UNDP’s focus on developing the capacity of national systems for health helps to ensure that country infrastructure, information systems, procedures and management are enhanced with the aim of improving and sustaining the performance of both national programmes and Global Fund grants. A comprehensive capacity development strategy of enhancing national health systems, rather than the more traditional, narrower approach of training and technical assistance (TA), creates greater resilience. The focus on health systems reflects the transition from the Millennium Development Goals to the Sustainable Development Goals (SDGs).
Central to UNDP’s capacity development strategy is the focus on strengthening national systems in all the essential functional capacities along with strengthening the enabling and legal and policy environments. UNDPs approach to capacity development focuses on the wider requirements of national disease programmes to include needs of national responses and programmes rather than just focusing on Global Fund grants. This provides the opportunity to apply greater integration between the three diseases and identify potential synergies with broader public health programmes.
The World Health Organisation (WHO) states that a well-functioning public health programme is built on having trained and motivated health workers, a well-maintained infrastructure, and a reliable supply of medicines and technologies, backed by adequate funding, strong health plans and evidence-based policies. WHO health system strengthening focuses on:
GAVI (the Global Vaccine Alliance) focuses on WHO’s six building blocks that contribute to a strengthened health system:
In addition to these six requirements, community mobilisation and demand generation are other areas of importance for a strong health system.
As part of its new strategy ‘The Global Fund Strategy 2017-2022: Investing to End Epidemics’ the Global Fund is prioritising investments in building Resilient and Sustainable Systems for Health (RSSH). The Global Fund is identifying specific funding opportunities for countries to focus on developing capacity in systems that not only affect the three diseases but the full national health programme as well.
To enhance sustainability, the Global Fund is encouraging countries to implement programmes through country systems, including national health information systems, national procurement and supply chain systems and public financial management systems. They are also focusing on improving systems for local oversight supported by civil society, and programmes to remove human rights barriers, which are essential in ensuring that all communities are active and equal partners in national health responses. In contexts where there are currently capacity constraints that do not allow for implementation through these country systems, applicants are encouraged to make use of RSSH funding to strengthen the relevant system components so that these country systems can eventually be used for implementation.
The Global Fund is using its differentiated approach in allocating resources for RSSH and in agreeing what these resources should focus on. In Challenging Operating Environments more investments are needed in human resources for health, health financing and governance, and transparent and accountable public financial management. Countries in the sustainability or transition planning process should work towards ensuring their health systems are more sustainable through, for example, developing and implementing robust, costed disease-specific National Strategic Plans (NSPs).
The Global Fund has developed seven sub-objectives under its core objective of building RSSH:
Within these RSSH objectives, they have highlighted priority capacity development areas that countries should focus on when assessing capacity, creating capacity development and transition plans and submitting funding requests.