Need for Health Systems Strengthening most critical in Low and Middle-Income Countries

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Dr. Anthony Nsiah-Asare Director-General Ghana Health Service
Dr. Anthony Nsiah-Asare Director-General Ghana Health Service

The Director General of Ghana Health Service, Dr. Anthony Nsiah-Asare has acclaimed the importance of health system strengthening interventions in developing countries, noting that recent outbreaks of Ebola and Zika virus show that weak health systems are a threat to global health security.

Dr. Nsiah-Asare made the observation at a recent meeting on embedded research for health systems strengthening held in Accra. Addressing participants at the opening of the two-day meeting, the Director-General said the shift in focus of international health agenda from disease-specific approach to health system strengthening approach has been backed by a lot of evidence. Apparently, developed countries have far more enhanced capacity for health systems and policy research compared to low and middle-income countries. According to him, “increasing evidence demonstrates that health systems capable of delivering services equitably, efficiently and in coordinated manner are essential for achieving improved health outcomes.”

Dr. Nsiah-Asare disclosed that Ghana has always appreciated the role of research in health policy and appealed for leveraging embedded research to enhance policy decisions and guide implementation. He said the country will continue to place emphasis on more engagement and alignment of research objectives with the priorities of national decision and health policy as the way forward for ensuring that research findings will at all time be put to use. He therefore, called for the sharing of Ghana’s experiences in implementation-research from the Doris Duke Charitable Foundation (DDCF) funded Ghana Essential Health Intervention Program (GEHIP) and the CHPS+ programs to participants. He thanked the DDCF as well as the Alliance for Health Policy and Systems Research and other partners for bringing together diverse organizations and experts to discuss ways of harmonizing and building consensus for embedded research.

The Executive Director of Alliance for Health Policy and Systems Research, Dr. Abdul Ghaffar told participants that the WHO affiliated outfit is committed to contributing towards the achievement of the UN Sustainable Development Goals, Universal Health Coverage and Health System Strengthening. He said the meeting in Ghana was intended to provide the platform for developing a framework for embedded research, look at embedding research into programs and policies versus embedding research into the health systems and to create understanding on how embedded research contributes to system thinking, participatory leadership and demand driven research.

Highlighting the background and contribution of the Doris Duke Charitable Foundation, the Program Director of the Africa Health Initiative (AHI), Lola Adedokun said the mission of her organization is to improve the quality of people’s lives. She noted that the Africa Health Initiative was created by the DDCF in 2009 to support selected health system projects across five African countries. She lauded Ghana and Tanzania for achieving 45% and 20% reduction in under-five mortality and mortality among children aged 1-5 years under their respective projects that ended 2015. She added that similar impact was made in Rwanda, Mozambique and Zambia. She further revealed that under its second phase, the AHI is supporting the replication and scale up of strategies of the first phase programs in Ghana, Mozambique and Ethiopia.

Ms. Lola Adedokun, said the DDCF supports research that provides locally relevant solutions through understanding of challenges with routine services and the creation or refining of existing approaches to service delivery. She lauded the benefits of embedded research including the ability to achieve country ownership, expand primary health care system, and utilization of existing data and information systems.

Speaking on Ghana’s experience in conducting embedded research in an interview, Dr. Koku Awoonor, Director of Policy Planning Monitoring and Evaluation of the Ghana Health Service said embedded science for Ghana’s Community-based Health planning and Services (CHPS) development was designed to maximize prospects that results will be utilized for accelerating scale-up and improving health service operations. He indicated that in Ghana, embedded science has been a process of developing a people-centered approach to the community-based primary health care system-CHPS.

Relating the history of Ghana’s Primary Health Care strategy (CHPS), Dr. Awoonor pointed out that CHPS itself is a result of evidence-based policy, which resulted from a research carried out by the Navrongo Health Research Centre and rolled out nationally after a successful pilot. He described the strategy as “…a breakthrough in enhancing community involvement and ownership of primary health care interventions towards achieving Universal Health Coverage”. Explaining further, he said “embedded research in CHPS is an application of systems thinking, a process of applying research to steps in a process of changing systems structure, function or content and a partnership of researchers and implementers that compliments the authority and structures of the organizations deemed to be the focus of the change process”.

The embedded research for health system strengthening meeting brought together over 40 participants from various countries including USA, Switzerland, United Kingdom, South Africa, Mozambique, Ethiopia, Mexico and Ghana.

Story by: Mathias Aboba

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