Despite swine influenza calling world experts home to advise their governments, it was business as usual here on Tuesday April 28 at the World Congress for Public Health in Istanbul. Tuesday was the first full day with 9 concurrent sessions. I sought out those which addressed health systems, as this is an area finally recognised as vital if developing countries are to reach MDG targets by 2015, and equally relevant to the expanded EU. No longer does health have to follow economic growth: improved population health is seen as a driver for wealth, its an expectation & a human right. What exactly is a health system? To get a clear definition I had to wait for later talks. One speaker even described it as a fuzzy concept and actually thought this could prove to be an advantage! Meanwhile…

The Brazilian Minister for Health delivered a detailed description of the programmes and restructuring they have successfully delivered…and then dashed back home to deal with the swine fever threat. The Assistant Regional Director WHO Africa pointed out that though her region has benefited from increased resources for health (Global Forum, GAVI etc), they are focussed on a narrow range of diseases…HIV, TB, malaria…and in the past these programmes & donor governments have discouraged reallocation to build-up inadequate health systems.  Recently Global Forum and GAVI have changed their minds recognising that scale up of successful interventions is constrained by inadequate health systems. Apparently, WHO reports concentrated minds wonderfully.

Redesigning health systems, we heard, should now include social determinants of health and not just aspects of clinical health services. Sanya Nishtar, founder of the Pakistan NGO Heartfile, defined these determinants as: maternal education, intersectoral factors, health seeking behavior and quality of governance. Combine healthcare services with these determinants, under governance, and you have a health system (that’s the definition I am hanging on to!). She further defined a health system by how it was financed…in Pakistan and most developing countries, it’s a mixed system of public and private providers. You have to recognise this to succeed…for instance governance reform (build capacity & transparency) needs to be applied to the private system too, in support of the public. Her NGOs work has also shown that governance changes outside the health sector such as tax reform will impact positively on health systems.

Other illuminating talks covered:

  • Why politicians are now paying attention to heath system reform and the quality of that attention!
  • How do politicians make policy decisions…what evidence do they use, where do they find it and what do they do in an evidence vacuum?

Health system reform is now at the top of the agenda for governments, international organisations and donors. A return to primary health care, redefined for the current situation, seems to be emerging as the consensus solution for better health in low income countries. This involves 4 reform groups: universal coverage to be achieved through applying the best fit for financing the system, service delivery, policy reforms including training more informed healthcare providers(see HIFA2015 campaign) and lastly leadership, to regulate.

Health systems, fuzzy or not, are addressed by our database resource Global Health…health services, access, delivery, human resources, training, unique content from and about developing countries…AND we aim to identify & make available the evidence to support decision-makers.


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