Management and Health Systems Strengthening

Why Strengthen the Health System?

Keeping people healthy and mortality low is a complicated task involving many different components: prevention, access to care, nutrition, maternal and child health, family, and so much more. There are also many things outside of specific health areas that can impact health, including employment, education, housing, income, and many others.

The important about strengthening health systems and assisting health workers is the fundamental base for healthcare worldwide. Historically it has to focus on single concerns such as HIV or malaria. This is helpful, but strengthening the health system means it will be able to respond to any disease. “We must learn to listen if we want to be heard.” on the importance of developing a better, more coordinated health system in the three main affected countries and how this could be the difference between containment and widespread infection. Throughout the conference, “We must learn to listen” reminded us of our mission and of the necessity of learning from those we are trying to help and soliciting their input to change and improve the health system.

The key to improved health is to refine and strengthen health systems. As organizations, if we work together and listen instead of just talking, I believe real change will happen in the world and lives will be saved.

How to Lead Successful Health Care Projects

Consider the next project you will be managing. Perhaps it is a quality, safety, or patient experience project. Perhaps it is a facilities improvement, new construction, revenue cycle management, or cost streamlining project. Whatever it is, when orchestrated in a health care setting, you cannot rely exclusively on classic project management principles to produce the organization’s anticipated results, because health care projects must always balance the interests of the patient with those of the organization.

This unique dual-stakeholder situation requires project management skills that are specialized for health care organizations.

The School of Public Health teaches these targeted skills to clinical, operational, and administrative project leaders through Health Care Project Management: The Intersection of Strategy, People, and Process. This acclaimed 4-days course provides practical, evidence-based approaches that help cement the success of a health care project.

This includes strategies to:

• Plan your project
• Pitch it effectively to sponsors and stakeholders
• Initiate the project successfully
• Execute and deliver your project
• Close out the project
• As a participant, your experience will be focused and relevant, designed to help you achieve optimal project outcomes.

 Clinicians come to this course to build skills and to build confidence with the project management approach. They learn the key disciplines of project management specifically as they apply to their practice, as well as how to master the “people side” of project management.  They take home tools and evidence-based guidelines to manage their next projects, and the assurance that they are managing their projects effectively.

Professionals in operations or administrative roles come to this course to learn best practices to improve project outcomes, streamline their own work, and create inefficiencies for their organizations. They also advance their interpersonal skills for managing cross-disciplinary teams. And they will appreciate the many ways in which that unique stakeholder—the patient—shapes responsibilities and account abilities on the projects they manage.

Skills Development

This program provides strategies for more effective management of projects in health care settings and skills development for managing project teams and processes. Coverage includes:

PROCESS MANAGEMENT

• Project scope
• Project plan
• Success measures
• Resources
• Project initiation
• Execution control
• ROI
• Information flow
• Risk mitigation
• Interventions
• Project close-out
• Sustaining project gains

PEOPLE MANAGEMENT

• Executive support
• Team building
• Role definition
• Meetings and huddles
• Feedback
• Recognition
• Negotiation
• Conflict resolution
• Engagement
• Accountability vs. Responsibility

Action for Health

Health education, health monitoring, and subsidized clinic care to children and pregnant women.

Health Savings
We empower women with financial knowledge and independence and help them break down financial barriers to health care access.

 Communications & Advocacy
We empower community members with important health information and the capacities needed to enact lasting change in the local health system.

Health System Strengthening
 We work with partner stakeholders in the communities and clinics to improve the quality, capacity, and accessibility of health care.

The Child Survival Strategy

Its specific objectives are:
• To proportionally reduce the neonatal, infant and child mortality rates while achieving
the overall objective
• To ensure the greatest possible reduction of mortality among the children of the poorest
and most marginalized sections of the population.
• To contribute to the reduction of maternal mortality to achieve the Millennium
Development Goal by 2015
• To ensure the availability of quality essential health care for women and children in the
community and health facilities

The strategy focuses on:

• the health system, but long term gains will also depend on progress in other sectors, 
• reducing poverty
•  improving food security, 
• raising levels of maternal education and the status of women in society, 
• and the provision of safe water and sanitation.

The main pillar of the strategy is the Health Service Extension Program, which aims to scale
up coverage of essential health services to the rural community. Success will depend on this
program being rolled out as rapidly as possible while ensuring high quality care and full
coordination of its activities and integration with higher tiers of the health service.

Implementation of the Key Interventions
The Strategy spells out the actions to be taken at each level of the health system, starting with
the community. The emphasis is on prevention and promotion, but first level treatments of
malaria and diarrhoea have been added to the original Health Service Extension Program.
Basic treatment of common killers was added to save lives in the interim before promotive
actions are fully effective and to enhance the credibility, and thus, the effectiveness, of the
HEWs’ efforts in prevention and promotion.

The focus on key interventions has implications for the planning and development of the
various programmes and delivery mechanisms within the health system. This presents an
opportunity to focus on essential programme improvements in a way that will produce rapid,
observable results.

Three levels of the health system are involved. Most of the key interventions start in the
community and Health Post. Much of the preventive and promotive work is the primary
responsibility of the HEWs, as the management of illness starts with the family’s ability to
recognise the illness and seek early treatment. All of these actions must be supported by the
Health Centre staff, through the provision of referral care, technical support and close
collaboration with the HEWs. The District Hospitals have an important role in referral care,
training and in operational research.

The Strategy, therefore, requires action to build and maintain the capacity at all three levels.
The Woreda Health Office must be strengthened to effectively plan, support and monitor the
necessary actions and inputs at all three levels. The focus needs to be on overcoming the
major bottlenecks of access to care, increasing availability of skilled human resources,
improving supply and logistics, systems strengthening for the effective supervision and the
referral of women and children who need higher level care.

5 Ways to End AIDS by 2030

By 2020, if the fast-track approach goes to plan, 90 percent of people who live with HIV will know their status, 90 percent of people who know they are HIV-positive will be on treatment, and 90 percent of people on treatment will have suppressed viral loads, making them less likely to transmit the virus. And by 2030, AIDS will no longer be a threat to our public health.

The goal is ambitious. There are still a lot of global problems and prejudices to overcome. But today experts can see what once seemed impossible — ending the epidemic — is finally within reach, and these five focus areas are going to help make it happen.

1. More health workers, ready for anything.

Lab technicians, doctors, nurses, even the truck drivers who deliver antiretroviral therapies and other meds to clinics around the world are all health workers, and they’re at the heart of health and well-being in any community.

HIV demands all different types of health workers and skill sets, including palliative care, counseling, research, pharmacology and obstetrics, to name just a few. Pediatrics is another big one, as one of our greatest challenges ahead will be making sure all HIV-positive infants and children are on treatment.

According to the World Health Organization, we need some 7.2 million additional doctors, nurses and midwives worldwide. And unless we invest in the global health workforce, that number will grow to 12.9 million by 2035.

To end the AIDS epidemic, the world needs more health workers who are trained and ready to do the job, stationed in the right places, connected to the right technology, and safe from infection and violence. Countries also need to make better use of the health workers they have. Without health workers, we can’t test or treat even a single person — much less end an epidemic.

But it’s not just health workers’ skills the world needs. It’s also a commitment to equitable, unbiased health care for all.

2. Focus on key populations.

Members of key populations — something of a euphemism for sex workers, men who have sex with men, transgender people and injectable drug users — are marginalized and stigmatized. Their isolation and high-risk behaviors mean these groups have much higher HIV prevalence rates than others and they suffer the bulk of new infections.

Not so long ago, U.S. policy tried to prevent global health organizations from working with certain key populations. And when we did, we were often required to first document our moral indignation by proclaiming our opposition to, for example, prostitution.

Today this policy has changed. But that doesn’t mean that these key populations are getting the HIV services they need. Take Uganda’s infamous anti-homosexuality law — enacted and then repealed this year — which made it difficult for many to seek or even provide care without risking life in prison. Similar laws are still on the books in some countries.

Many members of key populations have been turned away by health workers. And many more have been socially outcast for so long that health care doesn’t even seem like an option anymore. So they fall through the cracks of health care systems around the world.

One example is in South Sudan. The HIV rate among the general population is relatively low, only 2.2 percent among adults. But among female sex workers — and there are many, particularly wherever there’s a strong military presence — the rates are much higher. The ongoing war and all its effects on the health system have turned the country into a tinderbox for potential HIV infections.

That’s why IntraHealth International, in partnership with the South Sudanese government, reaches out to sex workers at brothels and lodges, trains peer educators (that is, other active female sex workers), promotes and distributes condoms, provides testing and counseling for HIV and syphilis, and links women to other critical health services. Of the 546 sex workers we tested between July and September of this year, almost 32 percent were HIV-positive. Fortunately, most are now enrolled in treatment and getting the care they need.

3. Rock-solid health systems.

Over the past 35 years, we’ve seen what a strong health system can do to help countries respond to HIV. And in the past year, we’ve seen another virus, Ebola, spread out of control in West Africa. It’s clearer than ever that vulnerable health systems around the world have a long way to go.

Strong health systems are the bedrock of any healthy population. They lay a foundation built on governance, financing, technology, research, service delivery, and the health workforce (also known as human resources for health). To successfully address an epidemic such as HIV requires focus on each of these things, not just a few.

One way to make these systems stronger — and to lower rates of HIV — is to ensure systematic HIV testing and counseling. Integrating different types of services (HIV and tuberculosis, for example, or HIV and family planning) is a way to reach those at greatest risk.

Starting this year, a new USAID-funded global project called Linkages will play a big role in strengthening health systems around HIV. The project will build capacity within governments and civil society to offer high-quality HIV services that are sustainable, evidence-based, and comprehensive, specifically to key populations.

4. Strange bedfellows, unexpected results.

What do you get when you gather motorcycle taxi drivers, local traffic police, and a regional health management team in rural Tanzania? Hundreds of men and boys eager to lower their chances of contracting HIV and want to learn road safety tips all in one place.

It happened this year as part of a drive to offer voluntary medical male circumcision to men and boys in hard-to-reach areas. IntraHealth worked with the union of Kahama’s motorcycle taxi drivers to gather hundreds of community members together to offer the service, which lowers a man’s risk of contracting HIV through heterosexual intercourse by 60 percent.

Everyone had a great time, especially when a popular Tanzanian comedian showed up and talked about his own circumcision. And hundreds of men and boys opted for the procedure during the event.

Global health needs more strange bedfellows — that is, innovative partnerships — like these if we’re going to end the HIV epidemic.

5. ARVs to treat and prevent.

It was 2011 when U.S. scientist Myron Cohen and his team at the University of North Carolina at Chapel Hill discovered that treating HIV-positive patients with antiretroviral therapy while their immune systems are still strong significantly lowers their risk of transmitting the virus. His study proved the concept of treatment as prevention.

Today, some 13.6 million people (of the total 35 million who live with HIV) have access to antiretroviral therapy. We’ve come a long way. But the final push will mean making sure as many people who live with HIV as possible are taking these medications to reduce their viral loads — and their chances of transmitting the virus.

It will also mean honing our overall approach. Think community-based testing campaigns, provider-initiated testing and counseling, and even self-testing. But countries need health workers and strong health systems to support these approaches.

The endgame

“PEPFAR, the Global Fund and UNAIDS are all changing their programming priorities,” says Karen Blyth, director of East Africa programs at IntraHealth.

The new focus: key interventions that save lives.

“That’s because we know now that a generalized approach often doesn’t work,” Blyth explained. “In Uganda, for instance, new HIV infections are now rising, after dropping for 15 years. So from this point on, it’ll be about targeting the hotspots of the epidemic — reaching exactly the right people in the right places with the right treatment and services.”

The next 15 years are going to make global health history. They may mark the end of the most damaging epidemic in our lifetimes, during which countries around the world rallied together to face a unifying threat. Of course, these five approaches alone won’t be enough to bring this chapter to a close. But each one is vital to reaching our goal.

10 global health issues to watch in 2015

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An empty Ebola virus decontamination zone at the Hastings treatment clinic as Ebola infection's decrease in Freetown, Sierra Leone, Friday, Jan. 23, 2015. With the Ebola outbreak weakening in West Africa, Sierra Leone eased restrictions on movement and commercial activity Friday even as the president warned that the fight against the deadly disease is not yet over. AP

 Here are our top ten predictions:

10. Mental health. Child mortality, AIDS, maternal mortality—these and a handful of other issues have dominated the global health spotlight for years. But what about depression, post-traumatic stress disorder, dementia, substance abuse, and other mental health challenges that affect high- and low-income countries alike?

“Mental health and well-being are fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living, and enjoy life,” World Health Organization officials say.

Ethiopia is just one country that began focusing on mental health services in 2014, when it trained health workers to provide mental health care within prisons for the first time. As the civil unrest, economic instability, and traumatizing Ebola outbreaks of 2014 continue into 2015, mental health needs will only become more urgent—and so will the need for more trained social service workers, psychiatrists, and other health workers.

9. Cancer. Results from the largest cancer study ever published—released last month by the Lancet—show that cancer kills more people in low- and middle-income countries than HIV, malaria, and tuberculosis combined.

“The reason that some countries lag behind is not surprising; it’s a matter of how much is invested in cancer care,”NPR reported on the study. “Dr. Corey Casper, head of global oncology at the Fred Hutchinson Cancer Research Center in Seattle, met a doctor in Uganda a few years ago who was then seeing 10,000 patients a year ‘in a facility that had…no roof, inconsistent electricity, and no meds.’ What’s more, says Casper, he was the only cancer doctor in Uganda and four surrounding countries.”

Cancer and other noncommunicable diseases will not get all the attention and resources they deserve in 2015, because Ebola will likely stunt global progress in addressing them this year. But they will continue to be a growing challenge for us all, including frontline health workers around the world.

8. AIDS: An end in sight or a reversion? In 2014, UNAIDS announced its new fast-track strategy to end the AIDS epidemic by 2030.

“If the world does not rapidly scale up in the next five years, the epidemic is likely to spring back with a higher rate of new HIV infections than today,” officials from the U.N. agency said.

That’s partly because half of the 35 million people who live with HIV today don’t even know they’re HIV-positive, so they don’t know they’re in danger of passing the virus on to others. This year will mark the first full year of a global strategy designed to avert 21 million deaths over the next 15 years. Can it help us address AIDS as a chronic illness, and make HIV’s threat to public health a thing of the past?

7. Family planning. FP2020, a global partnership to make family planning more widely available, will enter its third year in 2015, and it’s already reported some amazing global results—77 million unintended pregnancies averted, for example, and 125,000 women’s and girls’ lives saved. It also highlights Senegal’s impressive progress, including a new method of contraceptive distribution called the Informed Push Model, which completely eliminated contraceptive stockouts in all public health facilities in Pikine, Senegal, in just six months. Now the government is expanding the model nationwide.

This type of progress is possible everywhere, and we hope to see more of it in 2015.

6. Mobile tech. In the hands of trained, connected health workers, mobile technology has the power to transform health care. It can help a lone health worker in even the most remote, isolated village get up-to-date training and provide high-quality care. It can help patients avoid quacks. And it can help connect health workers to one another and to information that can save lives (including their own). In 2014, for instance,Liberia began using a technology called mHero that allows the Ministry of Health to send critical information to health workers’ mobile phones. And health workers can use it to send time-sensitive information to ministry officials and to one another. In 2015, this technology will help other countries combating Ebola and prepare them for future health threats as well.

5. Global health security and surveillance. In 2014, an outbreak of the mumps began sweeping through the National Hockey League in the US and measles cases reached a 20-year high. Polio persisted as some 350 cases were reported in eight countries. These are vaccine-preventable illnesses. Their resurgences—not to mention the far more dangerous outbreaks of Ebola in West Africa—are all threats to our global health security. In 2015, countries should continue to address these threats. But it will take international cooperation on a scale not yet seen to create better disease surveillance systems, establish laws and policies that bolster health systems, and prevent violent conflicts—that is, to ultimately make a healthier and safer world.

4. War and unrest. More than half of all hospitals in Syria have now been attacked by Syrian forces, and over a third are no longer functional. Physicians for Human Rights says 578 health workers have been killed in the ongoing conflict. The violence of 2014—including in Syria, Ukraine, Gaza, South Sudan, Central African Republic, and Nigeria—is not over. War, civil unrest, and acts of terrorism can hinder or even reverse progress in all aspects of global development, including health, education, and gender equality.

In 2015, the international community will continue trying to resolve these conflicts and prevent hospitals and health workers from becoming targets of violence. Last year in a landmark resolution, the United Nations stepped up to lead the global effort to protect health workers and hold accountable those who perpetrate violence against them.

3. Ebola. Ebola killed over 8,000 people in 2014, including hundreds of health workers. In 2015, West Africa and the world will continue struggling to contain the epidemic. We will also encounter Ebola’s devastating ripple effects: setbacks in HIV and maternal health progress, traumatized communities, and thousands of children orphaned by the disease and abandoned by their remaining family members. This last issue will add to the already great need for social service workers in West Africa who are trained and prepared to meet the specific needs of vulnerable children.

Ebola has made clear the global need to invest in health systems for the long term—and in health workers.

2. New sustainable development goals. This year marks target date for reaching the Millennium Development Goals, which have led to massive worldwide improvements in health and well-being over just 25 years. Now global leaders are finalizing a new set of objectives for global development: the sustainable development goals. These new goals could unite countries on the path toward one of the international community’s most ambitious goals: universal health coverage. To achieve it, we’ll need a greater focus on the global health workforce than the world has ever seen.

1. People-centered health systems.Perhaps more than any crisis in living memory, Ebola has shone a spotlight on the importance of people in health systems. Take away the people—as Ebola has done by killing 500 health workers in West Africa and beyond—and the system crumbles. Each part of the health system requires people to make health care work, and not just clinicians, but statisticians, finance experts, technologists, and, of course, all of us who seek health care services.

How do we make our most valuable resources—human beings—a priority as we strengthen our health systems?

In 2015, we could begin answering that question together.

cancer conflict Ebola family planning health systems HIV-AIDS mental health mobile health surveillance

Strategy Objectives Global Health

Global health is the goal of improving health for all people in all nations by promoting wellness and eliminating avoidable disease, disability, and death. It can be attained by combining population-based health promotion and disease prevention measures with individual-level clinical care. This ambitious endeavor calls for an understanding of health determinants, practices, and solutions, as well as basic and applied research on risk factors, disease, and disability.

10 objectives of the HHS Global Health Strategy focus on strategic priorities with mutual benefits to both the American people and those of other nations. The objectives build on core strengths and expertise within HHS, and contribute to the achievement of the three goals.

Objective 1: Enhance Global Health Surveillance
Strengthen global surveillance to detect, track, identify, control and prevent diseases and address health concerns that may directly or indirectly have an impact on the U.S. population.

Key priorities:

• Support countries and multilateral organizations to strengthen surveillance systems, addressing current gaps (e.g., integrating surveillance for human and animal diseases, and communicable and non-communicable diseases) and ensuring interoperability of systems, both within and across countries
• Assist with improving workforce and laboratory capacity to support diagnosis for disease surveillance
• Provide leadership and technical expertise, often embedded within Ministries of Health, to ensure surveillance efforts are timely, evidence-based, data-driven, internationally shared and actionable to inform public health policies and decision-making
• Develop and evaluate innovative surveillance, information management, and communication strategies

Objective 2: Prevent Infectious Diseases and Other Health Threats
Work with global partners to enhance health security and prevent the introduction, transmission and spread of infectious diseases and other health threats within and across borders.

Key Priorities:

• Support the development of sustainable capacities among partner governments and international agencies for addressing both public health emergencies and day-to-day public health needs, consistent with the International Health Regulations (2005)
• Facilitate development, use, and evaluation of vaccines and other prevention strategies such as vector control and safe water, focusing on achieving global disease reduction goals
• Support database and information technology infrastructure with global access and common portals for monitoring purposes, including measures for early warning systems and monitoring holdings of dangerous pathogens
• Ensure effective risk and crisis communication by coordinating with global partners to disseminate public information and emergency notification, especially to at-risk populations and stakeholders

Objective 3: Prepare for and Respond to Public Health Emergencies
Mobilize and support an immediate health-sector response to international outbreaks and public health emergencies.
Key Priorities:

• Support the development of sustainable response capacities and coordination mechanisms for addressing public health emergencies consistent with the International Health Regulations(2005)
• Provide technical expertise and share mechanisms for investigating disease outbreaks and identifying their cause
• Collaborate with international partners to develop best practices and standard indicators and guidelines for responding to natural and man-made disasters, including a focus on improved coordination and response practices
• Develop policy frameworks, agreements and operational plans to facilitate HHS decision-making in response to both single and multiple international requests for emergency assistance, including for the deployment of medical countermeasures and HHS personnel

Objective 4: Increase the Safety and Integrity of Global Manufacturing and Supply Chains
Enhance regulatory systems and global manufacturing and supply chains to ensure the safety of medical products, food, and feed that enter into the United States.
Key Priorities:

• Identify key risks in the global manufacturing and supply chain and implement strategies to mitigate them in cooperation with other governments and international agencies
• Strengthen strategic regulatory partnerships to promote a safer, higher quality global supply of medical products, food and feed  

Objective 5: Strengthen International Standards through Multilateral Engagement
Provide leadership to establish, strengthen and implement science-based international health and safety standards and support multilateral efforts to improve global health policies, programs, and practice.
Key Priorities:

• Ensure an appropriate leadership role . in the development of science-based norms and standards, particularly within the World Health Organization and other multilateral bodies addressing health issues
• Strengthen existing multilateral relationships and develop new strategic alliances to maximize the achievement of our global health goals and objectives

Objective 6: Catalyze Health Research Globally
Catalyze biomedical and public health research and innovation globally to promote the discovery, development, delivery and evaluation of new interventions that improve health and well-being across national borders.
Key Priorities:

• Address research priorities that are linked to scientific opportunity, public health needs, and the evolving burden of disease
• Support the rapid translation of research results into new or improved preventive, diagnostic, and treatment products and processes, and incorporation into health policies and practice, in diverse global settings, including resource-poor environments
• Encourage research that identifies causative pathways of the spread of infectious disease and other health threats

Objective 7: Identify and Exchange Best Practices to Strengthen Health Systems
Increase the exchange of best practices to improve health strategies, with a focus on comprehensive strengthening of health systems.
Key Priorities:

• Support collaborative health system strengthening activities, including workforce development, that are both consistent with country priorities and have the greatest potential public health impact
• Promote the global exchange of best practices and lessons learned to ensure that evidence supports decisions and program implementation
• Address the underproduction and retention of health professionals in developing countries

Objective 8: Address the Changing Global Patterns of Death, Illness and Disability
Encourage global action to address the major current and emerging contributors to global death, illness and disability.
Key Priorities:

• Promote the development, implementation, evaluation and dissemination of cost-effective prevention, policies, strategies and interventions for NCDs
• Promote the integration of effective public health policies and trade policies
• Strengthen health system capacities to address multiple NCDs by fostering evidence-based interdisciplinary practice and promoting integrated community approaches that include other sectors

Objective 9: Support the Global Health Initiative (GHI)
Support the GHI to achieve major improvements in health outcomes for women, children and families, as confirmation of the US commitment to the health-related Millennium Development Goals.
Key Priorities:

• Contribute to the achievement of GHI goals and principles in the areas of HIV, malaria, TB, neglected tropical disease, maternal and child health, nutrition, safe water, sanitation, and hygiene, and focusing on women-centered programming, country ownership, integration and coordination, and health system strengthening
• Support the integration of public health services for prevention and control of key diseases such as HIV/AIDS and vaccine-preventable diseases with other priority health interventions in health facilities and other settings, as appropriate.

Objective 10: Advance Health Diplomacy
Engage directly with diplomatic partners, and strengthen peer-to-peer technical, public health, and scientific relationships.
Key Priorities:

• Assign health attachés to selected for international cooperation, ensuring that political, security, development and health objectives are maximized
• Establish a Global Health Career Track within HHS to formalize career opportunities and training for people working in the global health arena, including in overseas assignments
• Partner with the Department of State to bolster knowledge about global health among the diplomatic corps
• Strengthen diplomatic knowledge, negotiation skills and understanding of development principles for HHS field staff and technical health experts