Good health services are those which deliver effective, safe, quality personal and non-personal health interventions to those who need them, when and where needed, with a minimum waste of resources. A health system encompasses the total of all the organizations, institutions and resources whose primary purpose is to improve health.
A health system needs staff, funds, information, supplies, transport, communications and overall guidance and direction. A health system has a responsibility to provide services that are effective at improving health and health equity, responsive to people's needs and desires, financially fair, and use resources efficiently, i.e. provide value for money.
A good health system improves people’s lives tangibly every day – whether it is a school providing immunizations, a regulation encouraging cessation of tobacco use, or a person with HIV/AIDS receiving antiretroviral medicine and care at an affordable clinic.
This Division’s goal of “universal access to quality health services for all” cannot be achieved without the development of a robust health system. Health systems are inherently complex. Work in one area without regard to other parts of the system may not improve total system performance. Even if only one aspect is tackled, an awareness of the needs of the whole of system approach is necessary.
WHO’s work in the Region is focused around three goals: strengthened national capacity in the management and organization of quality health services; improved leadership and governance in health; and enhanced coordination.
Robust health policy and planning processes encourage effective, equitable and efficient health care. Effective planning processes must be led by national authorities. Support to national health planning has been provided to Cambodia, the Lao People's Democratic Republic, Papua New Guinea, Solomon Islands and Tuvalu.
China is in the midst of ongoing health sector reform as it continues to experience rapid economic development. WHO is recognized as a valuable partner and source of technical expertise in health sector reform in this country.
With legal frameworks critical to the governance of the health sector, WHO assisted in reviewing the law on medical examination and treatment in Viet Nam and provided support to public health law development in Kiribati, Nauru, Tonga and other countries.
Improving aid effectiveness is an important part of building a strong health sector in countries where overseas development assistance is a significant contributor to health care financing. WHO is a signatory to the Paris Declaration on Aid Effectiveness, as are most of the Member States of WPRO. A study assessing the compliance by the Regional Office with Paris Declaration principles was completed and recommendations on improving compliance have been made.
Support to sector-wide approaches, aid coordination and joint annual health reviews have been supported in many countries, including Cambodia, the Lao People's Democratic Republic, Papua New Guinea, Samoa, Solomon Islands and Viet Nam.
A localized innovative approach included a “Statement of Intent” among health donors in Viet Nam.
WHO provided technical assistance to countries to design funding proposals to global health initiatives aimed at strengthening health systems in a more holistic fashion. Cambodia, China, Fiji, the Lao People's Democratic Republic, Mongolia, Papua New Guinea and Solomon Islands benefited from this support.
To introduce the principles of quality assurance and quality improvement, as well as patient safety, support was given to a train the trainers programme in 6 Asian countries (Mongolia, China, Lao PDR, Cambodia, Viet Nam, and Philippines) and 12 Pacific island countries (Papua New Guinea, Solomon Islands, Vanuatu, Samoa, Kirbati, Marshall Islands, Tonga, Fiji, Palau, Cook Islands, Tuvalu, Micronesia).
Support was provided to both proposal and policy development on disease surveillance, malaria, tuberculosis, HIV/AIDS, reproductive health, child survival, patient centred care, and non-communicable diseases during the year.
Health service delivery and governance have been raised higher on the global public health agenda and the unit is responding to the demand for work with global health initiatives.
A major exercise on fostering synergies between global health initiatives (GHIs) and health systems brought teams from 8 WPRO and 5 SEARO countries together. The country teams were composed of programme managers of disease programmes supported by the GHIs, namely HIV, TB, malaria, immunization services, and maternal/child health who sat together with a manager in charge of health systems/planning. They worked together to identify common health systems bottlenecks and come up with ideas for practical, synergistic interventions and activities.
The private sector is taking on increasing importance in many settings. A review of public-private partnerships was completed in Papua New Guinea including recommendations on how to manage this important aspect of the health sector.
The recognition of the need for robust health systems to achieve improved health outcomes has coincided with a move for the renewal of primary health care. The Regional Committee in 2008 called on the Regional Director of WPRO to develop in consultation with Member States a regional strategy on health systems strengthening and primary health care to be presented to the Regional Committee in 2010. A draft strategy has been developed and consultations through key informant interviews are in process in all Member States.
Across the region there remain large gaps in coverage of crucial aspects of health services, health services that are of low quality so that even when available they do not contribute optimally to improved health outcomes, and inequities in health outcomes.
Challenges faced include:
- making the health system strengthening agenda clear and concrete;
- building a consensus on health systems issues; and
- clarifying the role of WHO in policy dialogue in health systems.