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As part of broad global investments in HIV/AIDS, PEPFAR has contributed to improvements of larger health systems, with impacts on maternal and child health.10 However, PEPFAR has not had a strategic vision or plan to incorporate a health systems lens into its programming. In the first phase of PEPFAR, health systems activities were largely ad hoc, varied across countries, and did not always factor in an intervention's impact on the country's broader health system. In 2009 PEPFAR developed a strategic framework tool for HSS. This tool is designed to help country teams plan HSS activities. Such planning can maximize the positive impacts of prevention, care, and treatment activities and identify opportunities to leverage and partner with other health and development programs. Through this framework, PEPFAR programs can identify:
Supporting strong government leadership of health systems, which is integral to sustainability Health systems are strongest where governments have leadership and technical skills to address health system weaknesses. While a network of public and private partners deliver services, governments play the lead role in overseeing health systems among multiple actors at national, district, and community levels. In collaboration with other USG programs and international donors, PEPFAR supports governments to identify opportunities for HSS within their HIV and broader health sector plans. By working with governments, PEPFAR can create technical capacity necessary to engage, coordinate and oversee the multisectoral activities falling within the six building blocks. PEPFAR will provide mentoring and technical assistance to government employees and promote the involvement of a multisectoral country response in addressing a country's health needs. Expanding efforts to partner with multilateral organizations on this issue Organizations such as the Global Fund, the Global AIDS Vaccine Initiative (GAVI), the World Bank, WHO, and the International Health Partnership Plus (IHP+) are expanding HSS activities. Heightened donor interest provides PEPFAR with an opportunity to work in partnership and strengthen health systems at the country and regional level. As part of larger efforts, PEPFAR can work with countries to leverage additional donor resources and coordinate activities to realize a broader impact on an overall health system. As part of the GHI, PEPFAR will explore opportunities for joint programming and increased coordination around implementation and evaluation of health systems activities. Including considerations of health systems dynamics in work to define, map, and implement plans to address country-level need With its focus on rapid scale-up during the first five years of PEPFAR, the program sometimes established parallel health systems within a country, rather than strengthening the complex health systems that exist in each country. The process of assessing a health system itself can be a skill- and relationship-building tool with ministries, civil society, the private sector, and donor community counterparts. PEPFAR is working with partner governments to expand understanding of each health system at the national, provincial, district, and community level. Through this engagement, PEPFAR is supporting creation of new, or review of existing, health systems assessments that contribute to overall country HIV/AIDS plans. Developing good indicators to track progress with health systems strengthening The challenge in health systems lies in identifying impact. It is difficult to determine exactly which health systems parameters are most closely associated with positive health outcomes, which interventions are most effective at improving health system performance, and which measures most effectively track progress. Setting appropriate targets, developing sound indicators, and monitoring change can be particularly challenging. PEPFAR, in collaboration with the GHI and other donors, will work to develop universally accepted and harmonized indicators for HSS. In addition, PEPFAR is supporting countries in expanding their own mechanisms for data collection to measure the most important health services and health outcomes in a country. | |||
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Health Systems Strengthening (HSS)
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