The interface between health systems and vertical programmes in Francophone Africa: the managers’ perceptions

Keugoung, Basile; Macq, Jean; Buvé, Anne; Meli, Jean; Criel, Bart

doi:10.1111/j.1365-3156.2010.02716.x

Cited by 24 publications

(18 citation statements)

References 19 publications

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“…There is very little evidence to guide decisions about the most effective delivery strategy: [84] how vertical programs affect horizontal efforts in strengthening health systems or how these can support each other effectively and efficiently [84,125,131] or be combined into diagonal services [11,42,120-126]. A systematic review found some evidence in low and middle-income countries that utilisation and outputs of healthcare delivery may improve when a service is added to an existing service.…”

Section: Resultsmentioning

confidence: 99%

Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach

Toit¹,

Faal²,

Etya’ale

et al. 2013

BMC Health Serv Res

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BackgroundThe impact of unmet eye care needs in sub-Saharan Africa is compounded by barriers to accessing eye care, limited engagement with communities, a shortage of appropriately skilled health personnel, and inadequate support from health systems. The renewed focus on primary health care has led to support for greater integration of eye health into national health systems. The aim of this paper is to demonstrate available evidence of integration of eye health into primary health care in sub-Saharan Africa from a health systems strengthening perspective.MethodsA scoping review method was used to gather and assess information from published literature, reviews, WHO policy documents and examples of eye and health care interventions in sub-Saharan Africa. Findings were compiled using a health systems strengthening framework.ResultsLimited information is available about eye health from a health systems strengthening approach. Particular components of the health systems framework lacking evidence are service delivery, equipment and supplies, financing, leadership and governance. There is some information to support interventions to strengthen human resources at all levels, partnerships and community participation; but little evidence showing their successful application to improve quality of care and access to comprehensive eye health services at the primary health level, and referral to other levels for specialist eye care.ConclusionEvidence of integration of eye health into primary health care is currently weak, particularly when applying a health systems framework. A realignment of eye health in the primary health care agenda will require context specific planning and a holistic approach, with careful attention to each of the health system components and to the public health system as a whole. Documentation and evaluation of existing projects are required, as are pilot projects of systematic approaches to interventions and application of best practices. Multi-national research may provide guidance about how to scale up eye health interventions that are integrated into primary health systems.

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Section: Resultsmentioning

confidence: 99%

Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach

Toit¹,

Faal²,

Etya’ale

et al. 2013

BMC Health Serv Res

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“…These synergies are pre-requisites for attaining programme objectives and health system goals [44,45], and achieving long-term outcomes [41,44]. Therefore, a routine monitoring of the interface by managers of general health services and of programmes will provide avenues for optimizing the interaction between programmes and general health services by proactively searching and seizing all opportunities [46]. …”

Section: Discussionmentioning

confidence: 99%

The interface between the national tuberculosis control programme and district hospitals in Cameroon: missed opportunities for strengthening the local health system –a multiple case study

et al. 2013

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BackgroundTuberculosis remains a major public health problem in sub-Saharan Africa. District hospitals (DHs) play a central role in district-based health systems, and their relation with vertical programmes is very important. Studies on the impact of vertical programmes on DHs are rare. This study aims to fill this gap. Its purpose is to analyse the interaction between the National Tuberculosis Control Programme (NTCP) and DHs in Cameroon, especially its effects on the human resources, routine health information system (HIS) and technical capacity at the hospital level.MethodsWe used a multiple case study methodology. From the Adamaoua Region, we selected two DHs, one public and one faith-based. We collected qualitative and quantitative data through document reviews, semi-structured interviews with district and regional staff, and observations in the two DHs.ResultsThe NTCP trained and supervised staff, designed and provided tuberculosis data collection and reporting tools, and provided anti-tuberculosis drugs, reagents and microscopes to DHs. However, these interventions were limited to the hospital units designated as Tuberculosis Diagnostic and Treatment Centres and to staff dedicated to tuberculosis control activities. The NTCP installed a parallel HIS that bypassed the District Health Services. The DH that performs well in terms of general hospital care and that is well managed was successful in tuberculosis control. Based on the available resources, the two hospitals adapt the organisation of tuberculosis control to their settings. The management teams in charge of the District Health Services are not involved in tuberculosis control. In our study, we identified several opportunities to strengthen the local health system that have been missed by the NTCP and the health system managers.ConclusionWell-managed DHs perform better in terms of tuberculosis control than DHs that are not well managed. The analysis of the effects of the NTCP on the human resources, HIS and technical capacity of DHs indicates that the NTCP supports, rather than strengthens, the local health system. Moreover, there is potential for this support to be enhanced. Positive synergies between the NTCP and district health systems can be achieved if opportunities to strengthen the district health system are seized. The question remains, however, of why managers do not take advantage of the opportunities to strengthen the health system.

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“…Some assert that new additional financing, while enabling the scale up of HIV services, has overburdened already weak health systems, and thus worsened access for the target population [3,4]. In contrast, others indicate that HIV programmes and funding may also have a positive impact on health systems by reinforcing health support functions, such as human resources, infrastructure, laboratories and drug supply [5-7]. Yet, few studies have systematically explored the possible positive spill-over effects of HIV/AIDS programmes on health systems [8].…”

Section: Introductionmentioning

confidence: 99%

Positive spill‐over effects of ART scale up on wider health systems development: evidence from Ethiopia and Malawi

Rasschaert

Pirard

Philips

et al. 2011

Journal of the International AIDS Society

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BackgroundGlobal health initiatives have enabled the scale up of antiretroviral treatment (ART) over recent years. The impact of HIV-specific funds and programmes on non-HIV-related health services and health systems in genera has been debated extensively. Drawing on evidence from Malawi and Ethiopia, this article analyses the effects of ART scale-up interventions on human resources policies, service delivery and general health outcomes, and explores how synergies can be maximized.MethodsData from Malawi and Ethiopia were compiled between 2004 and 2009 and between 2005 and 2009, respectively. We developed a conceptual health systems framework for the analysis. We used the major changes in human resources policies as an entry point to explore the wider health systems changes.ResultsIn both countries, the need for an HIV response triggered an overhaul of human resources policies. As a result, the health workforce at health facility and community level was reinforced. The impact of this human resources trend was felt beyond the scale up of ART services; it also contributed to an overall increase in functional health facilities providing curative, mother and child health, and ART services. In addition to a significant increase in ART coverage, we observed a remarkable rise in user rates of non-HIV health services and an improvement in overall health outcomes.ConclusionsInterventions aimed at the expansion of ART services and improvement of long-term retention of patients in ART care can have positive spill-over effects on the health system. The responses of Malawi and Ethiopia to their human resources crises was exceptional in many respects, and some of the lessons learnt can be useful in other contexts. The case studies show the feasibility of obtaining improved health outcomes beyond HIV through scaled-up ART interventions when these are part of a long-term, system-wide health plan supported by all decision makers and funders.

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The interface between health systems and vertical programmes in Francophone Africa: the managers’ perceptions

Cited by 24 publications

References 19 publications

Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach

Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach

The interface between the national tuberculosis control programme and district hospitals in Cameroon: missed opportunities for strengthening the local health system –a multiple case study

Positive spill‐over effects of ART scale up on wider health systems development: evidence from Ethiopia and Malawi

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