Building resilient and sustainable systems for health, which is one of the four strategic objectives in The Global Fund’s Strategy for 2017-2022, articulates a new and targeted focus for strengthening health systems. The Board adopted the new Strategy at its meeting in Abidjan on 26-27 April (see GFO article.)
The ambitious Millennium Development Goals (MDGs) of the early 2000s drove a global health funding trend that increasingly targeted specific diseases and helped reduce their burden. This had positive spill-over effects to the wider health sector. However, concurrent unintended side effects constrained the capacity of countries to meet the broader health needs of their populations. In addition, the rapid emergence of non-communicable diseases, including the wake-up call of potentially catastrophic epidemics such as Ebola, proved extremely challenging for resource-scarce health systems.
From the start, The Global Fund has taken the position that disease-focused investments are only as effective as the health systems through which they are implemented. Its approach to health systems strengthening (HSS) has reflected emergent health threats and the global discussion, including the new focus towards the attainment of the Sustainable Development Goals (SDGs). With increasing global support for the primary care approach, and with efforts towards universal health coverage accelerating, international partners like The Global Fund are allocating and advocating for investments that generate system-wide effects.
The Global Fund support for HSS was enhanced with the introduction of the new funding model and The Global Fund’s 2012-2016 Strategy, elaborated in a concept paper, Resilient and Sustainable Systems for Health.
Along with the renewed focus came an increase in funding requests for cross-cutting HSS. This prompted the Technical Evaluation Reference Group to commission a thematic review, which generated recommendations for further refining the Global Fund approach to HSS (see GFO article). These recommendations are reflected in the new Strategy.
Building resilient and sustainable systems for health
Within the framework of The Global Fund’s mandate to fight HIV, TB and malaria, the strategic objective on building resilient and sustainable systems for health in the new Strategy aims at supporting countries’ efforts to strengthen their response to the health challenges they face. The Strategy says that to impact health outcomes, strong health systems should provide financial protection and equity, and contribute to universal health coverage. The Strategy focuses on harmonized approaches, integrated service delivery, strengthened community responses, and promoting equitable access to quality services.
The strategic objective on health systems contains seven operational objectives, as follows:
- Strengthen community responses and systems.
- Support reproductive, women’s, children’s, and adolescent health, and platforms for integrated service delivery.
- Strengthen global and in-country procurement and supply chain systems.
- Leverage critical investments in human resources for health.
- Strengthen data systems for health and countries’ capacities for analysis and use.
- Strengthen and align to robust national health strategies and national disease-specific strategic plans.
- Strengthen financial management and oversight.
Below, we briefly summarize each operational objective.
Community responses and systems. The Global Fund recognizes that communities are critical actors in improving peoples’ health, and that they play a vital role in making services more accessible, and in overcoming stigma, discrimination, and other human rights abuses. The Strategy acknowledges that there are existing policies to facilitate community involvement in program design, service delivery, and advocacy. However, the Strategy says that community-led responses can and should be strengthened further.
The Global Fund says that it will seek to ensure that community responses and systems are able to contribute effectively, including even after the Fund no longer provides support to a country. To do this, the Fund will, among other things, strengthen its guidance in this area; ensure that where possible Global Fund representatives meet with community groups in-country to better understand and address issues around program barriers and implementation; and build capacity among community-level implementers.
Reproductive, women’s, children’s, and adolescent health; and platforms for integrated service delivery. Support will be provided for the integration of comprehensive services in reproductive, maternal, newborn, child and adolescent health, to ensure that the health needs of women, children, and adolescents are addressed simultaneously. The Global Fund will support countries to ensure that entry points for patients for screening and diagnosing HIV, TB, and malaria also serve as entry points for diagnosing other diseases. This will result in cost savings and increase the ability to scale up for impact. Activities to strengthen this service model include scaling up integrated community case management, integrating services for HIV with sexual and reproductive health, and ensuring adolescent-friendly health services.
Procurement and supply chain systems. Approximately 40% of Global Fund support over the next strategy period will go towards the procurement and supply-chain management of health products. The Strategy calls for (among other things) capacity building on forecasting and quantification, storage and inventory management, distribution, quality assurance, and information management and reporting. The Global Fund will continue to support the use of its pooled procurement mechanism where needed, while encouraging countries to include funding within their grants for critical investments in the national procurement systems.
Investments in human resources for health. The Global Fund believes that a strong policy framework for building human resource capacity is essential to a functioning health system. The Strategy calls for the Fund to work with health partners to support the development of long-term “human resources for health” plans. Activities will include developing a policy framework for training, recruiting, retaining, paying, and motivating staff.
Data systems. The Global Fund believes that a functioning health information management system is essential for policy-makers, program staff, and consumers – as is the capacity across the health system to manage and use that data to identify gaps and barriers to improve the delivery of services. The Strategy calls for the Fund to systematically invest in country-specific M&E plans as well as country data systems and tools for assessing data quality. The Strategy says that this targeted effort will also include enabling communities and local providers to access, use, and act upon this data to highlight issues with program quality and barriers to accessing services.
National health strategies and national disease-specific strategic plans. The Global Fund believes that national health strategies and disease-specific strategic plans are necessary to ensure alignment of country-supported programs with the real health needs of the population. Under the Strategy, the Fund will support countries as they work to strengthen and implement their plans. This includes ensuring that the plans are designed through inclusive, multi-stakeholder processes. The Strategy calls for the Fund to work with national governments, partners, and country level implementers to ensure that disease plans are appropriately costed and implemented, linked to national health strategies, and include measures related to sustainability.
Financial management and oversight. Under the Strategy, the Fund will continue to support countries to build financial management capacity in order to enhance the efficiency, accountability, and transparency in their monitoring and reporting of health spending; and to reduce fragmentation and the associated cost of having multiple or parallel financial management systems for absorbing grant funds from The Global Fund and other donors. In addition, financial management capacity will be strengthened through partnerships and collaborations.