No mysteries in creating stronger healthcare systems
Financial Times, October 5, 2007
Letter to the Editor
Sir, Thanks to Andrew Jack for a highly informative overview on how health aid can skew state priorities (“From symptom to system”, September 28). Investing in health systems versus specific diseases need not be a dichotomous choice. Nor is health system strengthening as mysterious as some critics imply.
Selective, simultaneous investments in particular health conditions and in system improvements suited to each particular country will answer both Jim Kim’s question, “What do we do next?” and Chris Murray’s charge that we don’t know “what to do best to deliver primary healthcare”.
In the late 1990s, Bangladesh chose to add essential obstetric care to relatively strong family planning and safe abortion services, while undertaking pivotal system-wide investments in training, information and management, decentralisation and logistics.
Their rate of maternal mortality, one of the world’s highest, dropped by 22 per cent and mortality among children under five by 24 per cent in four years.
Other countries make different choices depending on the state of their health systems. Mozambique is training physician assistants to perform caesarian sections in upgraded primary health centres, backed by skilled midwives, at health posts nearer the villages that can provide a range of maternal and child health services as well as information and simple treatments for malaria and tuberculosis control.
There are no magic bullets for eradicating diseases, nor will we find pat formulas for strengthening health systems. But one core principle applies: all countries can build strong systems for the long haul, beginning with careful choices about short-term priorities that address the largest number of people in need – usually poor women and their very young children.
International Women's Health Coalition
New York, NY 10001, US
Originally published in the Financial Times, October 5, 2007.