This document outlines HAI's model of health systems strengthening which focuses on working with public sector institutional health systems. It discusses the importance of strong public health systems for scalability, equity, and specialized services. HAI works in key areas like integrating services, leadership and management, health systems research, and community linkages. Examples from Timor-Leste and Côte d'Ivoire show HAI's work improving maternal and child health services, developing health facilities, training health workers, and strengthening community outreach. The document concludes by discussing opportunities to further strengthen whole health systems through integrated services, workforce issues, information systems, and leadership coordination.

1. Working with the “institutional” health system: HAI’s model of health systems strengthening Emily deRiel, MPH – deriel@u.washington.edu CORE Spring Meeting April 30, 2010

2. Outline Importance of public-sector institutional health system How HAI works Examples: Timor-Leste, Côte d’Ivoire Opportunities to strengthen whole health system (institutional and community)

3. Importance of the public-sector institutional health system Scalability Equity and access (vs private sector) Challenges of private sector: no quality advantage, greater cost, hard to regulate, doesn’t reach the poorest Specialized services and referral system Trust Kruk et al, 2010: “a functioning, equitable health system can have important health and statebuilding benefits in post-conflict countries.”

4. How HAI works Key areas Integration of services into primary health care Leadership and management Health systems research Community linkages Advocacy

5. WHO building blocks Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes WHO, 2007

6. HAI areas and WHO building blocks

7. HAI example: Timor-Leste Improving maternal and newborn care, child spacing Development of birth-friendly facilities Leadership and management On-site training and mentoring of MCH District Program Officers; supervision tool Support for district midwives and CHWs through monthly SISCa events

8. HAI example: Timor-Leste Health systems research Formative research/assessments, evaluations Operations research workshop in fall 2010 Community linkages SISCa activities (as above) Health promotion materials

9. HAI example: Timor-Leste

11. Regional/district assessment meetings

12. Site visits with district supervision teams

14. Some opportunities to strengthen whole health system Services Integrated package of services based on community needs Stronger referral systems Demand generation Workforce Ongoing supervision and support/payment of CHWs Training and advancement opportunities

15. Some opportunities to strengthen whole health system Products/Vaccines/Technologies Procurement systems that extend to community level Info Data collection and input mechanisms and reporting Financing Mechanisms that ensure poorest have access Leadership/Governance National priorities, standards, protocols Coordination of activities within national plan Planning/needs at community level informs national plan, and vice versa

16. Small group discussion What models or frameworks of the health system do you find most useful for your work? and/or What improvements can be made to existing models to better incorporate the community role in health systems?