HEALTH SERVICE DELIVERY STRENGTHENING HEALTH SYSTEMS TO ENSURE EFFECTIVE DELIVERY OF HEALTH SERVICES Stronger health systems. Greater health impact.
PHOTO: WARREN ZELMAN DECENTRALIZATION MSH engages all levels of the health system from the community to the ministerial level to develop their capacity to plan, lead, and manage. At the community level, MSH mobilizes local leaders and communities to support and use health services. At the facility level, we train workers to provide evidence-based care, to use state-of-the-art quality assurance and quality improvement practices, and to manage their work effectively. At central, provincial, and district levels, we develop and support new roles for ministries of health and other government entities working in a decentralized environment to support better health service delivery. CAPACITY DEVELOPMENT AND SUSTAINABILITY MSH works with partners around the world to build local capacity within the health system. In Chiapas, Mexico, MSH is helping improve the quality and availability of essential obstetric and neonatal care to the poorest 20 percent of the population. In Ethiopia, MSH helped the Ministry of Health s Gender Directorate increase equal participation, benefits, and outcomes for men and women in the health system through the development of a national strategic plan and the preparation of the National Gender Training Manual. By building local capacity, we strengthen local ownership and increase sustainability. MSH also provides sustainability planning and support, particularly where donor support is diminishing and stakeholder ownership is weak. REVISING AND RESTRUCTURING MSH is sometimes called upon to revise and restructure governments health service systems, particularly where service provision and management is weak at the district and community level, public-private linkages are weak, or where population changes, such as urban growth or migration, have challenged the health system s ability to meet that population s needs. In Rwanda, MSH has worked hand-in-hand with the Ministry of Health for over a decade to strengthen every aspect of its health system from developing sustainable financing mechanisms and a national insurance scheme, to data collection and use, to standardizing and improving the quality of services in public facilities. In Liberia, MSH supports several quality assurance and quality improvement interventions, the implementation of a nationwide performance-based financing scheme, and is building the capacity of staff at the Ministry of Health and Social Welfare.
INTEGRATION OF SERVICES Management Sciences for Health (MSH) helps improve and expand global health through the integration of health services. MSH s integration strategies link service levels of decentralized health systems, engage the private sector in public-private partnerships for service delivery, and make critical linkages between priority services such as HIV & AIDS with maternal and child health. Integration enables providers to treat all health needs of individuals and families efficiently regardless of the initial reason a person seeks care. SERVICE PACKAGES FOR UNIVERSAL HEALTH COVERAGE MSH helps countries achieve remarkable health impact by providing bundled health services. Known as essential packages of health services because they provide the greatest impact and value, they vary in their composition according to a country s needs. Typically these essential packages of health services include maternal, newborn, and child health services; immunization; public nutrition; communicable diseases treatment and control; and regular supplies of essential drugs. These essential services are the keystone of MSH s universal health coverage strategy. MSH s integrated packages such as those we have supported in Liberia, Uganda, and Haiti are evidenced-based, tailored to country needs, and delivered by capable and trained providers. They can be scaled-up as capacity is built to develop a stronger and sustainable health system. Even in post-conflict Afghanistan, with some of the worst health indicators in the world, MSH has worked with and supported the Ministry of Public Health to successfully implement an integrated package of services to improve child survival. PUBLIC-PRIVATE PARTNERSHIPS A strengthened public health system often requires the participation of the private sector, which can provide additional resources. MSH innovations in health finance, policy, and systems help compensate and regulate private providers in a public system. A primary mechanism for integrating private providers into public-private service delivery systems is performance-based contracting. MSH supports all aspects of performance-based contracting and provides assistance to private sector providers, facilities, and insurers to participate. PHOTO: GWENN DUBOURTHOUMIEU
PHOTO: GWENN DUBOURTHOUMIEU HEALTH SYSTEMS STRENGTHENING A health system consists of all organizations, people, and actions whose primary interest is to promote, restore, or maintain health. MSH and our country partners work within the World Health Organization (WHO) health systems building block framework to ensure delivery of services that address local needs. Within the service delivery building blocks, we work with local partners to ensure that providers are able to consistently deliver essential health services to clients day after day, from household to hospital. To that end, we promote local and country ownership and the use of evidence-based improvements, objective quality assurance, and quality improvement techniques. For example, our work in Rwanda has led to an initiative to work toward hospital accreditation. STRONGER HEALTH SYSTEMS Æ GREATER HEALTH IMPACT MSH applies our health systems strengthening approach through these four practices: Capacity building We strengthen local individuals and institutions and foster leadership through program implementation. Innovation We develop and scale up health systems innovations. Evidence We contribute to and apply the global health evidence base. Advocacy We advocate at regional, national, and global levels for universal health coverage (UHC). MSH integrates these health system building blocks to achieve strong health systems: Leadership, management, and governance Service delivery and demand Human resources Medicines, vaccines, and technologies Health care financing Health information MSH focuses on these five priority health areas in addition to integrated service delivery: HIV & AIDS and tuberculosis Maternal, newborn, and child health Family planning/ reproductive health Malaria and communicable diseases Chronic diseases
HEALTH SYSTEM BUILDING BLOCKS MSH improves health services by strengthening both the supply (government and private sector service delivery) and demand (increased use of services driven by community mobilization). Our comprehensive approach to strengthening health systems links health service delivery, health care financing (to increase access and financial risk protection), health information systems (to improve the evidence base), human resources, supply chain management, and interventions that strengthen leadership, management, and governance, policy formulation, and implementation at all levels. STRENGTHENING PRIORITY HEALTH SERVICES In strengthening health systems, MSH also focuses on maternal, newborn, and child health; family planning and reproductive health; HIV & AIDS, tuberculosis, malaria and other infectious diseases; and chronic diseases. MSH s expertise allows us to address lagging priority health areas during transitions from centralized or vertical service delivery that is, separate and unlinked services for maternal health, child health, malaria, and HIV & AIDS. MSH is a leader in community-based service delivery of priority services, including integrated community case management and innovative ways of working with community health workers. We are committed to addressing people s most pressing health needs and ensuring cultural sensitivity, gender equity, and youth-friendly services. PHOTO: RUI PIRES
TAO OF LEADERSHIP Go to the people Live with them Love them Learn from them Start with what they have Build on what they know. But of the best leaders When their task is accomplished The work is done The people will all remark We have done it ourselves. Lao Tzu Management Sciences for Health (MSH) works to save lives by closing the gap between knowledge and action in public health. Since 1971, we have worked with policymakers, health professionals, and communities in over 150 countries to improve the quality, availability, and affordability of health services. COVER PHOTO: WARREN ZELMAN management sciences for health Saving lives and improving the health of the world s poorest and most vulnerable people by closing the gap between knowledge and action in public health. WWW.MSH.ORG 200 RIVERS EDGE DRIVE MEDFORD, MA 02155 UNITED STATES TEL + 1 617.250.9500 COMMUNICATIONS@MSH.ORG www.msh.org/our-work/health-system/health-service-delivery