Accelerating Progress Toward Resilient, Responsive Health Systems

Farai Chieza, PSI’s Regional Representative for Eastern and Southern Africa and Michael Chommie, PSI Myanmar’s Country Representative interviewed Alex Ergo, PSI’s Health Systems Director, to discuss why health systems strengthening (HSS) is the bedrock of healthcare’s future – and how a consumer insights-driven approach can help health systems deliver better quality, more affordable and more accessible primary healthcare. 

Farai Chieza: PSI recently launched a new unit – the health systems accelerator, or HSA. What is the HSA all about? 

Alex Ergo: From the availability and focus of development assistance to adjusted global health priorities and the evolving roles of international NGOs, public health is rapidly changing. The “sustainable” in the Sustainable Development Goals calls the entire global health community to act with urgency to strengthen health systems for the long term.  

PSI’s new Health Systems Accelerator builds on our 50 years of experience using consumer and market insights to design innovative solutions to address the global health challenges of the day. Today, we work closely with consumers, market actors and government partners to diagnose problems together, generating insights that aim to better connect and integrate the different layers of the health system from self-care all the way to secondary care. We are already connecting different types of healthcare providers including community health workers, pharmacies and clinics. We will continue improving our work in better connecting the public and private sectors. Finally, we seek to ensure that public money not only funds public sector healthcare facilities, but that it also flows to private service provision, to digital care and to self-care.  

The end goal is simple: we want to make it easier for consumers to access quality and affordable primary healthcare. And we want to do it in a way that allows them to use their voice, control and choice. 

Chieza: Why now? And what does PSI’s HSA aim to achieve? 

Ergo: Let me start with your first question: why now? Having strong health systems is important. We in global health have all known this for a while. What may have come as a surprise over the past 15 months, however, is just how fragile health systems are, all around the world including in places where we least suspected it. If we were to draw one big lesson from the COVID-19 pandemic, it should probably be that so much more needs to be done to prepare health systems for the global challenges of tomorrow. At PSI, we believe there has never been a better time to contribute to shaping stronger, more resilient and more responsive mixed health systems. If we truly want everyone in the world to have access to effective primary healthcare that they can afford, even in times of crisis, we need to rethink how healthcare is delivered and financed – we need to meet consumers where they are with options that are more convenient, more affordable and that put more control into their hands. At PSI, we call that Consumer-Powered Healthcare. 

And this brings me to your second question: what does the HSA aim to achieve? The HSA is there to facilitate, and accelerate, efforts – both at the global level and at the country level – to shape these stronger, more resilient and more consumer-powered mixed health systems. What does that mean in practice? It means helping our country teams elevate consumer and market insights to the level of policymakers, to make ongoing efforts to move toward universal health coverage more consumer powered. It also means supporting our country teams as they work with government partners and others to identify and address systems barriers that stand in the way of more integrated primary healthcare ecosystems. These barriers may relate to the integration of public financing with non-public delivery, for example, or to the integration of the different layers and actors of the health system that I referred to earlier.  

Michael Chommie: HSS is critical, yet it’s not a new topic. How do you see HSS evolving?  

Ergo: If you look at all the donor-funded HSS efforts underway today, there are two major observations: first, these efforts tend to be heavily public sector focused; and second, they tend to be extremely siloed, with many of these efforts focusing on one particular building block such as the supply chain, or human resources for health. With respect to the first observation, I expect to see quite some change in the coming years. The recent publication by the WHO of guidance around governance of mixed health systems is definitely a clear and encouraging signal. As for the second observation, I would argue that a siloed approach to HSS is probably not the most effective way to achieve health impact. Health systems are comprised of different parts that need to align to realize efficiencies and ultimately success. HSS must go beyond the individual parts to also consider their interactions. Big donors are increasingly realizing that. Just look at USAID’s vision for health systems strengthening 2030, which was launched only a few weeks ago. One of the very first sentences in the vision document states that USAID will shift from strengthening individual functions of the health system, which they define as building blocks, to focusing more on the intermediate outcomes of equity, quality and resource optimization.  

Chommie: So, one building block for HSS won’t cut it?  

Ergo: Precisely. PSI focuses on building integrated quality care networks and leveraging digital technology to ‘wire’ the mixed health system and to help the consumer more easily navigate that system. I would argue that this is a much more holistic approach to HSS. We are not just focusing on one building block, right? We are looking at all that is needed to improve the consumer experience — we are considering health seeking behavior, channel innovation, quality of care, supply chain, information systems, health financing and so forth. 

Chommie: As PSI steps fully into the HSS space, what strengths do we bring to these efforts within the global health arena? 

Ergo: Our work with private healthcare providers is a recognized strength, and so is our focus on our archetypal consumer, Sara. These two attributes power PSI’s unique ability to gather insights, understand incentives, and change behaviors. These skills are critical to effectively shape mixed health systems and shift policies to, ultimately, advance consumer-powered health care. And what is more, these skills are in dire shortage in the HSS space. PSI is both excited and eager to contribute our expertise where it is needed most. 

Chieza: How does all of this you have outlined apply to emerging markets? 

Ergo: The thing with health systems strengthening, or shaping mixed health systems, or improving health financing arrangements — there is no real start or finish line. It’s an ongoing process and wherever you work, that process has already started and there is ample opportunity to contribute.  

For PSI, what we can do, and how, will vary greatly depending on where the country is on its journey toward UHC, and which pathway to UHC the country has chosen. In countries such as Kenya, India or Nigeria, for example, we have government-led efforts to establish national or state level health insurance schemes. Those countries are already putting in place mechanisms to accredit private healthcare providers, to contract accredited providers, to purchase services from those contracted providers, and to monitor the providers’ performance. In other countries, the government has decided to take a very different pathway to UHC. In Senegal, for instance, this involves ‘mutuelles’, a form of community-based health insurance. And then you have some countries, like Somalia, that have not decided yet how they will move toward UHC.  

Once we understand which pathway toward UHC a country has chosen, and which stage of progress it has reached, we can work with key national stakeholders and strategic partners to co-design interventions that will help take the country to the next stage. Even in a place such as Somalia, where the pathway is not yet clearly defined and the long journey towards UHC is only starting, there is a lot our health coalitions can do to either guide health reforms or start laying foundations—by developing some of the functions that would be required irrespective of the pathway the country ends up choosing. Wherever we are in the world, there is something we can do to shape stronger, consumer-powered mixed health systems.  

To connect with the Health Systems Accelerator at PSI regarding potential partnerships, contact Alex Ergo at aergo@psi.org. 

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