4.05 Health system strengthening

From the Secretariat annotation on the EB agenda

The review will include a summary of current debate on national and global approaches to national health policies, strategies and plans, and the role of such dialogue in the achievement of better health outcomes and the mobilization and alignment of resources behind country priorities. The report will cover the building blocks for health systems including, at the request of a Member State, a review of early progress made in the implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel.

PHM Comment (From the PHM Letter to EB members)

A report (Document EB128/8) is provided by the Secretariat pointing towards strengthening the role of WHO in supporting national work towards health system strengthening. 

This is an inadequate report.

Notwithstanding the promise of the annotation on the EB agenda, there is nothing in this report about the implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel. Indeed there is nothing about the workforce crisis, no reference to how brain drain in health is to be managed; no reference to the policy question of compensation of L&MICs whose exported professionals are staffing the hospitals and clinics of richer countries.

There is no mention in this report of the policies of the World Bank which since 1993 have promoted the horizontal stratification of health systems (private for the rich, social insurance for the middle and minimal safety net packages for the poor), nor is there any explicit analysis of the contribution of the disease specific funding bodies in promoting vertical fragmentation and internal brain drain. There is no mention of IMF restrictions on ‘fiscal space’ in actually applying resources which may be available.

The report acknowledges that health care reform is fundamentally a political process but the focus on the rational logic of ‘best practice’ does not offer any guidance with respect to the politics of health care reform. In particular there is no mention of the advocacy, accountability and participatory role of civil society in driving health system reform. 

Documents

• Document EB 128/8
• EU Resolution on Health System Financing
• India Resolution on Health System Strengthening

See also:

• Commentary on the HSS agenda item
• UNRISD Poverty report