Apr 11, 2006

Message from Mark McPherson:, UK

I realise I do not post comments on here normally but thought the question asked on this occasion was an important one that seems to be missed a lot. I was in Brazil recently and talked to a number of people about the healthcare system. They were very proud of Brazil's stance on HIV however when looking deeper there seemed to be serious issues with basic access to things like CD4 monitoring. This was to be expected however what surprised me more was that very little attention had been paid to public health issues and the broader welfare agenda. Co-infection with TB there was rife and predictably an over burdened health service was working in a context where little effort was made to relieve poverty and as such people were living in accommodation where infection with TB was likely to be rife. This is just one example. Whilst I realise access to medical treatment is the urgent need, we know from our European experience that the best health overall is experienced by ensuring a range of services are available, which includes broader welfare state-ism.

A second point worth making is that without good generic health care systems there is no way of implementing specific programmes. I would suggest that the fund has at least some sort of policy position about what basic health care and welfare systems need to be in place in order for effective specialist programmes to be effective. At that point it may be easier to take a view on what the funds strategy for influencing that may be.

Please note that these views are not necessarily the views of i-Base but personal views based on work in the UK in a number of fields and travel in a range of counties.

Best regards

Mark McPherson

ASM - Apr 11, 2006

I think the most appropriate approach for the GFATM would be to make health systems strengthening (HSS) its additional proposal selection criteria. This way the GFATM will be harvesting proposals that relate HSS to the three diseases, escaping the risk of losing focus on them that might arise in case of establishing a separate HSS component or devolving it to other agencies.

mngaara - Apr 11, 2006

Separate component - linked to other interventions

Moderator: Thanks Mngaara,

Kindly feel free to share with us your reasons for preferring the approach of having one separate component that is linked to other interventions.

Chris.

LPPrayas - Apr 11, 2006

Question: What is the most appropriate approach for the Global Fund to be involved in supporting health systems strengthening?

We are engaged in different project works in many parts of our state which our NGO has taken-up time to time. Through our organization I am personally accustomed to work amongst the tribal people (High-risk zone for Malaria, Tuberculosis and HIV/AIDS) and the poor sections of society who are also affected by illiteracy and superstitions. To build a sustainable future the foremost requirement is to make them self-supporting while educating them. But the main hurdle is the absence of infrastructure for this purpose.

Therefore, the most appropriate approach for the Global Fund to be involved in supporting health systems programmes are: i) It should be educational, ii) It should be job (employment creation) oriented, iii) it should be Network based, and iv) It should be technically sound and based on strong infrastructure.

Pinaki Mukherjee
Secretary, LPPRAYAS

bhushana - Apr 11, 2006

I think approach (a) would be a good one to follow, because HSS (Health Systems Strengthening) is everyone's business. Approach (b) goes against this principle and sounds almost like shrugging the responsibility of the disease programmes on to others. Approach (a) would also permit proposal submitters to address broader HSS issues that go beyond or cut across the individual vertical programmes.

In addition to having the option of using approach (a) [not instead of it], proposal submitters should also be required to integrate HSS aspects into "vertical" or disease-oriented components.

Approach (a) was the approach adopted in Round 5, but is being abandoned for Round 6.

I think that perhaps this approach was adopted in Round 5 without sufficient preparation by the Global Fund. For example, while the guidelines for the disease-oriented components provide detailed ideas about good practices, recommended activities and appropriate indicators, this was not the case for the HSS component. This, in a sense, doomed this component to failure. Another problem was that proposal submitters did not want to jeopardize their overall proposal by linking a HSS component to it on which they were not confident of securing approval.

In any case, in my view, the Global Fund should provide more guidance to proposal submitters about how to strengthen the quality of the HSS aspects of their proposals, whether they are stand-alone or integrated within a given disease-oriented component.
_________________
Anjana Bhushan
Technical Officer (Poverty, Gender and Human Rights)
Western Pacific Regional Office
World Health Organization

basmakh - Apr 10, 2006

I think, to make sure that other donors are funding HSS (Health Systems Strengthening). HSS could be directed to be general structure of the Health system with emphasis on the three diseases. But it should go hand in hand with other TA’s or grants as this will have a great impact on the outcome of the grants.

Apr 10, 2006

Message by Beatrice Minja, Tanzania

The most appropriate approach is having a separate health system strengthening (component) system for the Malaria problem. We would love to see a strong structure that specifically focuses on Malaria and this structure should put more attention to the household level. Households are complicated institutions which are working at the bottom level in the overall health system /structure .However this is the most crucial area in the health system because that is where desired changes in making Malaria history shall come from. In the current health systems households/communities are receiving minimal attention in resource allocation (Financial, Technical, material .....).
In order to make a difference in eradicating malaria an improved system must focus on transforming the existing system to enable households own the change process in addressing the Malaria Problem- a disease that can be prevented and treated and yet registering the highest death toll every minute that passes.

Beatrice
Tanzania NGOs Alliance Against Malaria

rvonrueden - Apr 10, 2006

The quality of healthcare systems and the degree of duplication of effort often created by single-disease interventions are critical to the effectivecness and ultimate value of the Global Fund's initiatives. Therefore, I strongly support a funding component focused on "health systems strengthening," with the caveat that the funding emphasizes close coordination with other programs and funding vehicles.

tarigwafa - Apr 10, 2006

Hello.
Health Systems are the the skeleton of health. By strengthening this skeleton, GF will give the required push for improving health, especially in the Third World Countries where Health Systems are fractured.
A Separate health system is not a wise idea, I think, because this will put sustainability of the system in risk of collapse.
To ensure sustainability of the GF service, you have to encorporate the GF support into the existing health system of the country.
Also to establish a seperate system in any country, you will spend more and more resources. And also seperate system will evacuate the "Wholistic Approach" of health from its meaning and damage the " Integrated Health Services' concept.
My opinion in this Article " to fill gaps in the existing health system is the most appropriate approach".
_________________
Tarig Dafallah

Tshabalala - Apr 10, 2006

Institutional Governance in the area of human resource management, procurement systems and priority-setting as a platform for effectiveness; presents itself as one of the entry points for the Global Fund with respect to the strengthening of health systems. Capacity to manage skills and knowledge in most health systems has not been granted strategic attention leading to the frustration of professionals across the skills divide. Effective utilisation of available resources is a mixture of skills and systems that are designed to give assurance to the quality and accessibility of health services at all levels of the system. Investing in HIV and AIDS, TB and Malaria should not obstruct the Global Fund from the holistic view of the health system. Essentially a strong and responsive health system will ensure financial and service-delivery sustainability across the system.

Apr 10, 2006

Question: What is the most appropriate approach for the Global Fund to be involved in supporting health systems strengthening?
Examples:

a.) To have a separate “health systems strengthening” funding component (same as the three funding components for AIDS, Tuberculosis and Malaria, for which proposals could also be addressed directly?)
b.) To encourage other donors to fund health systems strengthening, with the Global Fund focusing its funding on specific programs for the three diseases?
c.) Other approaches? (which still reduce transaction costs, ensure lasting impact and promote harmony with national and international partners)

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BACKGROUND ON HEALTH SYSTEMS STRENGTHENING
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Health systems strengthening is the regular process of building capacity within the health sector to ensure that health systems are effective, efficient and reliable within a context of changing population needs and disease patterns.

Numerous activities supported by international partners and country governments can be classified as examples of health systems strengthening. Some of these activities are already conducted as part of Global Fund grants. These include: the development and strengthening of national procurement and supply management systems for health products, the management of human resources for health, ensuring appropriate capacity and systems building for efficient health service delivery (such as the construction of hospitals and clinics), and the collection and analysis of health information in a systematic manner.