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Health: How do we make systems sexy?

Save the Children has long been the NGO with the clearest principles about building health systems. Through all the changing fashions in donor attention, we have always been pointing out that building a functioning health system must be the basis of development work.

Then it does not matter if a condition or a health threat facing a community is HIV, maternal mortality or malaria (which do have attention from donors) or elephantiasis, Chagas or River Blindness (which do not).

The question we have always faced is – how do you turn discussions about health systems into something accessible, interesting, inspiring and…well…sexy?

The media, politicians, campaigners all love a single disease or a single activity to talk about. When we explain that actually the important issue is the financing, the workforce, the information systems, the distribution networks and the policies which make a health system work, you can see their eyes glaze over.

They want to believe there is the magic bullet, the pill, the vaccine, the one activity which would turn around health in developing countries.

A global symposium was held last week in Switzerland looking at research into health systems and some of the participants have been grappling with this question. My colleague Nouria Brikci has been blogging from there, as has Washington academic and blogger Karen Grepin.

I don’t have a simple answer to this. I find issues like health financing, human resources and governance structures interesting and vital.

However, even in policy discussions, it is important to find ways to make them more accessible and to motivate people to take action.

For financing, Save the Children has long-worked on the issue of health user fees, not because we think removing them is the solution in itself but because it opens up the whole debate about how to raise enough money to fund health systems in fair ways that do not exclude the poor.

We are starting to look more at health workers and, for me, the terrible wages that overburdened health workers are paid, not to mention those who are expected to work without payment, is a powerful symbol of the human resources crisis.

I am cynical enough to know that very few of the magic bullet solutions ever prove to be as wonderful as people hope and they fail to get delivered because….wait for it….there is no strong health system to deliver them.

Any views? Would love to hear suggestions for how to motivate media, donors and campaigners to get behind health systems.

This blog will also appear on http://www.bmj.com

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