Health Systems II: Preparing a Health System to overcome challenges in responding to IHR obligations 10 18

At the end of this session, you will be able to: Learning objectives At the end of this session, you will be able to: describe the main characteristics of a performing health system and its mechanisms describe health systems capability to meet IHR describe the challenges and approaches to a performing health system when confronted with a public health event

Outline 1. Health System definition 2. Health System capabilites 3. Health System characteristics 3.1 Health System: Key Elements 3.2 Health System: Performance 3.3 Health System: Financing 3.4 Health system: Human resources 4. Health System Strengthening 5. Reminder: Public health emergency management 6. Reminder: IHR aims and obligations 7. Health System capacities needed for IHR 8. Organisational failings 9. Challenges and strategies: surveillance, reporting and responding Slide 2 of 19

1. Health System Definition Definition of a Health System (WHO) A Health system is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health. Components of a Health System A health system consists of all organizations, people and actions Objective of a Health System The primary intent is to promote, restore or maintain health, including efforts to influence determinants of health as well as more direct health-improving activities.

2. Health System capabilities Health System capability to meet the IHR All the building blocks must be in place and perform Governance  leadership and management for: Human Resources  different kinds Facilities  different levels and kinds, laboratory Supplies  medicines, technologies Transport and referral  remote areas Information & communication Financing  Funds Accessible Affordable Effective, quality care Cost-efficient Coordinated Rapid response

3. Health System characteristics 3.1 Health systems: Key Elements Characteristics of a Health System WHO’s building blocks can be seen as a bicycle wheel. If you take out a paddle, the bicycle will not go. Take out the handle, the bicycle will not work. Intersectoral collaboration is required to make the wheel of IHR implemnetation work.

3.2 Health System: Performance Performance in a Health System What is Performance in a Health System? Relations between functions and objectives of the health system: measuring populations health goodness and fairness: why it is important? How do you measure Performance? Improving key performance functions: service delivery creating resources (investment and training) financing (collecting, pooling and purchasing) stewardship ‘The best measure of a health system’s performance is its impact on health outcomes’ (Margareth Chan, WHO, 2007)

3.2 Health System: Performance (continued) Improving performance in a Health System As health systems are highly context-specific, there is no single set of best practices that can be put forward as a model for improved performance. Health systems that function well have certain shared characteristics: systems functioning efficiently to deliver interventions to those in need sufficient health workers having the right skills and motivation financing systems that are sustainable, inclusive, and fair health care costs should not impoverish households even deeper into poverty In Strengthening Health Systems to improve Health Outcomes: WHO’s Framework for Action Extract from the Forword of Margareth Chan, WHO (2007)

3.3 Health System: Financing Resources & Financing a Health System: A global challenge Some poor income countries in africa and some part of Asia will have poor foundation and resources to implement IHR

3.4 Health system: Human resources Shortage of skills and Health Workers Over 25% of countries in the world = severe health workforce crisis Health workers are inequitably distributed throughout the world and within countries (e.g. more in urban than rural area) Many countries which need to strengthen their health system are weakened by the brain drain of qualified health professionals Different levels of workers and task shifting  Without prompt action the shortage will worsen Action is needed, such as More direct investment in training is needed More efficient use of existing health workforce must be implemented Retention strategies

3.4 Health system: Human resources (continued) When looking at Africa, 25% of disease burden was tackled with 3% health workforce with very small proportion of health expenditure. Whereas, for America, 10% diseases burden with high health expenditure was euipped with 35-40 % of health work force.

4. Health Systems Strengthening Health System Reforms and Strengthening the Health Systems What could/might help…. Bringing together “program” and “system” expertise Well functioning health information Equitable access to medical products, vaccines and technology Health financing providing protection of patients and incentives to providers and users Leadership ensuring strategic policy, regulations and accountability Open policy discussion with stakeholders and users Transparency and accountability of the adminstration and of staff A more effective role of WHO at country level :

4. Health systems Strengthening (continued) The Primary Health Care Reforms ….are necessary to refocus health systems towards « Health for All » These four pieces need to work togther to revitalise the health systems. (WHO Report, Primary Health Care – Now More Than Ever, 2008)

5. Reminder: Public health emergency management Role of the Health System in IHR implementation and in Emergency Management Preparedness and Response This diagram depicts the roles of health system at any point for IHR implemnetation. Most important is the response.

6. Reminder: IHR aims and obligations IHR Aims to prevent, protect against, control and provide public health responses to Public Health Events of International Concern (including emerging and re-emerging diseases) Obligations 1 Surveillance and immediate and ongoing reporting 2 Health service response including points of entry Performance

6. Health system capacities needed for IHR Health Systems are closely linked to Core Capacities required under the IHR 1. National Legislation 2. Policy and Co-ordination 3. Surveillance Capacity 4. Preparedness 5. Response 6. Risk Communication 7. Laboratory 8. Human Resource Capacity Some central challenges of a Health System: Workforce shortage Financing Access (e.g. primary care) Equity/Solidarity Stewardship Need to be systematic and organised Requires exceptional leadership and management

Organizational Failings 8. Challenges Organizational Failings Deficient health policies Difficulties in priority setting Lack of resources Lack of coordination between health system components Partners’ funding and support not aligned with national priorities Weak implementation capacity and weak country systems (Public financial management, National procurement system and civil sector) Poor and unsafe delivery

9. Challenges and strategies Challenges and strategies: surveillance & reporting Active or passive surveillance – maintaining vigilance Role of community health workers – not purpose specific Ability to identify diseases Prompt reporting – use of mobile communications Confirmation team ready

9. Challenges and strategies (continued) Challenges and strategies: response Properly planned for? Organizational plan? Co-ordination, NGOs, development partners, call centre, response teams, referrals Visible leadership – public advocacy, staff motivation, problem solving, maintaining human dignity, mobilizing facility and human resources capacity, morale Trained human resources – which health workers do what Medicines and vaccines – procurement and supply Communication – health workers, public Financing the response Points of entry and travel

Thank you! Eric Buch Professor of Health Policy and Management Some slides from: Dr Astrid Stuckelberger with the collaboration of Prof. Philippe Chastonay Institute of Social and Preventive Medicine Faculty of Medicine of the University of Geneva Switzerland. In collaboration with Dr. Paolo Piva, Department for Health System Governance and Service Delivery WHO, Geneva, Switzerland Eric Buch Professor of Health Policy and Management Eric.buch@up.ac.za