Strengthening Health Systems Journal Publishes MSH Editorial

Sometimes the people who know best are, well, the people. Achieving the fundamental objectives of UHC and meeting the challenges of governing complex health systems requires people-centered schemes that include formal mechanisms to bring civil society and communities into the design and implementation of UHC programmes.

In its second issue, The Strengthening Health Systems journal has published an MSH editorial titled, “People-centered health systems for UHC: How to put people first while increasing health service access.” Written by MSH CEO Jonathan Quick, Senior Writer Jonathan Jay, and Research & Communications Specialist Chelsey Canavan, this editorial discusses a people-centered approach to UHC, highlighting three areas where civil society and communities play vital roles: ensuring the right services are provided under an essential package of health services, removing barriers to care such as user fees, and ensuring equitable access to health services.

In each of these areas and at every level of the health system, citizen representation is essential. Bringing communities into the process at every step in the design and implementation of UHC will help ensure meaningful increases in equity and improvements in health outcomes for the people the health system is meant to serve.

A PDF download is available and more information about the latest issue is available on the Strengthening Health Systems website.


MSH will host Universal Health Coverage Conference in Cape Town prior to Symposium

The post also appears on the SIAPS Program blog.

From September 28 to 30, 2014, global experts will convene in Cape Town, South Africa, in an invitation-only meeting organized by Management Sciences for Health (MSH) with funding from SIAPS to start a dialogue on medicines and universal health coverage (UHC). At last year’s meeting, it became clear that many national UHC plans do not give priority to medicines management. The meeting in Cape Town will focus on managing medicines in the context of UHC rollout. The meeting objectives are:

  • Sharing successful and unsuccessful experiences in how countries have incorporated medicines into their UHC strategies
  • Creating a shared understanding on how sound medicines benefits design and management can contribute to cost control
  • Building a case for use of evidence-based decision making in medicines benefits design and management
  • Sharing the pilot experiences of Namibia and South Africa as they implemented a new tool on medicines benefits management

For more information about this meeting and other UHC issues, please visit


Making Political Will Work for Health Systems

This post, written by Taylor Williamson and Derick Brinkerhoff, Health Policy Project, RTI International, originally appeared on the LMG For Health Project blog.

The Third Global Governance for Health Roundtable will be held in Cape Town, South Africa September 29-30th prior the the Third Global Symposium on Health Systems Research. The Leadership, Management & Governance (LMG) Project is collaborating on the Roundtable with the Health Policy Project and the Health Finance and Governance Project

Maternity care is free in Kenyan hospitals.Nearly 91% of Rwanda’s population is enrolled in a health insurance scheme. There are 2.4 million people on antiretroviral therapy in South Africa. What links these well-known examples of health system successes? Strong political will to improve health in these countries.

Commissioner of the Commission on Human Rights, Lauretta Vivian Lamptey, and Administrative Justice and the Director General of the Ghana AIDS Commission, Dr. Angela El-Adas, launch a partnership to protect the human rights of PLHIV and key populations. Photo Credit: Health Policy Project

Commissioner of the Commission on Human Rights, Lauretta Vivian Lamptey, and Administrative Justice and the Director General of the Ghana AIDS Commission, Dr. Angela El-Adas, launch a partnership to protect the human rights of PLHIV and key populations. Photo Credit: Health Policy Project

Political will is often only discussed in terms of its absence. How often have health systems experts heard that reform efforts were not achieved due to changes in the Ministry of Health, or that reform momentum ceased when donor funding ended?

Focusing on implementation failures reduces the concept of political will to the willingness and capacity of country officials to take responsibility for donor-funded programs.  For example, country officials are often willing to have donors fund programs, but balk at implementing complicated reforms or including donor priorities in national budgets.
The strength of a health system, however, depends on what country actors are willing and able to do, not just what donors will fund. To incorporate the perspectives of these country actors into the concept of political will, the USAID-funded Health Policy Project proposes a different approach to thinking about political will.

Reframing political will as the commitment of health system actors to act on policy objectives and sustain the costs of those actions over time can move country officials to the forefront of reform efforts. This approach places the responsibility of driving the reform process on country officials, who must formulate policy, implement programs that achieve their objectives, fund budgets to implement programs, and monitor program outcomes. Even when donor funding is available, political will requires the leadership of country officials to fulfill these roles.

Policymakers, implementers, and citizens are faced with the following questions that can inform the efforts of health systems experts to understand political will:

  • Where does the power to enact reforms rest? Are the willingness and capacity of individual decisionmakers, specific institutions, and/or a broader network of stakeholders taken into account?
  • What are the intentions of various health sector actors?  What motivates them to improve health systems? Can we infer that political will exists by observing budget allocations or public speeches?
  • Finally, what is the impact of civil society advocates? The media? Health providers? What about government structures and processes? Local variations in these influences can significantly affect the politics of health reform.

Based on these considerations, Derick Brinkerhoff, RTI International Distinguished Fellow in International Public Management, developed a model of political will that highlights seven components:

  1. Government initiative for policies and programs
  2. Choice of policies and programs based on scientific evidence and technically sound options
  3. Mobilization of stakeholders
  4. Public commitment and allocation of resources
  5. Design and application of credible incentives
  6. Continuity of effort
  7. Learning and adaptation

These components can be rated on a sliding scale to capture degrees of political will, from weak to strong.  They can also help health systems practitioners gain a greater appreciation for the political environment that supports health to improve their work identifying gaps and recommending reforms.

Reconsidering the “implementation failure” approach and applying a more rigorous analytical framework to political will can move health systems much closer to the goal of strengthening health systems for the long run, an aim shared by country officials, their citizens, and the international community.

How to Join the Symposium from Outside Cape Town

This post is cross-posted from the Third Global Symposium website.

Unable to make it to Cape Town? Follow the conference online!

The Symposium organizers encourage you to post comments or suggestions via Health Systems Global’s Twitter, Facebook or LinkedIn profiles.

Or contribute a blog or comment on one:

Or tweet a comment addressing one of the plenary themes for panels to consider:

And of course watch the plenaries live – or recorded, when you have time – via the Symposium website .

Join MSH in Cape Town

Join Management Sciences for Health (MSH) at the Third Global Symposium on Health Systems Research in Cape Town, South Africa from September 30th – October 3rd. We will be featuring our work in health systems innovations, financing and costing, access to medicines, leadership, management, & governance, and universal health coverage. Can’t make it to Cape Town? Follow live updates on this blog and on Twitter and Facebook throughout the week!