Jonathan D. Quick, MD, MPH of Management Sciences for Health (MSH) talks about health systems innovations and scale-up in this August 29, 2012 blog. This blog is cross-posted from MSH's Global Health Impact blog.
Each year over 10 million men, women, and children in developing countries die as a result of our collective failure to deliver available safe, affordable, and proven prevention and treatment. A recent analysis of innovations in products and practices for global health, from the Hepatitis B vaccine to use of skilled birth attendants, revealed virtually none of these life-saving interventions reaches much more than half their target population—even after as many as 28 years of availability. This reflects a vast gap between knowledge and action in global health.
Frieda Komba, a licensed drug dispenser in Tanzania (photo credit: MSH)
Successful Health Systems Innovations
Low- and middle-income countries (LMIC) benefit from continued innovations in health products and health practices, such as use of misoprostol to prevent post-partum hemorrhage, and technologies such as internet-based mHealth applications to protect the poor from catastrophic health expenditures. To ensure such innovations achieve large-scale, widespread coverage, they must be accompanied by much more effective health systems innovations.
In the late 1990s, when there were effectively no public health services in Haiti, MSH worked with USAID and local and international service delivery NGOs for perhaps the first large-scale test of performance-based financing (PBF) for health services in a LMIC. For well over a decade now the areas of Haiti in which this innovation in health financing and delivery has been implemented have consistently out-performed national averages for antenatal care, immunization, and other key measures (PDF).
In the mid-2000s, as part of our shared commitment to improving maternal and child health in Afghanistan, the ministry of health, the Hewlett Foundation, and MSH worked together to address unmet family planning needs. In a setting initially thought unfriendly to family planning, we found culturally-based innovations in meaning and message could bring together local religious leaders, healthcare providers, community health workers, and families themselves. Within less than two years the intervention districts achieved up to a four-fold increase in family planning acceptance, often exceeding levels in countries active far longer in promoting family planning.
Other recent global health successes, such as the remarkable scale-up of AIDS treatment over the last decade and the dramatic reduction in malaria mortality in Ethiopia and elsewhere, have each been achieved in part through health systems innovations.