Health Systems Strengthening
Importance of health systems strengthening
Tremendous progress in maternal and child health has been achieved since the Millennium Development Goal targets were set in 2000. Even with this progress, unacceptable inequalities remain both among and within countries: high rates of death, disase and under-nutrition persist amongst vulnerable groups of children and women, including in middle-income countries. Additionally the Ebola crisis in West Africa highlighted the fragility of the health sector in the nations affected.
The Sustainable Development Goals (SDGs) conceive health as a foundation for social and economic development and political security. In support of the SDGs, the United Nations Secretary General’s Every Woman Every Child Global Strategy for Women’s, Children’s and Adolescents’ Health calls for a shift from an exclusive focus on ending preventable maternal, newborn and child deaths ("survive") to also ensuring health and well-being ("thrive") and expanding enabling environments ("transform").
Delivering on these ambitious goals, and sustainably reducing inequalities in health requires more explicit attention to health systems, including their functioning and financing.1 Strong, flexible and well-resourced health systems are essential to achieving universal access to a core package of services, or universal health coverage (UHC), and ensuring global health security, including resilience in the context of health and other emergencies.
UNICEF’s involvement in health systems strengthening
UNICEF’s mandate is to advocate for and protect children’s rights, to help meet children’s basic needs, and to expand on opportunities to help them reach their full potential, with a particular focus on the most disadvantaged. UNICEF has a long history of initiatives with a specific focus on child survival and development, but acknowledges that a health systems strengthening (HSS) focus is also imperative in the post-2015 context .
With this background and in support of the SDGs, UNICEF has developed a new, agency-wide Strategy for Health, 2016-2030. The Strategy envisions a world where no child dies from a preventable cause, and all children reach their full potential in health and well-being. In order to achieve this, all programmes supported by UNICEF aim to:
- address inequities in health outcomes
- promote integrated, multi-sectoral policies and action
- strengthen health systems, with a particular focus on emergency preparedness, response and resilience
UNICEF programmes use local knowledge to inform practice, advocacy and policy at community, sub-national, national and global levels across multiple sectors (health, nutrition, HIV, water, sanitation and hygiene (WASH), education, child protection, and social inclusion and policy, early child development, adolescent development and participation, disability, gender, and communication for development (C4D)). This bottom up approach leverages first hand understanding of challenges and opportunities on the ground, and it is at the core of UNICEF’s approach to HSS.
UNICEF’s vision for health systems
UNICEF envisions a strong health system as one which includes preventive and promote services and curative care, supports family practices, and produces equitable health, nutrition and development outcomes for infants, children, adolescents and women of reproductive age. Health systems should be gender responsive and deliver integrated service packages of appropriate quality for all children and women, regardless of their location, sex, ethnicity, language or religion. Strong health systems should serve all levels of society and be accountable to local populations, nations and the global community.
Health systems can serve as a platform to deliver health, nutrition, WASH, HIV and other services that provide a foundation for early child development. They should explicitly strive to close the gap in access to these services for the most disadvantaged children and women, to ensure UHC, and improved and equitable health and nutrition outcomes. Health systems should also explicitly include community-level disease surveillance and control, enabling countries to be accountable to the International Health Regulations for global health security, and should be resilient during public health emergencies.
UNICEF’s health systems strengthening approach
UNICEF defines HSS as actions that establish sustained improvements in the provision, utilization, quality and efficiency of services delivered through the health system, and encourage the adoption of healthy behaviors and practices. These actions may also influence the health system context, including key performance drivers such as policies that impact on health in all sectors, governance, financing, management, capacity for implementation, social norms and country participation in initiatives designed to maintain national and global health security. They also implicitly improve health security by strengthening the system’s resilience, and its preparedness to respond efficiently and effectively in the context of emergencies.
UNICEF’s HSS approach involves activities at all levels, acknowledging the importance of community engagement and sub-national management capacity to the overall performance of the health system. It focuses on the most disadvantaged. Activities build on UNICEF’s mandate, capacity, priorities and comparative advantages. They are guided by a results-based approach that includes situation analysis, followed by the stepwise identification of priorities and resolution of bottlenecks to effective coverage of health services, for the achievement of health outcomes (see Box).2
UNICEF’s work on HSS is implemented under the general framework of its cooperation agreements with host governments. In all contexts, UNICEF partners closely with agencies with leading roles in the health sector, including WHO, UNFPA, the World Bank and others, and in support of the UN Development Assistance Framework. UNICEF recognizes that its level of support in HSS will depend on the country context and the capacity of government and development partners at local level.
UNICEF also acknowledges the current evolution and complementarity of different partner agencies’ approaches to HSS, UHC and global health security, including across different country contexts. In this spirit, to avoid duplication and improve coordination, UNICEF works closely with these agencies, in particular the members of the IHP+3, non-government and community-based organizations. This collaboration occurs at global level, regionally, and at all levels of the health hierarchy in countries.
UNICEF’s core areas of action in health systems strengthening
UNICEF’s HSS approach includes activities appropriate to the three major functional levels of health systems (community, sub-national and national) in different contexts, enabling promotion of good health, delivery of essential interventions to all children and women, accountability and achievement of equitable outcomes.
In addition, it includes five issue-specific areas of existing capacity and perceived priority. Their relevance and UNICEF’s activity vis-à-vis that of partners will vary according to the local context.
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1. WHO (2007), Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action, Geneva: WHO. http://www.who.int/healthsystems/strategy/everybodys_business.pdf
2. For more information see: https://www.unicef.org/health/files/DHSS_to_reach_UHC_121013.pdf