Health System Strengthening

Better health is a basic human right and an end in itself. A healthy population is also essential to development. Recent years have seen some rapid improvements in health partly driven by the Millennium Development Goals and the large international funds set up to accelerate progress towards them. However, these improvements have at times been achieved despite the poor state of health systems in many developing countries. Stronger health systems will be required to ensure efficiency, tackle growing challenges such as non-communicable diseases and progress towards self-sufficiency.

DFID has long had a good reputation for health system strengthening and this is reflected in its own work. But DFID now relies on international partners, which do not all share this reputation, in an increasing number of countries and to manage an ever-greater proportion of its expenditure. We recommend that DFID reviews in each country whether its funding arrangements enable its health systems strengthening objectives to be met.

Assessing the effectiveness and value for money of health system strengthening work by DFID and its international partners is more difficult than it ought to be. Expenditure and performance figures are not published and the research base is inadequate. This must change. We also recommend DFID takes the lead in system governance and finance, and publishes a new strategy on health workforces.

The UK has one of the best health systems in the world, but DFID makes only limited use of it. We call on DFID to work with the NHS in expanding volunteering schemes for doctors and nurses and making more use of NHS finance and management skills.

Finally, we urge DFID to demonstrate global leadership worthy of its health systems expertise. It should be a vocal champion of system strengthening and seek to influence its international partners to prioritise it in their work. It looks likely that universal health coverage will be a target in the global post-2015 development goals, providing a chance to increase international focus on system strengthening. DFID must grasp this opportunity.