Health systems strengthening (HSS) is a broad-based approach that addresses underlying causes of health problems, such as maternal mortality, and is an important aspect of the United Nations’ Millennium Development Goals to improve global health outcomes. Despite the effectiveness of the HSS approach, there is a lack of commonly recognized principles and definitions among global health professionals, which hampers the effectiveness of health programs, policies and management.
The goal is for the guiding principles—put forth in a consensus statement by 11 global health leaders from six countries—to become the common language for future global health development and policy initiatives. The group’s principles are designed to meet the needs of diverse regions, cultures and economic conditions.
“Health system strengthening has become a catch-all, so having some guiding principles is important for directing these efforts,” said Elizabeth Bradley, a professor at Yale and one the authors of the paper that appears in PLoS Medicine. “Common principles and definitions can help the field coordinate these diverse efforts better and ultimately be more efficient with global health efforts.”
The ten guiding principles are:
1) Holism– Consider all systems components, processes, and relationships simultaneously.
2) Context– Consider global, national, regional, and local culture and politics.
3) Social mobilization–Mobilize and advocate for social and political change to strengthen health systems and address the social determinates of health.
4) Collaboration–Develop long-term, equal, and respectful partnerships between donors and recipients within the health sector and among other sectors.
5) Capacity enhancement– Enhance capacity and ownership at all levels, from individuals and households to ministries of health, including leadership, management, institutional strengthening and problem solving.
6) Efficiency– Minimize waste and allocate funds where they are needed most.
7) Evidence-informed action– Make decisions, whenever possible, based on evidence and ensure transparency and accountability.
8) Equity– Target those who are disenfranchised.
9) Financial protection–Ensure that funding streams are predictable.
10) Satisfaction–Respond to needs and concerns of all stakeholders.
At Yale, various initiatives are underway to improve global health outcomes, including the Global Health Leadership Institute, which convenes an annual conference and works directly with health professionals to build leadership, management, and problem solving activities directed at country priorities. “Our work is consistent with principle #5 in health system strengthening and is important for achieving health improvements,” said Michael Skonieczny, executive director of the Yale Global Health Leadership Institute.
In addition to Bradley, authors from Brigham Young University, The QED Group, Karolinska Institute, Health Systems Actions Network, the Ministry of Health in Ghana, the Institute for Maternal and Child Health in Italy, EntrePaducah, Health Systems Actions Network and the Institute of Population and Department of Epidemiology and Community Medicine of Ottawa contributed to the paper.
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