Highlighting key achievements of USAID in improving global health, he noted, “since the founding of USAID by President Kennedy 50 years ago, child mortality has declined nearly 70 percent… over 50 million children lives were saved during the last twenty years alone.”
USAID's work on strengthening health systems has played a key part in these important changes. Dr Pablos-Méndez enumerated some of the many contributions that USAID has made across the six building blocks of effective health systems. For example, regarding health service delivery he noted that USAID strategy has focused on working with health markets to catalyze sustainable development, including social marketing and sustainable commercial health products, expanded private sector partnerships, new networks and social franchising. And in terms of health information management, USAID is developing the Human Resource Information System or iHRIS, a suite of three open-source databases to track health worker training, manage and deploy personnel, and provide long-term health workforce modeling and planning.
But Dr. Pablos-Méndez argued that the global health sector is now at an inflection point. The field is facing a rapid and complex shift in the environment. The disease profile in developing countries is changing to chronic, non-communicable diseases such as cancer and diabetes. And official development assistance is also changing. He observed that, “in the 1960s, such assistance represented 70 percent of the capital flows going into developing countries. But today, because of private sector growth and increased trade, domestic resources, remittances, and capital flows, it is just 13 percent - even as development budgets have continued to increase.” Former aid recipients are transitioning to donors. And there has been a slow demographic shift to aging populations, decreased fertility rates and urbanizing populations.
To respond to shifting epidemiology and economic transitions in developing countries, Dr. Pablos-Méndez called for flexibility, innovation and collaboration.
In anticipation of these shifts, Dr. Pablos-Méndez explained that US Global Health Initiative (GHI) will focus its efforts towards strengthening systems, fostering ownership and encouraging leadership, including greater domestic investment in healthcare. Interventions will be integrated across health areas and will move from a disease model to serving the needs of a patient. Smoking, obesity and basic prevention will gain prominence, and health financing will become increasingly central to country plans.
To foster cross-border learning, the Health Systems Office of USAID will act as a hub of knowledge management on complex systems, service delivery, governance, financing, training and professional development. Additionally, GHI promises to streamline PEPFAR and encourage greater interagency collaboration for a more strategic health response to the challenges of our times.
Dr Sara Bennett from the Johns Hopkins Bloomberg School of Public Health, and the CEO of the Future Health Systems consortium – which sponsored the event – was impressed by the breadth of activities outlined by Dr. Pablos-Méndez. She said, “you’ve provided us with a range of fresh and extremely challenging ideas when we think about the implications of economic growth and the shift in balance in power between countries, as well as the emerging epidemiological transition. And you’ve asked us really to challenge ourselves to think about how we can strengthen health systems.”
She also highlighted the importance of the D.C. Health Systems Board (HSB) as a forum for such discussion. Originally established in 2008, the Health Systems Board aims to provide a forum in the Greater Capital Area for discussion and debate about current issues in health systems research and policies relevant to low and middle income countries. The Board’s discussions concern both research about health systems and current policy issues related to health systems. Events are coordinated by the various institutional members, with this particular event hosted by the Johns Hopkins School of Advanced International Studies (SAIS).