Anatomy of an unsafe abortion (repost)

Another of these stories which brings home the point that all those decisions we are making about health systems are ultimately about people's lives:

http://drjengunter.wordpress.com/2012/02/11/anatomy-of-an-unsafe-abortion/

Health Systems Strengthening - what others thought

Jocalyn Clark blogged about my workshop on PLoS Medicine:
http://blogs.plos.org/speakingofmedicine/2011/11/25/what-is-health-systems-strengthening/

I also received a summary of the feedback forms and people really enjoyed the day, particularly the two part format with an overview of the theory in the morning and experiences from the field in the afternoon. And almost everyone said what they learned will affect their practice :) Really chuffed and happy that people found the workshop useful. Thanks again to my speakers and Anne Radl for her support - I wouldn't have been able to do this without you :)

Doctors and Critical Care - or: Quality, not Quantity

Interesting piece on the procedures (and more important lack thereof) doctors chose for themselves shall they become critically ill - and the (complex web of) drivers that lead to very different decisions for their patients:
http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/

Health Systems Strengthening

As some of you might know, I organised and led a workshop on Health Systems Strengthening this weekend. I got interested in how the systemic view, which I took on the UK health system in my PhD, applies to the developing world following a Gates Distinguished Lecture last year. The more I read about it, including Nigel Crisps book (a review here), the more intrigued I got. By chance I met Anne Radl from the Cambridge Humanitarian Centre and she encouraged me to share my knowledge.

I opted for a 2 part design - in the morning I led a 2h session, supported by Jocalyn Clark, a PloS Medicine editor from Toronto who had been in charge of a recent series of HSS articles. In the 2h I tried to cover the basics - what is health systems strengthening, why do we need it and how can we do it. We had a great group of participants, who shared their experiences of working in places like Ethiopia, Bangladesh or the Gulf region - this really enriched the session. Over lunch there was some time for more informal exchange and networking and I was really impressed by the diverse and interesting backgrounds.

In the afternoon we had three speakers who shared their field experience and brought the concepts which we had we covered in the morning to life. First, Egbert Sondorp joined us via videolink from Amsterdam and shared his experiences of trying to rebuild the Afghan health system after the end of the rule of the Taliban. He stressed the importance of small steps and a long-term strategy. In Afghanistan the strategy was trying to ensure the delivery of a basic set of services as a starting point, but it is clear that other building blocks, such as stewardship and sustainable financing, will have to follow. Next was Geoff Walsham of the Cambridge Judge Business School, an expert in information and communication systems and technologies. He shared insight obtained while carrying out work in India and stressed that information technology can only be one part of the story. Our final speaker was Bruce Mackay from HLSP, a health sector consultancy. His field experiences were Bangladesh and Mozambique. He also stressed the importance of the private sector, particularly for the poor in developing countries. The WHO reports that in Bangladesh about 75% of health service contacts are with non-public providers, yet most health system plans hardly mention these providers at all.

Each of the presentations had been followed by a short Q&A session, so that after a short coffee break there was a chance to have a more general discussion between the two speakers who were present in person and the audience. All in all, I think it was a very successful day - and from what I have seen of the feedback forms the participants shared this view. Thanks to Anne and my speakers for making this possible.

If you're interested in my handout, you can find it here.

I also got an email from the World Bank, suggesting some further references:
Roberts et al, "Getting Health Reform Right" published by OUP (a text book the World Bank uses for teaching about health systems strengthening and sustainable financing)
and even more at this link.

Figure of the day (2)

In 2008 the 5% of the population with the highest health care expenses accounted for 47.5% of total health care spending.

On the other hand, the 50% of the population with the lowest expenses only accounted for 3.1% of total health care spending.

Source: Kaiser Family Foundation
http://facts.kff.org/chart.aspx?ch=1344

Preventing NCD for US $1.20 per person per year

The WHO just published a report investigating low-cost interventions to prevent non communicable diseases and/or lessen the economic impact of NCDs. I find it interesting and encouraging that the recommendation span both individual intervention such as screening but also large-scale population-based interventions (e.g. action against tobacco use or campaigns for better nutrition).

Expert Comment - Part 2

On September 16 I blogged about an expert comment by Dr Sudeep Chand of Chatham House about the UN meeting on non-communicable diseases. In a follow-up he assesses the outcomes of the meeting.

Unfortunately, it seems a chance was missed to address the global challenge of health in a global, coordinated way: "There is little in the declaration that is specific on international cooperation or coordination. [...] Health system development, the regulation of industry, and key interventions across sectors such as education, environment, agriculture, and transport remain areas for intervention at the national level."