By Kate Hawkins, Communication Officer for Health and Social Change

We’ve published seven new briefings on “scaling up” in the health sector. Among the themes covered are improving access to health services, building sustainable health systems, and harnessing a spirit of innovation to improve equity. Photo: Shimla street scene by Liz Highleyman from Flickr (Creative Commons)

The papers follow a workshop held at IDS earlier this summer with more than 40 academics, policy makers and innovators.

The workshop aimed to explore approaches that have fostered innovation and change in the health sector. We also looked at practical ways for innovators, governments and funders to work together to enable health systems to meet the needs of the poor.

For the last couple of years, Future Health Systems and the STEPS Centre have been looking beyond traditional narratives about how poor people access health services. In fact, health systems may evolve in many different directions over time – some of which are often ignored or under-recognised.

Real world challenges

The workshop shed light on real-world challenges experienced by those working directly in the health sector.

A common challenge was how to tailor global goals, or donor expectations, to the local context. When reforms of health systems come from the international level, there is a significant transfer and allocation of resources. So these reforms are intensely political. Jeff Mecaskey of Health Partners International talked about the Partnership for Reviving Routine Immunisation in Northern Nigeria, which is working to understand and build on different political interests, and pinpointing which interests might be drivers for change.

Abbas Bhuiya, from ICDDR,B in Bangladesh, explained how scaling-up efforts need to engage with the informal sector which makes up 95 per cent of the health workforce. Informal providers earn their living by selling drugs, and over-prescription and other harmful practices are common.

The private sector was also a focus of the paper by Barun Kanjilal, of the Indian Institute of Health Management Research. Barun described how a major change in the relative roles of market and state since 1990 in India had been reflected in the health sector. India has seen a rapid spread of largely unregulated private actors, as well as an expansion of opportunities for modern medicines and innovations.

Citizen-state relations was another area of focus. The Treatment Action Campaign in South Africa supports the right of people living with HIV to access quality comprehensive prevention and treatment services and to live a healthy life. Initially, the campaign had a bio-medical focus but this led on to campaigning on a broader set of vulnerabilities and socio-economic rights, as treatment access became more widespread. Other campaigns have taken similar journeys.

A shift in focus from health care provision and access, to issues of social justice, equity and the experiences of marginalised groups was also central to the paper on indigenous people in Brazil, given by Alex Shankland of IDS.

The resulting seven briefing papers provide more information on each of the following areas:

>> Framings of scaling up
>> Large scale health interventions
>> Local innovations
>> Scaling up in context of transition
>> Information and communication technologies
>> Citizen and health system relations
>> Building evidence to support rapid change