3. Strengthening Health Systems

Abstract

The success of efforts to improve health in developing countries depends in large part on the strength of their health systems. While these countries possess a range of capacities to enhance the functioning of their systems, low–income countries face considerable constraints in doing so, not the least of which is poorer access to health resources. Strengthening health system capacity to improve performance requires special attention to the relationship among the health system, its patients (clients), and their communities.

While governmental stewardship and regulation can benefit health services delivery, giving patients a voice in the local health system is also important in encouraging good performance. Achieving systems goals set by health policies also requires a well–trained workforce. Effective approaches to improving health workers' performance often include a combination of financial and other incentives, such as higher salaries and adequate and appropriate training. In addition, some of the more successful elements of recent institutional reforms involve contracting out services, especially to nongovernmental organizations.

It is possible to deliver good–quality care, even in resource–poor settings. Legal mandates and regulations, professional oversight, peer review, and resource allocation formulas are among the tools available to decision makers and managers. With these tools and instruments, health systems can be strengthened in different country contexts to deliver interventions effectively, efficiently, and equitably, but the best strategies often are often incremental and gradual and encompass action at all levels, from increasing leadership at the national level to enhancing support at the local level.