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Making poor countries' health systems work effectively is arguably the biggest challenge that faces the global health community. At the International AIDS Conference, which was held a few weeks ago in Toronto, time and again failing health systems were cited as the major reason for the slow roll-out of antiretroviral drugs for HIV. But strengthening a health system is notoriously difficult to do and relies on the effective interaction of people from a wide range of disciplines and backgrounds; the health-systems community does not have a cohesive identity and often fails to provide adequate guidance to countries struggling with health-system reform.
For these reasons, the recent launch of the Health System Action Network (HSAN), should be cautiously welcomed. HSAN is very much in its infancy and its precise remit is still being developed. However, the steering committee hopes that it will: provide information on effective strategies to strengthen health systems; be an advocate for investing in strong health systems; and facilitate opportunities for members to share experiences with each other. If they can pull this off, HSAN could indeed be a valuable resource. For as Julio Frenk, the Minister of Health for Mexico, points out in a Public Health article in this issue, “every reform initiative should be seen as an experiment, the effects of which must be documented for the benefit of every other initiative, both present and future”. HSAN has a tough job ahead. It is backed by some influential donors—including the Bill and Melinda Gates Foundation, as well as the development agencies of the USA, UK, Sweden, and Canada—but is designed to be a grass-roots organisation. To survive, let alone be successful, HSAN will need to engage people, both globally and locally in developing countries, who understand the critical role of health systems in improving health and who are also influential enough academically, politically, and socially to make a difference. Otherwise, HSAN risks being yet another ineffective talking shop that does more harm than good by proving that the health-systems community is unable to interact effectively. The Lancet 2006; 368:892Copyright © 2006 Elsevier Limited |
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