The Canadian Society for International Health (CSIH)
recognizes that the viability of health systems around the world have been
challenged by imposed economic reforms, poor investment into the sector, and the
limited attention paid to the social determinants of health. The economic
reforms that were prerequisites for the large international loans made to low-
and middle-income countries in the 1980s and 1990s further challenged health
systems through the requisite decentralization of the social sectors, including
health. While historically there had been great momentum for primary health care
strengthening, which called for strong community-based continuity of care that
emphasized prevention and promotion, reality has fallen far short of the
aspirations of Alma Ata and the call for Health For All.
Increased awareness of the devastating economic effects of diseases such as HIV,
malaria, and TB has resulted in critical and significant investment in their
prevention, treatment, and management. However, global programmes were designed
on the assumption that sufficient infrastructure existed in the low- and
middle-income countries to implement the necessary training, capacity-building,
prevention, treatment and support, and management. These programmes also assumed
the existence of levels of absorptive capacity that were simply not present. The
inability of many countries to adequately or effectively implement these
vertical programmes and services has become a critical concern to donors,
governments, researchers, as well as civil society.
CSIH Partners for Health Systems Strengthening
CSIH’s overall framework for health systems
strengthening is driven by values and vision of equity and accountability,
supported by the two pillars of a social determinants framework and a “health in
all policies” approach. In applying this approach, CSIH works with partners in
government, civil society, community, and academia to build and sustain the
necessary leadership and long-term stewardship required for a sustainable health
system.
The conditions in which people live and work have dramatic consequences on their
overall health and well-being. Therefore, the ability of a ministry of health to
work intersectorally with other departments such as education or labour is
critical. “Health in all policies,” brings attention to, and more effective
implementation of, policies and programmes outside of the health sector. CSIH
supports countries and global health partners to address the social determinants
of health that are known to be among the worst causes of poor health,
inequalities and inequities.
Central
to this discussion is the role that can be played by civil society, the impact
of its interaction with the health system, and its ability to build
accountability and transparency around the public and private actors responsible
for health. Of particular importance is the ability of civil society to engage
and promote the rights of vulnerable and/or marginalized populations. CSIH has
built a strong understanding of the role played by coalitions and advocacy in
public policy formulation and local and regional governance, and their potential
to influence the development of equity-oriented planning and resource allocation
decision-making.
The level of investment into those health, social, and economic issues relevant
to a nation’s burden of disease will be a critical predictor of health outcomes.
Health systems research can provide decision-makers, policy advocates, and
health services managers with the information and evidence base they need to
address these issues accordingly. Yet the state of health systems research and
its architecture in low- and middle-income countries is often ignored or
diminished. CSIH works with many research institutes, academic institutions, and
organizations globally to promote and support research for development,
particularly in low- and middle-income countries.
CSIH has identified and supported several key elements of a health system
for which technical assistance will have the greatest impact on improving health
outcomes.
Health Human Resources
While all components are important to the effective functioning of a health
system, human resources are particularly critical because they both represent a
significant proportion of the health budget and directly affect the effective
and efficient delivery and quality of services provided. Issues related to human
resources development include policy support, appropriate training and
allocation, sufficient remuneration, and community-based outreach. CSIH
recognizes and promotes the fact that human resources for health should reflect
a (contextually-appropriate) mix of health care providers, managers, and social
professionals at all levels of the system (national, state, district,
community).
Community Interventions and Health Promotion
CSIH supports the improvement of health through education, community action, and
the promotion of health in all policies. At the same time, it is important for
population-based approaches to health promotion and disease prevention be
aligned with person-based care delivered through the health care system. CSIH
recognizes the importance of integrating all levels of care within the health
system and the critical role that primary care – first point of contact – has in
substantially improving health and thereby contributing to a more efficient and
effective use of the costly and specialized levels of care.
Service Delivery (treatments and programs)
This element of the health system includes delivery models, infrastructure,
management, safety and quality, and demand for care. Such services range from
personal health care (diagnosis, treatment, care, rehabilitation, etc.) to
public health services such as mass education and sanitation. CSIH has supported
capacity building to improve and enhance the delivery of services and programs
that are needs-based and appropriate (affordable, relevant, evidence-based,
accessible, etc).
Health Information Systems
Accurate and up-to-date information and evidence plays a critical role in
appropriate policy development and clinical decision-making within the health
system. While often overlooked, this is an area in which CSIH has had
significant experience. The capacity to utilize reliable, valid data for
decision-making and resource allocation for improved service delivery has been
built and/or strengthened by CSIH at the program and policy level in many
countries.
Health Financing and Resource Allocation
National health financing policies are required to support a sustainable health
system. However, with global trends towards decentralization, capacity
development at the municipal level for effective planning and resource
allocation is often lacking. CSIH is developing the institutional and individual
capacity and political will with local government units to institutionalize
concepts of equity in planning and resource allocation within the fiscal
realities of national governments.
CSIH Projects Related to Health Systems
Strengthening
Balkans Primary Healthcare Policy Project
Guyana Public Health Strengthening Project
Balkans Youth for Health Project
Philippines Health Equity Reform Project
South Caucasus Health Information Project
Youth for Health Project — Ukraine
Building Capacity for Health Reform Project in Bolivia
Central
to this discussion is the role that can be played by civil society, the impact
of its interaction with the health system, and its ability to build
accountability and transparency around the public and private actors responsible
for health. Of particular importance is the ability of civil society to engage
and promote the rights of vulnerable and/or marginalized populations. CSIH has
built a strong understanding of the role played by coalitions and advocacy in
public policy formulation and local and regional governance, and their potential
to influence the development of equity-oriented planning and resource allocation
decision-making.