The World of Initiatives - International AIDS Society - IAS Home …举措-国际艾滋病协会-国际家居世界….ppt

Bringing a Health Systems Perspective to Programming for HIV/AIDS and Health System Strengthening Peter Berman Lead Economist, The World Bank Adjunct Professor, Harvard School of Public Health Vienna, July 2010 Abandon the Antagonism Between Categorical Programs and Health System Strengthening Lets put it away! Competition over resources…by other means Evidence is inconclusive – categorical programs can strengthen wider systems or weaken them All health programs are means to improving outcomes Health systems perspective seeks to maximize outcomes There are synergies, but there are also real, and troubling, trade-offs across outcomes There are efficiencies in delivery, but there are also real, and troubling, inefficiencies in delivery Allocative efficiency issues are not unique to HIV/AIDS, but there are some unique problems “Do no harm” as minimum standard. “Seek out synergies” more proactive. (Essence of the “diagnonal approach”) Ultimate Goals of Health Systems Health Status Risk Protection Public Satisfaction Level Distribution From Control Knobs to Outcomes * “Diagnosis and Therapy” of the Health System “Health System Analysis” – an analytical basis for programming for categorical programs and HSS Significant body of work across countries at all levels of income, e.g. National studies: Mexico, India Health in Transition series World Bank country studies, e.g. CSRs in Africa USAID supported “health system assessments” Distinction between description, analysis, prediction Review of 12 major World Bank studies (Bitran et al, 2010) Comprehensive reviews Overall framework sound Some key elements weak Organization and service delivery Health systems analysis of categorical programs Governance and institutional analysis Linkage to policy process More and better health system analysis needed to integrate categorical programs with national health strategies and their HSS elements Typical HSA Structure * Programming from an HSS Perspective: Two Dimensions From