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How should DFID approach health systems strengthening?

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Future Health Systems is a research consortium working to improve access, affordability and quality of health services for the poor. We are a partnership of leading research institutes from across the globe working in a variety of contexts: in low-income countries (Bangladesh, Uganda), middle-income countries (China, India) and fragile states (Afghanistan) to build resilient health systems for the future. After a successful first five-year phase from 2006-2011 (see our success stories), we are entering a new six-year phase of research, funded mainly by UK aid.

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How should DFID approach health systems strengthening?

Future Health Systems

The UK Parliament's International Development Committee recently launched an enquiry into the approach that the UK Department for International Development (DFID) takes to health systems strengthening. The committee noted that:

DFID’s approach supports targeted cost-effective interventions and seeks to ensure that these interventions support the longer term development of a health system fit to meet the needs of the population. In some circumstances this means supporting private sector providers (for-profit or non-profit, formal or informal) to deliver more good quality essential health commodities and services to poor people, and helping to strengthen the capacity of governments to regulate these provides and to finance use of the services by the poor.

The International Development Committee has decided to undertake an inquiry into this topic to examine how effectively in practice DFID is implementing its objectives.

The steering committee of the Future Health Systems research consortium prepared written evidence for submission to the committee. In our response we discussed four health systems strengthening areas:

  •  scaling effective interventions - DFID has emphasised generating rigorous evidence about interventions. However, much of this evidence describes whether an intervention has worked, with less attention given to why. Our experience has led us away from a model of linear scaling up of proven ideas toward treating health systems as complex adaptive systems.
  •  engaging health markets - health markets have spread quickly. The important question is not should DFID be engaging with these health market systems, but rather howbest to do so.
  •  unlocking community assets for health - community members are often the best experts to consult on the most effective strategies for improving their health. The empowerment of community members, however, needs to be matched by accountability mechanisms to the communities.
  •  building capacity - FHS puts capacity development at the heart of health systems strengthening. Without local research capacity, iterative cycles of learning and implementation would be impossible to maintain.

Written submissions will be available on the committee's inquiry page in due course.