Eye to the Future
USAID’s vision for strengthening health systems for sustainable results
As a Peace Corps volunteer in Nicaragua in the late 1990s, I saw how community trust in a health system is essential. I worked with a health care system instituted by the government that relied on trusted community members to deliver health messages to their peers. It worked. Nicaraguans sought basic, preventative health care and learned about behaviors that can prevent the spread of diseases.
After the Peace Corps, I worked for the North Carolina state government to set up a child immunization registry. I saw how digitizing hand-written records could be a tool for increasing the vaccination rate across the state, but only if integrated into the everyday processes nurses and other health workers followed when administering the vaccines.
In my time working on improving country health systems, I’ve seen the pendulum swing from favoring programs that focus on broad policy reforms like instituting community-based health systems to those that strengthen specific functions of the health system like digitizing records. Programs had a tendency to be “either-or.” But in my experience, both are needed to help countries deliver health care and prevent, detect, and treat diseases.
USAID’s new 10-year Vision for Health System Strengthening 2030 combines these interrelated approaches. Rather than focus on only broad policy reforms or single functions, we support approaches that address the system as a whole — from policies to resources like financing and commodities. We support solutions that are derived locally through community engagement and include the perspectives of a range of stakeholders.
By integrating and aligning policies and resources; we can better identify the investments that will help sustain improved health outcomes and reinforce our health security and economic stability.
I have also seen how countries’ health systems struggle to rebound when natural disasters hit. I saw this firsthand in Nicaragua after Hurricane Mitch and subsequently through my involvement at USAID in recovery from the earthquake in Haiti in 2010 and responding to the Zika epidemic in 2016. During these emergencies, it quickly becomes clear that health care needs cannot be met without the right policies and resources in place, including flexibilities that allow for sharing and adapting as the situation changes.
The COVID-19 pandemic has demonstrated on a global scale the fragility of health systems and why it’s important for our global health security to help countries strengthen their health systems to help prevent future pandemics or minimize their far-reaching effects. Now is the time to act to change the way countries and aid donors approach health system strengthening.
As President Biden said, “When we strengthen health systems around the world, we reduce the risk of future pandemics that can threaten our people and our economy.”
The COVID-19 pandemic makes it clear: When a country can maintain even basic health care for its population in the face of emergencies, people tend to trust their health system and continue to seek care so they can go to work and go to school.
USAID recognizes that to get people to wash their hands and adopt other behaviors that protect them, we must engage with everyone from community members to politicians to effectively prevent the spread of infectious disease. To better monitor the spread of disease, we must strengthen laboratories’ testing capabilities. And to improve the use of accurate data, we must ensure decision makers adopt and understand how to use information systems.
Resources like water and sanitation facilities, safe and effective medicines, and adequate distribution of health workers aren’t available if the policies, governance, and data aren’t in place to support them.
A whole-of-society approach is needed to strengthen health systems to ensure they are accountable, affordable, accessible, and reliable for everyone. USAID is ready to continue our work with our partner countries and their institutions to embrace this approach, and our 10-year vision for strengthening health systems is a demonstration of that commitment.
About the Author
Kelly Saldana is the Director of the Office of Health Systems for USAID’s Bureau for Global Health. She started her career as a Peace Corps volunteer in Nicaragua and has been a passionate advocate for the importance of investing in health systems ever since. She has worked for USAID for 18 years in health and served on several interagency task forces for international health emergencies.
