Strengthening Health Systems:
From Global to Local
Sara Bennett, Associate Professor
Johns Hopkins School of Public Health
Global Health Council Satellite Session
Health System Strengthening:
What is Everyone Doing?
June 13, 2011
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Key points
 There is both conceptual confusion and multiple
approaches to HSS
 Conceptual confusion is problematic – but it may
be premature to fix conceptual frames
 Multiplicity of approaches is a good thing, if it
reflects responsiveness to differing contexts
 Need to embrace more nationally driven HSS
agendas and support the development of
national-level capacity to drive such agendas
2
Different current approaches to HSS
3
Problems of lack of conceptual clarity
 Too much time spent explaining things to each
other and to outsiders!
I support a
diagonal
approach to
HSS with
positive
synergies
Oh, but how do
you accommodate
system dynamics
and emergent
behaviors?
 Fragmentation and lack community across a
small field
 Lack of agreed standards to track
commitments and achievements
 Cyclical trends in priority for health systems
4
Intrinsic features of field that promote
cyclical policy (source: Rochefort 1988)
 Complexity of field and heterogeneous
problems
 Exaggerated ideologies – over-confidence,
disillusionment
 Incomplete development of scientific basis
 Mismatch of goals and means
 Linked to social and economic cycles
 Not sexy!
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From global to local
• Context specificity of HSS
• Cycles leave insufficient
time for country
implementation
• National commitment to
HSS may be more
important than global
funding
• Need for local research to
build global evidence
base
6
Future health systems – DFIDsupported research consortium
Philosophy
Country-driven research, focus on local
capacity development
Countries
Afghanistan, Bangladesh, China, India,
Uganda and neighbours
X-cutting
themes
Unlocking community capabilities,
stimulating innovation, understanding
intervening in complex adaptive systems
M-health schemes to better link informal
providers to formal health care system
• Vouchers for transport to facilities
• New approaches to regulation
• Community scorecards for health
Interventions •
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Reflections
 Diversity of proposed interventions reflects local
contexts and histories
 Country leadership motivates and empowers
country researchers
 Responsiveness to local concerns facilitates links
to policymakers and other research users
 Planned research processes incorporate learning
and adaptation
 Relinquishing leadership can be frustrating for
northern researchers and challenging for
generalizable findings
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