Interactions between health systems and Global Health Initiatives – what we learnt to inform research methodology Joseph Perriëns on behalf of Badara Samb Senior Adviser to Assistant Director-General Team Leader, Global Health Initiatives Health Systems and Services World Health Organization

This talk Background on health systems Findings of "Positive Synergies" –By "Building Block" –Meaning for future research

The main goals are: –Improving health and health equity –Responsiveness, financial fairness and efficiency The intermediate goals are: –Greater access and coverage –Quality and safety A health system consist of all organisations, people and actions whose primary intent is to promote, restore or maintain health

Sticking points: Challenges to scale up services for HIV, TB, malaria, and immunization HIV/UA assessment report Global Plan to stop TB World Malaria report GAVI/Norad report Inadequate financing HR crisis Affordable commodities Stigma, discrimination… Accountability Partnership alignment Inadequate financing Laboratory capacity HR crisis Quality drugs Drug efficacy Information system Inadequate financing HRH and Community services M&E HR crisis Inadequate financing Leadership and management Inter-agency coordination

Where too look

Global progress on MDG 4

Global progress on MDG 5

Findings of "Positive Synergies" - 14 new studies - Over 250 studies and reports

Financing – Association of GHIs with overall increases in global resources for health – No clear correlation between GHI resources and domestic health budgets or reallocation of resources – GHIs have contributed to some improvements in health aid-effectiveness, particularly in the area of predictability of financing – Indication that disease-specific funding may not be well enough aligned

GAVI and Health Systems Strengthening

Global Fund and Health Systems Strengthening

Health workforce – Some potentially negative impacts on already overstretched human resources for health – Measures to strengthen the health workforce ongoing – Measures more on in- service training for disease-specific services, and task shifting

Governance – Evidence of early lack of alignment – More recent progress – Enhanced community participation

Health information – Focus on coverage, and surveillance for specific diseases – Innovations in generation and use of new information and communication technologies – Failure to invest in more rational, robust, efficient and independent common data architecture.

Supply management – Improvements in availability and affordability of a number of commodities – Growth in the volume of commodities not matched by improvements in the management of supplies

Service delivery –Expanded access and uptake of targeted services (caution: attribution) –Mixed evidence of expanded access and uptake of non targeted services –Evidence on role of GHIs in fostering equity and quality of non targeted health services is weak and mixed

Pre-natal visits and polio vaccinations, Haiti

Research considerations GHIs and country health systems are dynamic, complex entities. »Studying their interactions defies over- simplistic, single variable, linear analysis and raises caution with respect to generalizations »Implementation research should reflect this complexity, and include both quantitative and qualitative methods, from a variety of disciplines such as health, anthropology, systems engineering and economics, and include the input of all important stakeholders