Any intervention or improvement in global health cannot be sustained without an efficient and sustainable health system.

Last time I wrote about why strengthening the efficiency of a health systems is the first job of every global health program. This time, I want to emphasize that without an efficient and sustainable health system, any other intervention or improvement cannot be sustained; it will not make the desired impact, and the return of the investment cannot be measured.

Yes, it is possible to have a health system that efficiently manages all its assets: public primary health care facilities, hospitals, and public health programs; a health system that regulates and coordinates the private health sector, and non-profit organizations; and a health system that works with academic institutions to ensure the country produces the work force it needs.

It is that simple. It is not easy but it is simple. It takes commitment and technical partners that know how to run a health system. I believe that if you follow these simple (though not easy) steps you can have most health facilities that look like the one in the photo above by 2030.

Here are the first steps to get started and strengthen a country’s health system:

1. Put standard operating procedures (SOPs) in place so the health system’s governance functions of policy making and reform, surveillance, monitoring and evaluation, planning, budgeting and financing, regulation, accreditation, and donor coordination work like clockwork.
2. Create a database of the country’s health facilities and rank them according to performance indicators and quality of healthcare.
3. Assign a coverage population to every facility and ensure they have the SOPs to account for all the services they provide to their coverage population.
4. Revise job descriptions, performance plans and supervision standards, and performance targets and measures of all health staff involved in management of the country’s public health programs.
5. Revise job descriptions, performance plans, supervision standards and performance targets and measures of all health staff in public health facilities to ensure they are accountable for their share of health outcomes
6. Simplify and computerize all health information to ensure accuracy, transparency, and informed decision-making
7. Simplify and computerize the supply chain of all medicines and supplies. Pass and implement legislation to regulate all medicines and medical supplies and equipment used in the country to ensure the country has sufficient supply of essential medicines and supplies to achieve health targets at all times.
8. Pass and implement legislation to give accreditation to all private healthcare providers and organizations to ensure they all meet quality criteria and account for their share of the national health outcomes.
9. Network all health facilities, public and private, into local health systems that work in a coordinated and decentralized manner to ensure they all can coordinate and contribute to meet local health needs and targets.
10. Assist the government to sign memoranda of understanding with every academic and training institution working in the country to ensure they do their share and train the required numbers of health professionals every year in order to meet the current and future health needs of the populations.

Please let me know what you think and share the work you are doing to strengthen health systems and achieve global health goals. Contact me on LinkedIn, Facebook or Twitter. This week I am going to be following the UN General Assembly #globalgoals to find out what is being done to strengthen health systems.

To learn more about health system strengthening and how to implement the steps above, contact RGH at programs@realizingglobalhealth.com