Quality (297) Lancet GH: Seizing the moment to rethink health systems

14 September, 2021

A new paper in The Lancet Global Health, and a comment from me below.

CITATION: Seizing the moment to rethink health systems

Kojo Nimako, Margaret E Kruk

Lancet Global Health 2021

Published: September 07, 2021



The COVID-19 pandemic has made vivid the need for resilient, high-quality health systems and presents an opportunity to reconsider how to build such systems. Although even well resourced, well performing health systems have struggled at various points to cope with surges of COVID-19, experience suggests that establishing health system foundations based on clear aims, adequate resources, and effective constraints and incentives is crucial for consistent provision of high-quality care, and that these cannot be replaced by piecemeal quality improvement interventions. We identify four mutually reinforcing structural investments that could transform health system performance in resource-constrained countries: revamping health provider education, redesigning platforms for care delivery, instituting strategic purchasing and management strategies, and developing patient-level data systems. Countries should seize the political and moral energy provided by the COVID-19 pandemic to build health systems fit for the future.

COMMENT (Neil PW): I'll be interested to hear comments from HIFA members. I'm not a health system specialist and I found the paper quite challenging. What do we mean by 'redesigning platforms for care delivery'? Are 'strategic purchasing' and a 'national data platform with individual-level data' the answer to strengthening health systems? From a non-specialist perspective, there is one glaring priority in LMIC health systems: to better understand and address the basic needs of frontline health workers so they are empowered to deliver the care for which they are trained. The problem is not so much the pre-service training, it is the failure of health systems to meet the needs of frontline health workers. On HIFA we have described these as SEISMIC needs:

• Skills

• Equipment

• Information

• Systems support

• Medicines

• Incentives

• Communication facilities.

Support health workers and they will deliver.


Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org