CORE Group Global Health Practitioner Conference Advancing Community Health Across the Continuum of Care

WHO Building Blocks Platform

for Health Systems Strengthening: Adding Communities to the Mix

Alexandria, Virginia Wednesday, April 15, 2015

2:00 – 3:30 PM

Session Agenda

• David – Problem Summary • Emma – First Thoughts (Pre-First Draft) • Eric – Evidence and Advocacy • Small group work here to stimulate further

development and commitment

Problem Summary • Civil society, communities and community health are minimally

represented in existing health system strengthening (HSS) models • As the Maternal and Child Survival Program (MCSP) and CORE

Group, we seek to end preventable child and maternal deaths in 24 high priority countries

• Our objective: Articulate and advocate for the roles that ‘communities’ can play in HSS in order to stimulate dialogue and address gaps in global health care

• Where to begin? There are multiple HSS models, and who is to say there is a best one? World Bank? GAVI? Global Fund? WHO? We chose the WHO Building Blocks model as our starting point, somewhat arbitrarily. We are not married to this, we simply wanted to begin the discussion.

Scope of Activity to Date Concurrent panel was held at the Fall 2014 CORE Group Global Health Practitioner Conference: Where is the “C” in Health Systems Strengthening?

• Joseph Petraglia, Pathfinder International • Alfonso Rosales, World Vision US • Eric Sarriot, USAID Maternal and Child Survival Program • Karen Cavanaugh, USAID • Amalia Del Riego Abreu, Pan American Health Organization • Ngashi Ngongo, UNICEF

Scope of Activity to Date • Building iteratively, we started a small working group

in early 2015 from MCSP and CORE Group, and are expanding our network/coalition outward

• Reviewed the six building blocks and considered additional ‘blocks’

• Considered each block and reflected upon how communities could/should be incorporated building on the work of Karen LeBan, Emma Sacks & USAID/W

• Began a literature review and developed a glossary of terms – A sub-theme of this activity is: ‘What constitutes evidence?’

WHO’s original objectives for the six building blocks

• Promote common understanding • Address new challenges and set priorities • Address questions of health system financiers • Strengthen WHO’s role in health systems, in a

changing world

USAID Definition of Health System Strengthening (HSS)

• Strategies, interventions and activities designed to sustainably improve health system performance.

Let’s consider the Building Blocks, One at a Time

1. Service Delivery – Good health services are those which deliver effective, safe, quality personal and non-personal health interventions to those that need them, when and where needed, with minimum waste of resources. Questions & Comments – What are non-personal health interventions? (Population based?) Where is infrastructure? This is clearly aspirational rather than explicit in nature.

Let’s consider the Building Blocks, One at a Time

2. Health workforce – A well-performing health workforce is one that works in ways that are responsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances (i.e. there are sufficient staff, fairly distributed; they are competent, responsive and productive). Questions & Comments – What about community and/or informal staff? Paid versus volunteer? Full-time versus part-time? Should they be from the communities they serve? They need to live and work very near their service populations, and be focused on overcoming inequity.

Let’s consider the Building Blocks, One at a Time

3. Information – A well-functioning health information system is one the ensures the production, analysis, dissemination and use of reliable and timely information on health determinants, health system performance and health status. Questions & Comments – Dissemination to whom? Communities receiving services? Health determinants are usually limited to SES, if that is collected. How is equity access really assessed?

Let’s consider the Building Blocks, One at a Time

4. Medical Products, Vaccines and Technologies – A well-functioning health system ensures equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use. Questions & Comments – Who may use these technologies in communities? Is selected task shifting embraced by the national medical community? Timeliness and availability of essential medicines is a huge challenge for community based health care; iCCM rollout is an example of a strategy facing many barriers within national supply chains.

Let’s consider the Building Blocks, One at a Time

5. Financing – A good health financing system raises adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them. It provides incentives for providers and users to be efficient. Questions & Comments – Out-of-pocket expenses continue to be a major barrier to health service use worldwide. Full funding of basic services for people in low/no resource settings is urgently needed.

Let’s consider the Building Blocks, One at a Time

6. Leadership/Governance – Leadership and governance involves ensuring strategic policy frameworks exist and are combined with effective oversight, coalition building, regulation, attention to system-design and accountability. Questions & Comments – ‘Strategic policy frameworks exist’ may imply a top-down approach, rather than an epidemiologically driven, bottom-up approach to inform priorities and investment.

What’s Missing?

• Community - Whether community is rarely mentioned, or frequently mentioned, it is not explicit and often disappears during the planning and budget process.

• Community based health services - run by, and for communities, with limited or no access to national health services. This is the reality in many parts of the world, and planning for more facility based care will not make unmet health needs (and inequity, and preventable death) go away.

• Health production - of households and communities, based on meeting basic public health needs (often outside the medical model of service), and practicing healthy behaviors.

• Civil society engagement - for resource generation, active participation in advocacy, planning, implementing, managing and measuring, and accountability of public resources, at multiple levels (local, regional, and national).

For more information, please visit www.mcsprogram.org

This presentation was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of the authors and do not

necessarily reflect the views of USAID or the United States Government.

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