Health Systems
- The Demographic Stretch of the Arc of Life: Social and Cultural Changes That Follow the Demographic Transition
The demographic transition from high to low levels of mortality and fertility brings about changes that stretch the “arc of life,” making each stage of life longer and creating new ones—a phenomenon we call “the demographic stretch.” This stretch can transform societal structure, for example, by extending childhood, shifting working ages up, delaying marriage and childbearing, improving women’s status and equity, and pushing the burden of chronic disease and disability to older ages. Global health efforts must address the resultant economic and social changes.
- The Astronomy of Africa’s Health Systems Literature During the MDG Era: Where Are the Systems Clusters?
The volume of literature on health systems in sub-Saharan Africa has been expanding since the 2000 MDG era. Focus has remained generally on categorical health themes rather than systems concepts. Topics such as scaling-up, organizational development, data use for decision making, logistics, and financial planning remain underrepresented. And quite surprisingly, implementation science remains something of a “black hole.” But bibliometric evidence suggests there is a shift in focus that may soon address these gaps.
- Leveraging the Power of Knowledge Management to Transform Global Health and Development
Good knowledge is essential to prevent disease and improve health. Knowledge management (KM) provides a systematic process and tools to promote access to and use of knowledge among health and development practitioners to improve health and development outcomes. KM tools range from publications and resources (briefs, articles, job aids) and products and services (websites, eLearning courses, mobile applications), to training and events (workshops, webinars, meetings) and approaches and techniques (peer assists, coaching, after-action reviews, knowledge cafés).
- How Can We Better Evaluate Complex Global Health Initiatives? Reflections From the January 2014 Institute of Medicine Workshop
An IOM workshop on evaluation design drew on recent evaluations of 4 complex initiatives (PEPFAR; the Global Fund to Fight AIDS, TB and Malaria; the President's Malaria Initiative; and the Affordable Medicines Facility-malaria). Key components for good evaluations: (1) a robust theory of change to understand how and why programs should work; (2) use of multiple analytic methods; and (3) triangulation of evidence to validate and deepen understanding of results as well as synthesis of findings to identify lessons for scale-up or broader application.
- It's not Ebola … it's the systems
The 2014 Ebola outbreak in West Africa demonstrates key deficiencies in investment in health systems. Despite some modest investment in health systems, our field has instead largely chosen to pursue shorter-term, vertical efforts to more rapidly address key global health issues such as smallpox, polio, malaria, and HIV/AIDS. While those efforts have yielded substantial benefits, we have paid a price for the lack of investments in general systems strengthening. The Ebola deaths we have seen represent a small portion of deaths from many other causes resulting from weak systems. Major systems strengthening including crucial nonclinical elements will not happen overnight but should proceed in a prioritized, systematic way.
- Strategies to reduce risks in ARV supply chains in the developing world
Key strategies of the main ARV procurement program for PEPFAR to reduce supply chain risks include: (1) employing pooled procurement to reduce procurement and shipping costs and to accommodate changing country needs by making stock adjustments at the regional level, and (2) establishing regional distribution centers to facilitate faster turnaround of orders within defined catchment areas.
- A stewardship approach to shaping the future of public health supply chain systems
Guiding Principles: (1) Governments should see themselves as stewards of supply chains, providing vision, guidance, and oversight, not necessarily as operators of supply chains. (2) Governments should not be afraid to leverage the multiple supply chain actors and diverse options available; these can be woven into a coherent, integrated system, providing flexibility and reducing risk. (3) Governments will need new skills in leadership, regulation, market research, contract design, oversight of outsourced providers, financial analysis, and alliance-building.
- Strengthening government management capacity to scale up HIV prevention programs through the use of Technical Support Units: lessons from Karnataka state, India
A Technical Support Unit of managerial and technical experts, embedded in but distinct from the government, provided support in 5 key areas: strategic planning; monitoring and evaluation; supportive supervision; training; and information, education, and communication. This model likely contributed to effective and rapid scale up of Karnataka state's HIV prevention program. A clear mandate, close collaboration, and well-defined roles were keys to success.
- Strategic contracting practices to improve procurement of health commodities
Practices such as flexible, pre-established framework agreements can improve timeliness and cost of procurement and help improve commodity security. Addressing legislative barriers and building technical capacity in contract management may facilitate the use of such practices.
- Development and use of a master health facility list: Haiti's experience during the 2010 earthquake response
Collaboration between the Haitian government and NGOs after the 2010 earthquake contributed to a more accurate and complete master health facility list, which helped coordinate emergency response operations as well as strengthen the routine health information system. Open data and social networks facilitated the collection and sharing of health facility information and in maintenance of the list over time.