Why is HSR key for fragile and conflict-affected states to achieve UHC?

UHC is attractive even to countries with the largest challenges facing their health systems. But is it a realistic objective for fragile and conflict-affected health systems?

Why is HSR key for fragile and conflict-affected states to achieve UHC?

This blog post is part of a wider HSG blog series in the lead up to the Universal Health Coverage Forum 2017, which takes place in Tokyo, Japan from 12 – 15 December. In this series, HSG members provide their perspectives on how Health Policy and Systems Research is fundamental to acheiving Universal Health Coverage by 2030.

By William Newbrander, International Health Economist and Health Systems Strengthening Advisor, Palladium

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.

How health systems research can help FCAS move toward UHC

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.

In deciding how best to “build back better,” HSR can help ministries determine where to allocate its scarce resources as well as assess and make strategic decisions about accepting offers of assistance from donors, large and small. Often the donations, if accepted, while generous, require long-term commitments by ministries for expensive operating costs for many years. In some cases, the number of people benefiting from the aid provided is small, relative to the great needs of the population. To foster UHC in FCAS, key criteria for selecting interventions to expand access to health services should include:

  • 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?

These considerations will address many of the issues FCAS face in terms of access, equity, best use of scarce resources, and development and strengthening of financial and health information management systems.

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.

Improved HSR in FCAS will also help strengthen capacity of ministries to develop and implement health policies, oversee programs, manage resources, engage communities, and steward the delivery of services.

Impact of health systems research for UHC in FCAS

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.

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