Public HealthOvercoming health-systems constraints to achieve the Millennium Development Goals
Section snippets
Previous efforts to improve delivery of priority services
Many of the current global initiatives to achieve the health MDGs have strong service-specific or disease-specific foci (table 1). Service delivery arrangements are sometimes described in terms of vertical or horizontal approaches. Vertical approaches use planning, staffing, management, and financing systems that are separate from other services, whereas horizontal approaches work through existing health-system structures. In reality, in many low-income countries, few interventions are
Constraints currently faced by health systems
Table 2, which uses a framework developed by Hanson and colleagues,10 illustrates some of the major constraints to improving service delivery identified in reviews by major global health initiatives. A wide range of frameworks and instruments were used for these reviews; from short, structured checklists to detailed questionnaires and quantitative approaches to assessing barriers.10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 The reviews largely focus on constraints within the government system,
Parallel approaches
As discussed above, programmes specific to a service or disease can work in more or less vertical ways to achieve their goals. For example, several global initiatives are concerned with making good quality pharmaceuticals available to health facilities in a timely and reliable manner. This goal might be achieved through development of new and parallel pharmaceutical procurement and distribution systems, or by strengthening the existing pharmaceutical management system to meet the needs of all
Taking a system-wide perspective
As we have discussed, the system barriers identified by specific initiatives and programmes are rarely unique to their own focal disease, and the discourse of some global initiatives (such as Stop TB and 3 by 5)16 emphasises their need to take heed of the broader health-system context, and to contribute to overall system strengthening. For example, service-specific or disease-specific programmes may work with human resource planners at the ministry of health to increase the supply of nurses
Accelerating achievement of MDGs through improved knowledge on how to strengthen health systems
Disease or service-specific strategies to strengthen health systems on their own are unlikely to bring about the improvements in health systems needed to achieve the MDGs. Similarly, use of an intervention-specific or disease-specific lens to define the research agenda for health policy and systems serves to generate much useful knowledge,26 but on its own is incomplete. Such an approach must be complemented by a substantial additional body of knowledge and action that takes the functioning of
Advancing the learning agenda
If the case for greater learning about health systems is so strong, then why does health policy and systems analysis fail to get more support? Two examples illustrate the extent of the problem. An analysis by the Alliance for Health Policy and Systems Research reported that health-system research may attract only 0·007% of total health expenditure in low income countries.32 And only 48 of WHO's 1100 collaborating centres report a health systems research and development focus (Panisset U,
References (34)
Kickstarting the revolution in health systems research
Lancet
(2004)- A/RES/55/2: United Nations Millennium Declaration: resolution adopted by the General Assembly. 55/2. Sept 18,...
The Millennium Development Goals for health
Rising to the challenges (draft)
(2003)- et al.
The trouble with the MDGs: confronting expectations of aid and development success: working paper number 40
(2004) Harnessing the power of human resources for achieving the MDGs
(2004)High-level forum on the health MDGs
(2004)Knowledge into action for child survival
Lancet
(2003)World Health Report 2004: changing history
(2004)- Declaration of Alma-Ata. International conference on primary health care, Alma-Ata, USSR. September 6–12,...
- et al.
Selective primary health care: an interim strategy for disease control in developing countries
N Engl J Med
(1979)
Expanding access to priority health interventions: a framework for understanding the constraints to scaling-up
J Int Dev
Marginal budgeting for bottlenecks: a new costing and resources allocation practice to buy health results
Millennium project: interim report of task force 4 on child health and maternal health: United Nations Development Group
Progress Report May 2002–April 2003: multi-country evaluation of IMCI effectiveness, cost and impact (MCE): (WHO/FCH/CAH/03.5)
Report on the meeting of the second ad hoc Committee on the TB epidemic: recommendations to stop TB partners
Cited by (611)
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The effectiveness of private services in public hospitals: The case of St. Paul Hospital, Addis Ababa, Ethiopia
2021, Journal of Healthcare Quality ResearchSystems approaches to public service delivery: Methods and frameworks
2023, Journal of Public PolicyExploring paediatric rheumatology care: a ten-year retrospective analysis of the patient population in Ghana
2024, Pediatric RheumatologyInstitutional roles, structures, funding and research partnerships towards evidence-informed policy-making: a multisector survey among policy-makers in Nigeria
2023, Health Research Policy and Systems