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In Health Systems Strengthening, the Big Question Is Not What, but How

As the global health community gears up for the Third Global Symposium on Health Systems Research in Cape Town, South Africa, next week, health systems—specifically the tragic consequences when they fail—are in the news.

The Centers for Disease Control and Prevention predict that Ebola cases in West Africa could reach 1.4 million before the outbreak ends. Media coverage of the tragedy has led to conversations about how interconnected the world is, and how scary things can be.

The tragic Ebola outbreak has exposed—once again—that health systems are only as strong as their weakest links. It has shown global health practitioners and people all over the world that weak health systems make any efforts to improve health care challenging, and often short-lived.

We know what we need: stronger, more resilient health systems and, as the Lancet calls it, a “grand convergence” to reach universal health coverage. Even though the term “health systems strengthening” is less than 20 years old—and “universal health coverage” is even newer—we’ve known we need them for much longer than that. Perhaps it started with the September 1978 Alma Ata primary health care declaration and its goal of “health for all by the year 2000.”

Next week’s symposium comes at an opportune time. 

So whether we call it primary health care, health systems strengthening, or universal health coverage, we know what we need. But 36 years after Alma Ata, we’re still not sure how to get there.Next week’s symposium comes at an opportune time. The gathering will showcase the latest thinking on health systems, and shed light on how we can collectively build stronger systems and help turn research into real evidence that can guide decision-making.

At IntraHealth International, we’re looking forward to sharing some of what we have learned about how to strengthen the health workforce and how to ensure that evidence leads to enlightened and informed policies that support robust health systems.

We’ll share findings—from India, Kenya, Namibia, Uganda, West Bank, Zambia, and around the globe—to showcase health workers as the human element that makes people-centered health systems possible. As I will discuss next week, global health nongovernmental organizations, donors, and all partners must consider the impact of our efforts on systems as a whole.

Let’s judiciously weigh the benefits and costs of focused interventions, ensuring that we are not disrupting local labor markets or creating parallel, disease-specific systems in the interest of measurable results. As partners, let’s not add to the work of already over-burdened health workers, clinics, ministries of health, and health systems.

The Ebola crisis is bringing the world’s attention to health systems. So let’s work together to build evidence-based policies and programs.

Because health systems strengthening shouldn’t be just one part of what we do in global health. It should be part of how we do everything.