The forthcoming G8 summit in Japan represents a vital opportunity for the world's richest nations to drive forward action on health systems -- and the host nation can draw on its own good record to fuel that drive. The issues are explored in a Viewpoint in this week's edition of The Lancet.
Professor Michael Reich, Harvard School of Public Health, Boston, MA, USA, and Professor Keizo Takemi, Institute of Science and Technology, Tokai University, Tokyo, Japan, and colleagues say: "At the last G8 summit held in Japan, the Japanese government launched an effort to address critical infectious diseases, from which a series of disease-specific initiatives emerged. This year's summit provides another chance to catalyse global action of health, this time with a focus on health systems."
The authors discuss how focussing on disease-specific initiatives have led to unintended consequences of "creating a fragmented array on uncoordinated programmes supported by multiple donors that recipient countries must struggle to manage." Such programmes do not adequately address the broad systemic failures within health systems, which seem to lie behind the poor progress many countries have made towards achieving a number of Millennium Development Goals (MDGs). The Japanese government is seeking to transform the growing consensus on the importance of health systems into concrete action.
The authors draw on a computer analogy to emphasise the role of health systems. A computer's hardware and software support its ability to run specific programmes. Similarly, for a health system, the hardware alone (people, buildings, equipment, drugs) has limited effect on the public's health without functioning basic software (ie, financing and payment systems, organisational and management structures, regulatory controls). Once the health system is up and running, then you can then more successfully implement, for example, disease-specific programmes.
After 1945, Japan completely rebuilt its destroyed health system by focussing on national-disease specific programmes, and mobilising health workers in the community. Mothers received a mother-and-child health handbook to follow the growth of their new babies. The authors say: "Japan's positive experiences with its own health system motivate its convictions that developing countries today can do more to improve their own health systems, and that the G8 has both the capacity and the obligation to assist this process."
The authors call for enhanced learning about health systems and their many facets -- the political economy, values, and the cultural dimensions of how health systems work, as well as financial calculations. A responsible, independent, international research organisation is needed to coordinate the country-level efforts, with accountability to the global community and transparency about its methods and operations.
They conclude: "To advance this goal of enhanced learning, we believe that global health partnerships should agree to allocate a set portion of their funding for operational research and knowledge discovery in health systems…the G8 summit provides an opportunity to articulate a global commitment to learning about strategies for strengthening health systems, and to propose explicit institutions and financing for enhancing shared learning in the future."
Professor Michael Reich, Harvard School of Public Health, Boston, MA, USA T) +1 617-432-0686 E) michael_reich@harvard.edu
Professor Keizo Takemi, Institute of Science and Technology, Tokai University, Tokyo, Japan T) +1 617-496-8858 E) keizo55@takemi.net
Professor Marc Roberts, Harvard School of Public Health T) +1 617-432-3895 E) mroberts@hsph.harvard.edu
Prof. William Hsiao, Harvard School of Public Health T) +1 617-496-8850 E) hsiao@hsph.harvard.edu
PDF OF VIEWPOINT: http://multimedia.thelancet.com/pdf/press/Viewpoint.pdf
Journal
The Lancet