Global action on health systems: a proposal for the Toyako G8 summit
Prof Michael R Reich, Prof Keizo Takemi, Prof Marc J Roberts and Prof William C Hsiao
The Lancet, Volume 371, Number 9615, 8 March 2008
“….Global efforts to improve health conditions in poor countries have embraced two different strategies in recent decades, one focusing on health systems, the other on specific diseases. The interactions of these two strategies have shaped where we stand today….
”…..Health system improvement involves more than metrics; it requires attention to the political economy, values, and cultural dimensions of how health systems work. It requires an interest in and expertise about the details of system structuring (in finance, payment, regulation, and organisation management), as well as a commitment to reject a one-size-fits-all approach in favour of conditional guidance adapted to each country's specific situation. A responsible, independent, international research organisation is needed to coordinate the country-level efforts, with accountability to the global community and rigorous reviews and transparent methods for assessment—something like a Cochrane Collaboration for health system improvement.
To advance this goal of enhanced learning, we believe that global health partnerships should agree to allocate a set portion of their funding for operational research and knowledge discovery in health systems. These funds would support efforts to improve the performance of health systems—by gathering together experiences around the world, assessing successes and failures, doing well-designed pilot projects, and assuring the dissemination of knowledge. The G8 summit provides an opportunity to articulate a global commitment to learning about strategies for strengthening health systems, and to propose explicit institutions and financing for enhancing shared learning in the future….”
a. Department of Population and International Health, Harvard School of Public Health, Boston, MA, USA b. Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA c. Research Institute of Science and Technology, Tokai University, Tokyo, Japan