HEALTH SYSTEMS STRENGTHENINGtowards Universal Health Coverage (UHC)

Why Health Systems Strengthening ?

The above photo depicts a mother and a baby who are receiving health checks, a tetanus vaccine and a long lasting insecticidal net (LLIN) at a community health center in Angola.

In order to realize this kind of basic health services to be accessible to every child and everyone when needed without a financial burden (=Universal Health Coverage: UHC), timely and appropriate Health information and data system are essential to identify where and how many children and mothers need to be vaccinated; to grasp the status of distribution of bed-nets to prevent Malaria; and to check quality health staff, facilities and services are in place and are equitably accessible for everyone’s use in the community. This health information/data will be the basis as evidence, on which health policies (including budgeting), plans and program actions are implemented by the local and the central governments for their scale-up leading to sustainable health systems.

It is also necessary to strengthen procurement and supply chain management (including cold-chain) to ensure essential drugs and medical equipment are in place and accessible in quality conditions.

Further, capacity-building of human resources in the health sector is essential to manage health information systems, procurement and supply-chain and health system governance (policy development, evaluation, financing and so on).

Therefore, Health Systems Strengthening is a foundation for UHC, corresponding to SDG3.8.

This project aims to facilitate national health systems’ shift from aid-dependency to sustainable self-sufficiency.

The objective and outlines of this project

The objective of this project is to sustainably strengthen health systems focusing on the following three aspects:

1. Improve health data and information systems in Angola, Guinea and Togo.
   • To collect appropriate and timely health data (e.g. availability of essential drugs, vaccination coverage, geolocation of front-line health facilities and health workers) at community-level to provide quality health services.
   • To ensure such data are analyzed and monitored for appropriate health policies, plans and program actions at district level.
   • The government advances national level health policies, plans, budgeting and program actions based on evidence-based health data. The government may also be expected to design health and social protection systems where everyone has access to affordable quality health services.
   • Collection of reliable health dataAnalysis/useIdentifying health programmes to takeMonitoring and Evaluation of the programmes takenBuilding up evidence-based model casesScale-up at national or district levelSustainable health systems.

   © UNICEF/UNI148585/Vassie

2. Strengthen procurement and supply chain management, in Angola and Guinea(*). *not in Togo
   • Procurement and supply chain management of essential drugs, vaccines and other medical equipment including monitoring and updates. Procurement and supply chain management includes cold chain management systems.
   • Procurement and supply chain management has a strong link to data and information system/management.
   • UNICEF is shifting from “direct service delivery” to “technical assistances” for sustainable health supply chain.
   • Such technical assistances include quality standards, warehousing, safe and reliable procurement.
   • To strengthen resilient national capacity prepositioned for pandemics or other emergencies.

   © UNICEF/UN070232/Hatcher-Moore

   © UNICEF/UNI126130/Barongo

3. Capacity building of human resources in health system governance in Angola, Guinea and Togo.
   • Human resources remain at the heart of any health systems. Data, information and supply chain are all well utilized only when human beings manage and operate them well.
   • Vice versa, relying heavily on health human resources without data, information, essential drugs and supply chain would never lead to strong health systems. Therefore, capacity building of human resources for health, data/information and supply chain links and enhances each other.
   • Capacity building covers not only community health workers (CHWs) but also covers health workforce at district and national levels.

Program countries

Angola, Guinea and Togo. Health indicators, such as child mortality rates, of these countries have been at the lowest levels. But the recent progress and the governments’ commitment are strong; thus, Health Systems Strengthening is timely and equitable, and is needed to push this momentum further.

Target

The target population for this project is an estimated 8.5 million people including 1.6 million children under five and 424,000 pregnant women.

*The numbers of “Indirect” beneficiaries in Togo don’t include those of “Direct” beneficiaries.

Contribution

• Health Systems Strengthening in Angola, Guinea and Togo.
• Total 500 million Japanese Yen over 5 years (2018-2023)

Results and Impacts

The three target countries have made great strides in realizing strengthened health systems that are both sustainable and resilient.

Of the three target countries, none of them had clear visions of Health Systems Strengthening at the start of the project. However, now, all three countries have formulated multi-year strategic plans, and they are operating annual rolling workplans of Health Systems Strengthening.

In Angola, the Ministry of Health has adopted DHIS2 (District Health Information System) as the main platform of the national health management information system. Its use for decision making in the 25 target municipalities has increased from 51.6% in 2019 to 84% in 2023. This has benefited the entire population in the areas – not only mothers and children, but also men and people of all ages – which amount to 6,015,978 people.

In Guinea, through improved procurement and supply management, all the target health centers achieved continuous availability of tracer drugs for the treatment of major diseases affecting children under 5 years of age.

In Togo, data collected by Community Health Workers was integrated into Health Facilities data and then district and regional data through national HMIS system, establishing a functional and integrated real time information and monitoring system.

As of October 2023, all pregnant women and children under 5 years old in the target areas have access to quality health services. The total number of beneficiaries in terms of population covered is over 1.9 million.