Abstract:
BACKGROUND: The rising burden of disease and weak health systems are being compounded by the persistent
economic downturn, re-emerging diseases, and violent conflicts. There is a growing recognition that the global
health agenda needs to shift from an emphasis on disease-specific approaches to strengthening of health
systems, including dealing with social, environmental, and economic determinants through multisectoral
responses.
METHODS: A review and analysis of data on strengthening health sector reform and health systems was
conducted. Attention was paid to the goal of health and interactions between health sector reforms and the
functions of health systems. Further, we explored how these interactions contribute toward delivery of health
services, equity, financial protection, and improved health.
FINDINGS: Health sector reforms cannot be developed from a single global or regional policy formula. Any
reform will depend on the country’s history, values and culture, and the population’s expectations. Some of
the emerging ingredients that need to be explored are infusion of a health systems agenda; development of a
comprehensive policy package for health sector reforms; improving alignment of planning and coordination;
use of reliable data; engaging ‘street level’ policy implementers; strengthening governance and leadership; and
allowing a holistic and developmental approach to reforms.
CONCLUSIONS: The process of reform needs a fundamental rather than merely an incremental and evolutionary
change. Without radical structural and systemic changes, existing governance structures and management
systems will continue to fail to address the existing health problems.
