MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Specific sub-research questions pursued by MPS research partners included the following:
• How are major GHIs interacting with health systems at national and sub-national levels?
How are these interactions affecting the main components or “building blocks” of
countries’ health systems?
• How are they influencing processes such as scale-up of services; coordination of services;
and harmonization of donor priorities and activities?
• In selected local settings, is GHI support translating into impacts at the facility level? What
initial lessons emerge for improving policy and service delivery?
• Are the major GHIs interacting with health systems in similar ways, or can significant
differences among them be observed?
• How are major GHIs engaging civil society and communities? What is the role of civil
society and community organizations in strengthening synergies between GHIs and health
systems?
What specific areas of interplay between GHIs and health systems appear to be most
critical/strategic in accelerating action to improve health outcomes?
In formulating their research strategies and analyzing results, MPS researchers have adopted a
conceptual framework informed by WHO’s “building blocks” approach to health systems
strengthening. In an ongoing effort to clarify the problems, needs, expected outcomes, and key
variables in health systems performance, the WHO building blocks stress common elements that
recur in every health system and must work in concert if services are to be delivered effectively. In
their original formulation the building blocks included service delivery; health workforce;
information; medical products, vaccines and technologies; financing; and stewardship—meaning
leadership, governance and the fulfilment by officials and other professionals of their
responsibilities as guardians of the right to health [11]. To this list of fundamental systems
components, MPS researchers have added community and civil society participation as a further
critical dimension of health action.
In an iterative process, MPS researchers elaborated the WHO building blocks into a conceptual
framework that recognizes how the functioning of the building blocks is impacted by contextual
factors [5-7], as well as how systems components interact with and “feed back” upon each other
(Fig. 1). This framework reflects an emerging approach to health systems research in which the
focus has shifted from evaluating the efficacy and cost-efficiency of isolated biomedical
interventions to understanding how complex systems function to yield optimal health results. MPS
researchers readily acknowledge the incompleteness of the framework and its provisional
character. The framework has provided a fresh “way in” to the description and analysis of GHIhealth
systems interactions at country level, not a definitive answer. Nonetheless, the framework
has proved its value as a tool for shaping fruitful research questions and organizing results to
facilitate practical learning for policy and implementation.
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