievements • Cyclical trends in priority for health systems Oh, but how do you accommodate system dynamics and emergent behaviors? I support a diagonal approach to HSS with positive synergies

  5. Intrinsic features of field that promote cyclical policy (source: Rochefort 1988) • Complexity of field and heterogeneous problems • Exaggerated ideologies – over-confidence, disillusionment • Incomplete development of scientific basis • Mismatch of goals and means • Linked to social and economic cycles • Not sexy!

  6. From global to local • Context specificity of HSS • Cycles leave insufficient time for country implementation • National commitment to HSS may be more important than global funding • Need for local research to build global evidence base

  7. Future health systems – DFID-supported research consortium

  8. Reflections • Diversity of proposed interventions reflects local contexts and histories • Country leadership motivates and empowers country researchers • Responsiveness to local concerns facilitates links to policymakers and other research users • Planned research processes incorporate learning and adaptation • Relinquishing leadership can be frustrating for northern researchers and challenging for generalizable findings

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