Medical oxygen is a lifesaving, essential medicine. Access to it is vital for treating patients at all levels of the health system, during both routine and emergency care. The COVID-19 pandemic caused surges in demand for oxygen, resulting in critical shortages, especially in low- and middle-income countries. Even in the absence of a pandemic, health care facilities need medical oxygen to treat newborns, children with severe pneumonia, people with chronic and infectious conditions, and patients requiring surgery.
Tagged: health systems strengthening
Twenty years ago, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) was established to lead the global response to the HIV epidemic. Today, PEPFAR is a public health engine: a critical platform for strengthening health systems, preparing for and responding to pandemics, and enabling global health security. Here, we share how PEPFAR made it possible for FHI 360’s teams to effectively respond to COVID-19 in countries with established HIV infrastructure.
Strengthening health systems comes down to staff, stuff, space, systems and support. Whether providing primary care or responding to deadly outbreaks of infectious diseases, a holistic approach that places the patient and their community at the center of care and treatment is essential. In this episode, Dr. Paul Farmer and I discuss how human connection and authentic partnership should remain at the center of public health and human development work.
Dr. Paul Farmer is the Co-Founder, Chief Strategist and Chair of the Board of Trustees of Partners in Health, and a medical anthropologist, physician and author. His most recent book is Fevers, Feuds, and Diamonds: Ebola and the Ravages of History. His positive approach to disrupting under-resourced and poorly performing health systems is simple yet holistic: Address unmet needs for staff, stuff, space, systems and support.
Do investments in private hospitals and clinics catering to the wealthy strengthen primary health care systems in poor countries?
At a recent roundtable discussion in New York City, a representative of a private equity group presented plans to build private hospitals in emerging markets, such as Kenya, as one of the best ways to strengthen primary health care delivery. For most of us who have worked on strengthening health systems, investing in hospitals that cater to the well-off doesn’t sound like the best way to meet the health needs of the poor.
An Interview with
Kwasi Torpey, Director, Technical Support Division, FHI 360
Laboratory strengthening is a component of Strengthening Integrated Delivery of HIV/AIDS Services (SIDHAS), a five-year project to build local capacity for the delivery of sustainable, high-quality and comprehensive HIV/AIDS prevention, treatment, care and support services. FHI 360 implements SIDHAS in 13 states in Nigeria.
What is laboratory strengthening and how is SIDHAS meeting this need?
Lab strengthening is a form of support to improve the capacity of a lab for quality service delivery, helping to achieve optimal performance, increase productivity and efficiency, deliver accurate and replicable diagnostics services, achieve customer satisfaction and promote safety. Lab strengthening also provides infrastructural development, equipment maintenance and quality control services to allow timely delivery and accurate results.
FHI 360 has supported the improvement of labs through training and mentoring to facilitate good quality management systems and record keeping. This work in lab improvement aligns with the World Health Organization Africa Regional Office (WHO-AFRO) initiative known as Strengthening Laboratory Management Towards Accreditation (SLMTA). Working within SLMTA parameters with our Nigerian government counterparts provides regular collaboration and deepens the leadership, stewardship and sustainability of the country’s labs.
I am deeply concerned for the wellbeing of people in West Africa confronting the rapid spread of the Ebola virus. We wish to pay our respect to the courageous health workers battling the disease, and who have paid a disproportionate price for their heroism, as well as to the faith-based organizations that have remained on the front lines. We are now faced with a crisis of historic proportions that threatens not just the health of tens of thousands of people, but the economic and social stability of the region. On behalf of FHI 360, I want to express our deepest sympathy for all those affected by this scourge and our solidarity with our staff, counterparts, and colleagues in the affected countries.
This crisis will undoubtedly have broad consequences not only for West Africa, but for the wider world. If World Health Organization (WHO) officials are correct, the epidemic will take thousands more lives and we can expect an even deeper toll on already overwhelmed health systems. This is a crisis that requires the collective efforts of the international community.
The Ebola virus outbreak has exposed the fragility of health systems in poor countries—and shown how vulnerable nations are when basic social systems are unable to respond to critical needs. The world is now witnessing the terrible consequences of the failure to equip health systems, connect patients to direct medical care in rural areas, educate medical staff and the general population to risk factors and prevention methods, provide laboratory testing, and track disease surveillance data to monitor the spread of the virus.
By working to support WHO’s six building blocks of health systems, we can improve availability, use, and quality of health services delivered through both public and private facilities. We need to continue to develop and apply workable strategies to improve the quality of care and the performance of health systems, particularly in resource-constrained environments.
Imagine: a district health official sits at her desk with the results of a country-wide assessment that details 20 pages of vague recommendations to improve the health system. Suggestions range from “increasing use of financing mechanisms” to “providing adequate benefit packages for health workers” to “utilizing budget-neutral retention schemes to improve rural retention of health workforce.”
She realizes that these issues are potentially important to her work, but she faces more immediate challenges on a day-to-day basis. Just this morning, a local hospital director was in her office discussing the low number of women who attend their antenatal care appointments. Everyday issues such as this seem disconnected from the greater health system — but are they?
It is widely recognized that failure to reach health care goals can be attributed to constraints on the system, but the relationship between these constraints and specific health issues is not well understood. FHI 360’s Health Systems Strengthening unit has developed a tool to examine the links between the concrete problems in performance experienced at a subnational level and overarching health system issues.
FHI 360’s Health System Rapid Diagnostic Tool guides identification of bottlenecks and sets the scene for addressing those hurdles. The Rapid Diagnostic Tool provides a step-by-step framework, operational guide and metrics for an in-country team to process to identify and measure the strength of priority health system functions.
Other health system assessment tools exist, but their results are aggregated into lengthy reports — such as the report on our imaginary district health officer’s desk — full of recommendations that are difficult to act on and not linked to daily work. These other tools focus on assessing what health system problems exist at a high level. In Kenya, for instance, a dozen assessments have been performed in the past decade, and Kenyan health officials are very aware of the issues they face. What is not clear, however, is how to address those issues and how to achieve better outcomes.
The Rapid Diagnostic Tool dives deep with focused data collection and analysis to identify root issues that lead to poor health-system performance. Its level of detail makes it ideal for assessment at the regional, district or subdistrict level, as opposed to the health sector as a whole. The final diagnostic report serves as a basis for designing health systems strengthening interventions.
Delving into the root causes of many health system problems is like pulling a thread on a sweater. It quickly becomes clear that one problem is interrelated with many other issues and can be overwhelming for a project or individual to deal with alone. With the Rapid Diagnostic Tool, stakeholders work together to prioritize systems issues and find the root cause of more proximate problems. With this understanding in hand, they are equipped to design initiatives that will improve health system efficiency and effectiveness by addressing the underlying causes of poor performance. For more information on the Rapid Diagnostic Tool, contact the FHI 360 Health Systems Strengthening Unit at HSSD[at]fhi360.org.