Health systems strengthening: a common classification and framework for investment analysis

Significant scale-up of donors' investments in health systems strengthening (HSS), and the increased application of harmonization mechanisms for jointly channelling donor resources in countries, necessitate the development of a common framework for tracking donors' HSS expenditures. Such a framework would make it possible to comparatively analyse donors' contributions to strengthening specific aspects of countries' health systems in multi-donor-supported HSS environments. Four pre-requisite factors are required for developing such a framework: (i) harmonization of conceptual and operational understanding of what constitutes HSS; (ii) development of a common set of criteria to define health expenditures as contributors to HSS; (iii) development of a common HSS classification system; and (iv) harmonization of HSS programmatic and financial data to allow for inter-agency comparative analyses. Building on the analysis of these aspects, the paper proposes a framework for tracking donors' investments in HSS, as a departure point for further discussions aimed at developing a commonly agreed approach. Comparative analysis of financial allocations by the Global Fund to Fight AIDS, Tuberculosis and Malaria and the GAVI Alliance for HSS, as an illustrative example of applying the proposed framework in practice, is also presente

Analysing the equity of post-Soviet health care systems : evaluation of 1990s health reforms

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Global health initiative investments and health systems strengthening : a content analysis of global fund investments

Millions of dollars are invested annually under the umbrella of national health systems strengthening. Global health initiatives provide funding for low- and middle-income countries through disease-oriented programmes while maintaining that the interventions simultaneously strengthen systems. However, it is as yet unclear which, and to what extent, system-level interventions are being funded by these initiatives, nor is it clear how much funding they allocate to disease-specific activities - through conventional 'vertical-programming' approach. Such funding can be channelled to one or more of the health system building blocks while targeting disease(s) or explicitly to system-wide activities.; We operationalized the World Health Organization health system framework of the six building blocks to conduct a detailed assessment of Global Fund health system investments. Our application of this framework framework provides a comprehensive quantification of system-level interventions. We applied this systematically to a random subset of 52 of the 139 grants funded in Round 8 of the Global Fund to Fight AIDS, Tuberculosis and Malaria (totalling approximately US$1 billion).; According to the analysis, 37$ 362 million) of the Global Fund Round 8 funding was allocated to health systems strengthening. Of that, 38% (US$139 million) was for generic system-level interventions, rather than disease-specific system support. Around 82$ 296 million) was allocated to service delivery, human resources, and medicines & technology, and within each of these to two to three interventions. Governance, financing, and information building blocks received relatively low funding.; This study shows that a substantial portion of Global Fund's Round 8 funds was devoted to health systems strengthening. Dramatic skewing among the health system building blocks suggests opportunities for more balanced investments with regard to governance, financing, and information system related interventions. There is also a need for agreement, by researchers, recipients, and donors, on keystone interventions that have the greatest system-level impacts for the cost-effective use of funds. Effective health system strengthening depends on inter-agency collaboration and country commitment along with concerted partnership among all the stakeholders working in the health system

Virtual reality technology for experiential learning in global health training curricula: a prototype for testing

Background: Since the late 1990s there has been a rapid proliferation of global health academic programmes at universities around the world; however, evaluation of such programmes suggests that their quality often falls below expectations. Although graduates might have acquired adequate theoretical knowledge, they often lack the practical skills and hands-on experiences that are necessary for effective performance in real-world settings. To address the issue of limited integration of the experiential learning method into global health training curricula, we are developing a global health training course based on virtual reality (VR) technology. Methods: The VR application is being developed with the VR game engine software Unity. Some features of the VR application include: VR visualisation, VR simulation, interactive content, 3D holograms, 360° immersive video, and 3D data visualisation. In addition to acquiring theoretical knowledge through technical content, users will also be immersed in a highly realistic global health field environment and will be able to perform specific tasks. Findings: We have produced a prototype training module that simulates outbreak of Ebola virus disease in a low-income country setting. We will test the prototype to assess various technological and pedagogical aspects of the use of VR technology for global health training. The prototype will be tested by global health students and professors at global health academic departments in low-income, middle-income, and high-income countries. We will use data from testing to identify challenges and opportunities for scaling-up the application of VR, 360°, and 3D technologies in global health education. Interpretation: Integration of VR technology into global health training can improve the quality and outcomes of global health education programmes by allowing students an experiential learning component. Such methods of learning through doing are widely used in the education sector. For example, in clinical medical education, students spend only the first 2 years in classrooms, then move to teaching hospitals to acquire practical skills and experiences through practical tasks. Traditionally, incorporation of the experiential learning method into global health training has been a challenge, since it is not always feasible to deploy global health students to the sites of global health practise. VR technology allows educators to bring the global health field into the classroom in a risk-free and cost-efficient way. Funding: Georgian Innovation and Technology Agency

An assessment of interactions between global health initiatives and country health systems

Since 2000, the emergence of several large disease-specific global health initiatives (GHIs) has changed the way in which international donors provide assistance for public health. Some critics have claimed that these initiatives burden health systems that are already fragile in countries with few resources, whereas others have asserted that weak health systems prevent progress in meeting disease-specific targets. So far, most of the evidence for this debate has been provided by speculation and anecdotes. We use a review and analysis of existing data, and 15 new studies that were submitted to WHO for the purpose of writing this Report to describe the complex nature of the interplay between country health systems and GHIs. We suggest that this Report provides the most detailed compilation of published and emerging evidence so far, and provides a basis for identification of the ways in which GHIs and health systems can interact to mutually reinforce their effects. On the basis of the findings, we make some general recommendations and identify a series of action points for international partners, governments, and other stakeholders that will help ensure that investments in GHIs and country health systems can fulfil their potential to produce comprehensive and lasting results in disease-specific work, and advance the general public health agenda. The target date for achievement of the health-related Millennium Development Goals is drawing close, and the economic downturn threatens to undermine the improvements in health outcomes that have been achieved in the past few years. If adjustments to the interactions between GHIs and country health systems will improve efficiency, equity value for money, and outcomes in global public health, then these opportunities should not be missed