Strengthening national systems for health: focus areas

Investments in resilient and sustainable systems for health lay the foundation for the effective and equitable delivery of HIV, tuberculosis (TB) and malaria programmes, other essential health services and the achievement of universal health coverage. As a key partner of the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund), UNDP supports investments in strengthening systems for health. UNDP is increasingly requested by governments to provide technical assistance in core functional areas of health system strengthening, such as procurement and supply chain management or financial management systems.

These investments in building enabling processes, capacities and policy environments for health yield cross-cutting benefits in terms of improving health outcomes and advancing countries’ achievement of the health-related Sustainable Development Goals (SDGs). This includes efforts to enhance the sustainability and resilience of health systems that enable governments to accelerate progress towards universal health coverage and withstand the impact of global health crises and other emerging threats. The COVID-19 pandemic has underscored the vital role of health systems, revealing the costs of inadequate systems, processes and capacities as countries have had to cope with increased demands while maintaining the delivery of essential health services. The pandemic response has likewise illuminated the value of previous investments in building strong community systems for, for example, health, procurement and supply chain management systems, or health management information systems, which countries could adapt to mitigate the impact of COVID-19.

This section outlines the key focus areas in which UNDP works with governments, the Global Fund, the World Health Organization and other health and development partners to build resilient and sustainable systems for health. This includes guidance and examples based on UNDP’s experiences supporting country systems in the areas of : i) health management information systems; ii) procurement and supply chain management; iii) financial management; iv) human resources for health; and v) community systems strengthening, as well as cross-cutting investments in vi) anti-corruption, transparency and accountability, vi) environmental sustainability and vii) harnessing innovation and digital solutions for health.

Key areas for building resilient and sustainable systems for health

The Global Fund’s Modular Framework Handbook underlines the following key areas for investment in resilient and sustainable systems for health:

  1. Health product management and systems strengthening. This includes policy strategy and governance; storage and distribution capacity; procurement capacity; regulatory and quality assurance support; and avoidance, reduction and management of health-care waste.
  2. Health management information systems and monitoring and evaluation. This includes routine reporting; programme and data quality; analyses, evaluations, reviews and transparency; surveys; administrative and finance data sources; and civil registration and vital statistics.
  3. Human resources for health including community health workers. This includes education and production; remuneration and deployment; in-service training; and policy and governance frameworks.
  4. Integrated service delivery and quality improvement. This includes quality of care; service organization and facility management; and service infrastructure.
  5. Financial management systems. This includes public financial management systems and routine grant financial management.
  6. Health sector governance and planning. This includes national health sector strategies and financing; and policy and planning for national disease control programmes.
  7. Community systems strengthening. This includes community-based monitoring; community-led advocacy and research; social mobilization; building community linkages and coordination; and institutional capacity building, planning and leadership development.
  8. Laboratory systems. This includes national laboratory governance and management structures; infrastructure and equipment management systems; quality management systems and accreditation; information systems and integrated specimen transport networks; and laboratory supply chain systems.
Example: Building resilience against health crises through long-term investments in health systems

In Burundi, containing the spread of COVID-19 has been an urgent priority. Scaling up health programmes, helping governments buy the necessary health products and ensuring strong supply chains must be done in a way that builds national capacity and innovates while also using existing systems where possible. UNDP, with funding from the Global Fund, has been supporting the Ministry of Health in Burundi since 2017. This understanding of the country context is imperative, as the health landscape is constantly evolving. The improved health infrastructure developed as part of the malaria and Ebola responses and increased investments in medical equipment means Burundi is better prepared to respond to new disease outbreaks such as COVID-19. This work has been carried out in close coordination with national entities to guarantee sustainability, meaning it can benefit communities now and in the future.

The national health crisis centre, developed during the Ebola outbreak, is now the base for the country’s COVID-19 response and is fully equipped with 200 smartphones and laptops. Pumps purchased for indoor residual spraying of malaria can be repurposed for medical decontamination. UNDP has also been supporting the development of a mobile application, which will now be used to track COVID-19 cases.

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