Strategies to Promote Health System Strengthening and Global Health Security at the Subnational Level in a World Changed by COVID-19

Martin Alilio; Neetu Hariharan; Elizabeth Lugten; Kama Garrison; Rhea Bright; Wilberforce Owembabazi; Uwem Inyang; Saad El-Din Hassan; Kelly Saldana

doi:10.9745/GHSP-D-21-00478

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Health Systems Strengthening for Public Health: Core Levels and Functions

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TABLE 1.

HSS Strategies to Integrate GHS and UHC

Explicit governance, organizational, and management strategies to promote the integration of GHS and UHC at the subnational level	Align national and local priorities and policies to ensure that GHS remains a critical component of PHC priorities and strategies.
	Integrate the supply chain system with a focus on forecasting, transportation, storage, and stock management to promote efficiency, good stewardship of donated commodities, and limit waste.
	Strengthen cold chain supply systems.
	Integrate public health campaigns, including vaccinations, mass drug administration, and bed net distribution to ensure they are a planned aspect of district health program management rather than separate donor-driven efforts.
Flexible finance systems that consider exceptional emergencies	Develop a transparent process for using local funds for emergency/outbreak response.
	Strengthen subnational budget oversight and encourage the use of transparent financial management systems.
Coordination to institute clear lines of communication	Generate clear definitions of shared cross-cutting objectives and aligned leadership roles.
	Engage the community and multiple stakeholders in defining and addressing population health needs.
	Develop and implement plans for shared infrastructure that included international points of entry and the cross-border districts.
	Reboot mechanisms that promote sharing and collaborative use of data and analytics.
	Create an explicit platform for donor coordination at the subnational level with clear links to government systems and local partners as applicable.
Integration of programs and institutions at the subnational level into a comprehensive range of preventive, curative, and rehabilitative health activities	Establish a senior-level position within the DHMT to coordinate HSS and GHS strategies.
	Strengthen the planning and management capacity of the DHMT with a focus on the mandate and the ability to integrate programs and institutions into a single, comprehensive district health system.
	Leverage resources from private-sector providers, including memoranda of understanding and public-private partnerships at district, facility, and community levels.
	Provide community health care workers with coordinated roles in pandemic prevention and response.

Abbreviations: DHMT, district health management team; GHS, global health security; HSS, health system strengthening; PHC, primary health care; UHC, universal health coverage.

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TABLE 2.

Actions to Build Capacity, Establish Processes, and Promote Synergy at the Subnational Level

Create capacity within district health management teams to include all health professionals in one comprehensive system with management and deployment coordinated, as necessary	Promote the capacity for rapid response with teams capable of investigating and responding to outbreaks.
	Strengthen systems that promote strategic production, institutionalization, (re)deployment, and retention of human resources in alignment with needs that are defined at both national and subnational levels.
	Facilitate and implement models that integrate public health and health systems for optimal leverage and strategic use of human resources.
	Institute structures that sustain and advance one-health technical capacities as well as those that strengthen programs at academic and training institutions.
	Empower district and regional managers to promote transparency concerning workloads and planning among all health professionals regardless of current supervisory or management structures.
Build sustainable capacity to develop and implement laws, regulations, and policies within each country	Strengthen links between the community, civil society, and the private sector to increase transparency and accountability.
	Establish a participatory process that deliberately includes and empowers subnational authorities in the policy development and implementation process.
Support a culture of evidence-based decision making, collaboration, and improved information sharing	Support strategic improvements in methods used to integrate health information systems including relevant health surveillance data.
	Strengthen reporting systems and establish agreements, protocols, processes, and regulations that govern reporting at the country, regional, and global levels.
Institute robust facility-level protocols and programs to prevent and control infections	Support regular training and review of protocols in all health-related facilities.
	Combat antimicrobial resistance by supporting the translation of national rational use guidelines for medicines to subnational level actions.
	Address human and animal health, food production, and environmental aspects through multisectoral engagement and collaboration.