Why is Health Systems Research key for fragile and conflicted-affected states?
Ahead of the Universal Health Coverage Forum 2017, Health Systems Global members provide their perspectives on how Health Policy and Systems Research is fundamental to achieving Universal Health Coverage by 2030.
UHC and the needs of fragile and conflict-affected states
Universal health coverage (UHC) is a particular health system objective that emphasizes the importance of all people and communities having access to essential health services of sufficient quality without risking financial hardship for the recipient. This makes UHC attractive to even the countries with the largest challenges facing their health systems — those of fragile and conflict-affected states (FCAS). But is it a realistic objective for FCAS health systems?
FCAS usually face a number of critical challenges in seeking to restore and improve their health systems, including:
- Lack of access — few health services exist for a large proportion of the population outside urban areas
- Insufficient resources — human, financial, and infrastructure resources of the health system have been destroyed or severely compromised due to conflict or neglect or both
- Inequity in who receives the available health services — few public health services exist for the poor, other vulnerable groups, and in rural areas
- Poor health management information systems for planning, management, disease surveillance, and program adaptation
- Inadequate policy mechanisms for conceptualizing, developing, establishing, and implementing national health policies.
Health systems research (HSR) that involves costing of health services, combined with epidemiological and burden of disease information, can help FCAS weigh the impact of various potential health interventions. This research can be used not only for making decisions about specific priority interventions that are most effective in light of local health conditions, but can also be a means for developing the policy mechanisms needed to strengthen the health system in the rebuilding process.
- Impact: Do the proposed interventions have great effect or bearing on priority health problems?
- Effectiveness: Do the interventions have proven effectiveness? E.g., they have been proven to work in other countries with a similar situation.
- Scaling-up: Can the chosen interventions be adapted and implemented on a large (national) scale?
- Equity: Is it fair in terms of who will have access and benefit from the interventions?
- Sustainability: Are the interventions affordable for the long term?
Use of HSR can also help ministries to develop critical policy mechanisms by using the research findings to:
- establish priorities among competing demands
- establish criteria so the same factors are used in making choices among alternatives
- ensure consistency in decisions that are aligned with national health objectives, and
- ensure national health objective priorities are maintained over the long term.
Effective engagement with FCAS depends on ministries and donors acting in a coordinated manner so as to have a full understanding of health system challenges to inform the design of health programs and selection of interventions. Planning requires considering allocation (what health services are to be delivered), production (how the services will be organized), distribution (who will receive them), and financing (who will pay for them). This is where HSR has a critical role in facilitating the rebuilding of health systems in an equitable, resilient, and effective manner, which will help the FCAS move toward UHC.