Three Lessons in Strengthening Health Systems

By Lisa Bonadonna, GSK, and Mavis Owusu-Gyamfi, Save the Children

Three Lessons in Strengthening Health Systems

What does it take to make health systems more robust – to ensure they can handle everyday illnesses, as well as pre-empt and manage future challenges or crises? There is no easy answer to this question; but what’s obvious is that there’s no single way to strengthen a health system. We need to think laterally.

This was illustrated by the winners of our third GSK-Save the Children Healthcare Innovation Award – which recognises ideas, born in developing countries, that are helping to reduce deaths among children under five. The award is a major element of GSK and Save the Children’s five-year partnership. This time around, we sought to highlight innovations that are strengthening health systems and improving access to public healthcare for mothers and young children. With millions of people still unable to reach essential health services – such as family planning and child immunisations – the need for inventive approaches that transform access to healthcare is stark.

From more than 100 award entries across 26 countries, we found that organisations in developing countries are devising ingenious, creative ways of improving healthcare. Our four winners demonstrate the multiple, complementary approaches that are required to effectively strengthen health systems so that mothers and children can access the care they need, when they need it. Among the winning ideas, three lessons stand out.

Firstly, no health intervention exists in a vacuum – we need to think holistically about delivering care. 2020 MicroClinic Initiative, our winner in Kenya, found that isolation and fear could prevent pregnant women from seeking healthcare. So they devised a package of three interlinked interventions to encourage women to use medical facilities. This includes emergency transport to the clinic and making sure the mother has a birth companion who is supported and trained. Women who give birth in the clinic get a set of newborn clothing made from recycled cotton t-shirts. Put together, these interventions are helping to give mum and baby a better start. Over the three-year programme, no maternal or neonatal deaths have been recorded.

Secondly, the significance of data. Analysing data in a thoughtful way helps us to consider patterns of illness and interventions. Healthcare can be tailored and improved as a result. This is shown by our winner from South Africa, which has developed an audit tool to better understand deaths among children in hospital. And in Vietnam, PATH has created a paperless immunisation system that brings vaccination records into the digital age. Not only does this save health workers valuable time – no longer needing to write out records by hand – but also improves access to vaccination. Rates of full immunisation in the first year of life increased from 74.3 to 77.8% in a one-year pilot.

Thirdly, the importance of considering patients’ particular needs and responding accordingly. Our winner from Ecuador has done just that. Fundación VIHDA recognises that parents can find it challenging to measure out the correct dose of antiretroviral medicine for their newborn baby. So they have started using the ‘Pratt Pouch’, similar to a ketchup sachet. This foil pouch – originally developed at Duke University – is filled with the exact amount of medicine needed per dose and has improved accuracy from 50% to over 90% of mothers delivering highly accurate doses. Mothers surveyed indicated that they found it simple to use, more durable and less wasteful.

Taken together, these approaches demonstrate the power of lateral thinking when it comes to increasing access to healthcare. Rather than looking at a challenge in isolation, they have developed a thoughtful, responsive solution which recognises the particular environment in which they are working. It is no surprise that when it comes to tackling complex problems, it is often those living and working closest to the challenge who come up with the best solution. These are not always expensive or complicated. At a roundtable event with the Kenya winners and interested stakeholders, people were struck by the project’s significant results relative to its scale. It just goes to show that a perceptive idea, committed colleagues and some resources can go a long way. People were also excited by the innovation’s potential – for example, engaging new dads as well as new mums.

Through our award, we hope to give these clever ideas the resources and profile to replicate and reach their potential. Already, we are seeing great examples of this among previous winners. Living Goods Uganda, which won in 2014, has grown from 1,000 to 3,700 community health promoters, more than tripling the number of families served with health education and products such as fortified foods. In GSK and Save the Children’s flagship maternal and child health programme in Kenya, we have adopted Kangaroo Mother Care, which won in 2013 for promoting skin-to-skin contact between mothers and their premature babies. It is exciting to see these innovations helping to strengthen health systems and reach more children. We look forward to seeing this year’s winners go on to do the same.

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