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Global Health Thought Leadership

Disease Interventions Give Health Systems a Boost

Trachoma sufferers gather outside a health clinic in Mali to await surgery. The Carter Center’s disease-specific health programs aim to expand the capabilities of local health systems. THE CARTER CENTER/S. Bartlett

By Dr. Kashef Ijaz, Vice President-Health, The Carter Center, and Sarah Yoss, Associate Director of Special Health Projects, The Carter Center

When The Carter Center partners with a country to eliminate a disease through its disease-specific programs or otherwise improve health, a related goal is to strengthen the overall health system of the partner country. Strengthening health systems aligns with the Carter Center’s core belief that people can improve their own lives when provided with the necessary skills, knowledge, and access to resources. 

The Center’s Public Health Training Initiative has helped improve the preparedness of health professionals in Ethiopia, Nigeria, and Sudan, while our Mental Health Program has assisted in the building of a mental health care system in Liberia by supporting the training of hundreds of clinicians. Even beyond those focused initiatives, there is an element of health systems strengthening in all of our disease-specific health programs — Guinea worm eradication, river blindness elimination, trachoma control, lymphatic filariasis elimination, schistosomiasis control, and our efforts to eliminate malaria and lymphatic filariasis from Hispaniola. Each of our health programs work closely with ministries of health and local communities to strengthen public health capabilities and improve health services. 

Health systems strengthening, as defined by the World Health Organization, consists of efforts to achieve sustained improvements in health outcomes through the improvement of the six “building blocks” of a health system: 

  1. Service delivery – Health services and interventions are effective, safe, and high quality, and are delivered to those who need them. 
  2. Health workforce – Health workers are present in sufficient number, equitably distributed, competent, responsive, and productive. 
  3. Information – The health information system includes the production, analysis, dissemination, and use of reliable and timely information on health determinants, health system performance, and health status.
  4. Medical products, vaccines, and technologies – The health system ensures that resources are high quality, safe, effective, and cost-effective, and that people have equitable access. 
  5. Financing – Adequate funds are raised for health to ensure people can use needed services and are protected from impoverishment caused by having to pay for health services. 
  6. Leadership and governance – Strategic policy frameworks are combined with effective oversight, coalition-building, regulation, and accountability. 

Health systems strengthening is also key in promoting global health security, as has been apparent throughout the COVID-19 pandemic as well as previous events such as the Zika virus outbreak in Latin America and the Ebola outbreak in West Africa. Increasingly, national and global public health organizations, including the WHO, are framing health systems strengthening as integral to health security, promoting an approach that can build and maintain essential health services alongside the resources and capacities to prevent, detect, and respond to health emergencies, including epidemics and pandemics. 

This concept was summed up by Dr. Tedros Ghebreyesus, director-general of the WHO: “Quality health systems not only improve health outcomes in ‘peacetime,’ they’re also a bulwark against outbreaks and other public health emergencies. Universal health coverage and health security are two sides of the same coin.”

The Carter Center’s efforts focus on strengthening the capabilities, processes, and resources of ministries of health, national public health institutes , health training programs in academic institutions, the primary health care system, and community-based health workers, so that countries and communities will be equipped to stand on their own with robust domestic systems and will not have to rely on outside assistance.

Health systems strengthening promotes health security within the particular country and around the world by improving the country’s ability to identify and mitigate future outbreaks before they become pandemics. That alone should be incentive enough to support the effort. 


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