WHO Maximizing Positive Synergies
The research on “Maximizing Positive Synergies” project (MPS) engaged an ad hoc alliance of researchers from many countries and disciplines grouped in 3 consortia: Academic; Civil society; and Implementers.
Led by the GHD Project, the academic consortium comprised 15 of the world’s leading universities and institutions spanning all 6 of the WHO’s global regions. More than 75 individual researchers have contributed, and the consortium has generated case study evidence from more than 20 countries.
Introduction
Over the last decade, Global Health Initiatives (GHIs) have mobilized substantial new resources for health action in many low- and middle-income countries. The expansion of key services, particularly the provision of HIV/AIDS treatment, has been striking, and millions of people have benefited. But the scale-up of selected services by GHIs has placed new demands on national health systems, revealed weaknesses in those systems, and rekindled debates on how countries can best combine disease-specific programmes with broader agendas to improve the health of their people.
In May 2008, the World Health Organization launched the MPS project to engage stakeholders in a collaborative effort to build new knowledge on interactions between health systems and GHIs and to generate evidence-informed guidance for policy and implementation.
As the 2015 target date of the Millennium Development Goals approaches, and though the economic crisis threatens to slow recent health gains to which GHIs have contributed, the opportunity exists to accelerate health progress where it is needed most by sustaining ambitious global investments in health and ensuring that resources are directed strategically for maximum impact. Understanding interactions between GHIs and health systems is crucial to achieving this result.
The Research: Multi-Method Strategies
“Methodologically, the MPS project has helped to advance a broader movement that is expanding the tools available for health systems analysis. The approach builds richly layered case studies on specific health systems challenges by combining quantitative and qualitative methods at country, district and/or local facility level. The resulting data provide a multidimensional picture of how disease-specific programmes and broader health systems structures are interacting.” Dr. Julio Frenk, Dean, Harvard University, School of Public Health, at the High Level Dialogue meeting in Venice, Italy, June 15, 2009.
The MPS effort has pursued the following overarching research question: How can GHIs and national health systems optimize their interactions to capitalize on positive synergies and minimize negative impacts thereby achieving their common goal of improving health outcomes? (WHO, 2008c)
The starting point for the conceptual framework was the WHO’s ‘building block’ approach to health systems strengthening based on the functional categories defined in the 2000 World Health Report. Approaching health systems as a set of inter-connected parts, the building block metaphor lays stress on common elements that seem to recur in every health system and must function in concert if services are to be delivered effectively.
Type of analysis used by the Academic Consortium included:
- Systematic literature review
- Cross-country quantitative analysis
- Mixed-method country case studies and facility-level studies
- Cross-cutting comparative analyses of country studies
- Multi-country studies and policy analysis
The Academic Consortium Findings
As outlined by Dean Frenk in his Venice address, the main takeaway messages of the academic consortium research can be summarized in three headlines:
- Broadly positive impacts: Country-level findings from the academic consortium suggest that, while GHI impacts on health systems have been mixed, on balance, these effects have been positive.
- Variability: Case studies reveal variations in the nature and impact of interactions between GHIs and health systems across countries, among GHIs working in the same country, and among different implementing partners funded by the same GHI in a given country.
- Opportunity: Crucial opportunities to strengthen and more fully systematize positive synergies between GHIs and health systems through dissemination and adaptation of emerging good practice lessons were identified.
For more details about the methodology and findings of the Academic Consortium, please read this presentation (PDF).
Overall Findings
The overall findings of the MPS research effort were discussed during a high-level dialogue in Venice, Italy, 22-23 June 2009. The concluding statement was signed by nearly 80 Minister of Health or representatives from around the world. They endorse the need to:
- Infuse the health systems strengthening agenda with the sense of ambition, the scale, the speed, and the increased resources that have characterized the GHIs;
- Agree on clear targets and indicators for health systems strengthening;
- Promote country capacity for strong national planning processes and better alignment of resources with national planning processes;
- Promote the meaningful involvement of civil society organizations in the governance of health systems and the delivery of health services;
- Improve evidence-based decision making in health by building the capacity of countries to generate and use knowledge.
Feature Publication: Interactions between Global Health Initiatives and Health Systems:
Evidence from Countries, Academic Consortium Report, June 2009
Additional Publications
Publications shared during the High Level Dialogue, Venice, Italy – 23 June, 2009
Venice Statement on global health initiatives and health systems, Letter by Rifat Atun, Mark Dybul, Tim Evans, Jim Yong Kim, Jean-Paul Moatti, Sania Nishtar, Asia Russell; Lancet, September 5, 2009
Global health initiatives and country health systems: Improving interactions to improve health outcomes, Open Forum Blog, July 6, 2009
Les initiatives mondiales contre les grandes maladies ont des effets imprévus sur les systèmes de santé locaux ; par Paul Benkimoun, Le Monde, June 23, 2009
An assessment of interactions between global health initiatives and country health systems by World Health Organization Maximizing Positive Synergies Collaborative Group‡, Lancet, June 20, 2009
