Strengthening health systems in low-income countries by enhancing organizational capacities and improving institutions

Globalization and Health

Wim Van Damme⁴  Thiagarajan Sundararaman⁸  David Sanders⁹  Francis Omaswa⁶  David McCoy²  Stephen Jan^1,11  Graeme Currie¹  Tea Collins⁷  Somsak Chunharas^1,13  Francisco de Campos^1,12  Arvind Betigeri³  Allan Best^1,14  Rifat Atun^1,10  Robert Chad Swanson⁵ 

[1] Warwick Business School, The University of Warwick, Coventry CV4 7AL, UK;Queen Mary University, London, Blizard Institute, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London E1 2AT, England;Health Systems Action Network, K-57 A, Sheikh Sarai Phase -II, New Delhi 110017, India;Institute of Tropical Medicine, Antwerp, Belgium and University of Western Cape, Sint-Rochusstraat 2, 2000 Antwerpen, Belgium, South Africa;Department of Health Sciences, Brigham Young University, Provo 84602, UT, USA;African Centre for Global Health and Social Transformation, Plot 13 B Acacia Avenue, Kololo, Kampala, Uganda;World Medical Association, 13 Chemin du Levant, Bâtiment A, le John Keynes, Ferney-Voltaire, 01210, France;National Health Systems Resouce Centre, NIHFW Campus, Baba Gangnath Marg, Munirka, New Delhi 110067, India;School of Public Health, University of Western Cape, South Africa, Private Bag X17, Bellville 7535, Republic of South Africa;Department of Global Health and Population, Harvard School of Public Health, Harvard University, 665 Huntington Avenue, Boston 02115, MA, USA;George Institute for Global Health, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown 2050, NSW, Australia;Nucleus of Research in Public Health, Faculdade de Medicina da UFMG, Avenida Alfredo Balena, 190, Belo Horizonte, MG, Brasil;National Health Foundation, Building 1, 1st Floor, Office of the Permanent Secretary, Ministry of Public Health, Tivanond Road, Nonthaburi 11000, Thailand;Vancouver Coastal Health Research Institute, 6975 Marine Drive West, Vancouver V7W 2 T4, BC, Canada

关键词: Organizational studies;    Institutions;    Low-income countries;    Systems thinking;    Capacity;    Complexity;    Health systems;    Complex adaptive systems;   

Others  :  1133826
DOI  :  10.1186/s12992-015-0090-3

【 摘 要 】

Background

This paper argues that the global health agenda tends to privilege short-term global interests at the expense of long-term capacity building within national and community health systems. The Health Systems Strengthening (HSS) movement needs to focus on developing the capacity of local organizations and the institutions that influence how such organizations interact with local and international stakeholders.

Discussion

While institutions can enable organizations, they too often apply requirements to follow paths that can stifle learning and development. Global health actors have recognized the importance of supporting local organizations in HSS activities. However, this recognition has yet to translate adequately into actual policies to influence funding and practice. While there is not a single approach to HSS that can be uniformly applied to all contexts, several messages emerge from the experience of successful health systems presented in this paper using case studies through a complex adaptive systems lens. Two key messages deserve special attention: the need for donors and recipient organizations to work as equal partners, and the need for strong and diffuse leadership in low-income countries.

Summary

An increasingly dynamic and interdependent post-Millennium Development Goals (post-MDG) world requires new ways of working to improve global health, underpinned by a complex adaptive systems lens and approaches that build local organizational capacity.

【 授权许可】

   
2015 Swanson et al.; licensee BioMed Central.

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