21 July 2005
UNDG Policy Network On the MDGs
UNDG Policy Network on the MDGs
21 July 2005
UNDG Policy Network On the MDGs
Why and How
scaling up health systems
Strategies
By Dr. Paolo Piva
UNDG Policy Network on the MDGs
21 July 2005
UNDG Policy Network On the MDGs
Why health systems?
•Strong health systems are not an end in itself
•A means to achieve better health outcomes
•An absolute requirement for achieving the MDG
•Universal access to broad based HS could meet
–60-70 % of child mortality
–70-80% of the maternal mortality
–HIV/AIDS pandemic
•Essential
–To spend well increase aid for health
–To sustain health gains in the future
Learning Event
21 July 2005
UNDG Policy Network On the MDGs
Learning Event
Why Human Resources for health?
•Health workers are dying
•They are leaving public service
•Health workers live below the poverty line;
•Migrating from rural to urban areas
•Migrating to countries that rewards them better
•Shortage of health staff is a serious constraint
–To scaling up
–To respond to HIV/AIDS – TB
–Achieve health MDGs
21 July 2005
UNDG Policy Network On the MDGs
Learning Event
21 July 2005
UNDG Policy Network On the MDGs
Learning Event
Human Resources Challenges
•Improve pay and supplements,
•Incentives for those working in poorer areas
•Upgrade the skill-mix of health workers
•To strengthen essential emergency and surgical skills andknowledge of PHC
•Better partnerships with private providers, NGOs andcommunity partners
21 July 2005
UNDG Policy Network On the MDGs
Learning Event
How to scale up
•Increase the number of health service providers
–Increased volume of services
–different providers better suited for different groups
–Competition
•Increase the capacity of existing health providers
–By increasing human resources
–Financial (drugs, supplies, equipment etc.)
21 July 2005
UNDG Policy Network On the MDGs
Learning Event
Factors affecting the performance of health systems
•Amount of resources invested in the health system - minimumthreshold level of resources necessary for an essential package
•The way the health systems are designed and organized
–Health systems perform better with the contribution of all players
–Roles and functions clearly defined - stewardship, financing andservice provision
–Capability to manage structural and operational transitions,
–Capability to resolve problem
–Sustain motivation to enhance efficiency and improve performance
21 July 2005
UNDG Policy Network On the MDGs
Learning Event
•Selected Innovative Strategies 1/2
•Contracting: NGOs, private sector providers - focus on service delivery
•Performance-related pay and incentives:
–improving workforce performance
–benchmarks to determine the level of pay and incentives to be provided
•Subsidies for the poor:
–user fee exemptions
–risk pooling
–vouchers
•Decentralization: changing authority to the district/local level,
–priority setting, resource allocation and other key decisions
–capacity building for decentralization
•Hospital autonomy: de-linking hospitals from central control
21 July 2005
UNDG Policy Network On the MDGs
Learning Event
•Selected Innovative Strategies 2/2
•Reorganizing outreach workers - change
–Use of home-based and health post workers,
–Their professional requirements or volunteer status
•Accreditation of institutions providing services,
–Means of setting, monitoring and enforcing standards
•Social marketing: influence health behavior - use of health products
–Condoms, bednets, ORS, essential drugs, or contraceptives
•Community engagement,
–Communities involved in HS oversight, planning or operations
–Voice to community concerns,
–Hold providers accountable for their performance