Health systems are being redesigned by revolutionizing life sciences, telecommunications, systems thinking, knowledge management, and rights revolution, which is “turning abstract declarations into concrete entitlements that people can be empowered to demand.” Frenk mentioned that in order to strengthen health systems, integration between vertical interventions and integration of primary health care with the rest of the health system is warranted. Health systems should be seen in terms of their inter-relations between institutions and populations, and that a proactive continuous approach to health needs is necessary. Breman would agree that countries need to look more comprehensively at their total health care provision capacity and consider how to maximize what they have rather than create new capacity which may be unwanted and unmanageable. Similarly, Filmer et al., recommended that public health activities should emphasize control of infectious diseases and programs should include mechanisms to improve routine clinical care.
Health systems embark on functions of stewardship, financing, and resource generation. Stewardship function can be best achieved by broader regulatory and convening capacity to promote healthy policies. The area of financing is suggested to adapt three innovations: strive for universal schemes that promote fair financing across all groups in society, payment mechanisms that reward high quality care and responsiveness to the legitimate expectations of the population, and introduction of a set of guaranteed benefits. Resource generation requires training healthcare professionals with strong managerial components alongside technical proficiency, appropriate supervision, development of teamwork, and implementation of incentives to good performance.
I would like to further explore the area of resource generation in this posting. Mills commented that Gonzalez stresses the importance of ensuring that front-line workers in general health services feel fully part of the mass campaign, and of ensuring that they are not overburdened by demanding duties. Additionally, he points to the vital role that supervision plays for considering the use of specialized non-professional supervisors to supplement the normal supervisor mechanism of basic health services, especially during the critical phases of mass campaigns, and argues for transforming single-purpose staff into multipurpose workers to “provide the nucleus for basic health services.”
I would agree that collaboration by all layers of care is important in achieving health care goals, but I am uncertain of the idea of transforming specialized workers to a general role. Moving towards this model poses a risk, such as that experienced in India. Berman describes that in India’s health care system, less-than-fully-qualified (LTFQ) workers account for the vast majority of the providers; they are not registered and lack full medical qualifications. They may lack technical quality of the health care they provide, which may be useless and even harmful. This may also inflict further difficulty in obtaining research and generating data for benchmarks as basis for improvement.