Flagship Reports


Strengthening health systems: the role and promise of health policy and systems research

Improved performance in controlling emerging and re-emerging diseases in developing countries is dependent on the quality, equity and efficiency of health systems. Rapid progress towards targets is greatly hampered by weak, poorly functioning or in some cases non-existent health systems. It is critical to know how best to approach health system strengthening, and what specific actions are appropriate in different settings. Much is known about the barriers or constraints to greatly increasing (‘scaling up’) health services. However, remarkably little is known about how best to relax these constraints, whether through reformed service delivery strategies, or different human resource management policies, or new organizational structures.

The central concern of this book is how knowledge of health systems can be increased and applied to improve the health of the worst-off of the world’s population. Health systems research has much to contribute to our understanding of health systems and policies. Research can play a major role in policy formulation, especially when policy questions can be formulated in terms of clear and empirically verifiable hypotheses. The book provides case studies showing that the application of health systems research has contributed to problem resolution, and that a widely applicable scientific body of knowledge is developing. Progress is reviewed in the areas of equity, user fees, community health insurance, management reforms and the role of civil society organizations. Decision makers and community advocates can benefit from this knowledge for the design and implementation of sound policy.

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