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BUILDING RESILIENT AND SUSTAINABLE SYSTEMS FOR HEALTH

By Mark Dybul
Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria

A culture of continual improvement and innovation has driven a marked improvement in on-time delivery of medicines, health products and equipment in many countries.

What makes a health care system healthy is not so different from what makes an individual healthy. Resilience. Sustainability. Strength.

In every country, resilient and sustainable systems for health are essential. Early on, the Global Fund to Fight AIDS, Tuberculosis and Malaria recognized that only with strong systems for health can we possibly end these epidemics.

Our partnership organization supports AIDS, TB and malaria programs run by local experts in countries and communities most in need. We also support strengthening systems for health. The two reinforce each other. Fighting the diseases reduces the burden on the overall health system, and stronger systems accelerate progress against the diseases.

Today, of the nearly US$4 billion the Global Fund raises and invests a year, more than 40 percent support countries
in building resilient and sustainable systems for health.

BUILDING RESILIENT AND SUSTAINABLEIncreasingly, Global Fund investments go to community facilities that provide a range of integrated services. The facilities offer HIV, TB and malaria prevention and treatment programs, but they go further.

These facilities help address individuals’ multiple health needs at different points in their lives. In Kenya, for example, TB screening has been integrated into the country’s antenatal care platform, which also provides treatment to prevent the transmission of HIV from mothers to their babies. This has resulted in a 43 percent increase in the number of clients screened for TB during antenatal visits. These investments also strengthen the important link between health services and community responses. Communities are always first to respond to disease outbreaks.

Another pillar of a strong health system is its workforce. Investments in health worker training, expand a system’s
capacity to respond to the country’s health needs. In Vietnam, investments in human resources for primary care have made services more accessible, timely and affordable for citizens, especially among underserved populations in
rural areas. In the focal provinces, more doctors have been retained, service utilization at primary care centers has
increased by 7 percent and the rate of inappropriate referrals to higher centers has dropped by 30 per cent.

When systems for health are strong, people receive better quality care and more people can receive it. Many countries with strong health systems are making great strides toward ensuring that distance, inability to pay or stigma do not exclude people from receiving the quality health services they need. Senegal and Kenya have worked to find efficiencies in their delivery of services and health insurance coverage, boosting both coverage and sustainability of their respective health systems.

Improvements to procurement and supply chain management are also helping to build strong systems for health.
Over the last three years, a culture of continual improvement and innovation has driven a marked improvement
in on-time delivery of medicines, health products and equipment in many countries. Overall savings have
come through greater use of a pooled procurement mechanism. The efficiency, robustness and reliability form systems for health that can meet daily needs and for what may come in the future.

When we think about improving health in our world and ending AIDS, TB and malaria as epidemics, we need to think big, long term and efficiently. We need systems for health built to be resilient and sustainable. Retaining
attention and commitment to these systems is essential to build on gains of the Millennium Development Goals
in order to effectively progress toward the Sustainable Development Goals. We need systems for health that are
themselves strong and healthy.

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