House Of Commons Dani Sardà I Lizaran

Photo courtsey of Dani Sardà i Lizaran

Kate Hawkins, 2 July 2014

The UK International Development Select Committee is undertaking an inquiry into Health Systems Strengthening to examine how effectively in practice DFID is implementing its objectives. It is covering the following issues:

  • The impact of weak health systems on the achievement of DFID's and global health and development goals, and the extent to which poor health systems risk undermining the entire development effort
  • The effectiveness of DFID's current approach to health system strengthening

The REACHOUT position

Stakeholders were given the opportunity to submit written evidence to the enquiry, a full list of papers written for the Committee are available on their website. REACHOUT's evidence made the following points:

  • Close-to-community programmes are increasingly being initiated and scaled up in response to the human resources for health crisis. These programmes are providing an array of services which respond to health priorities at local level. They are often reliant on volunteer labour or employ staff who are poorly paid.
  • These programmes have the potential to provide health interventions which are responsive to community level needs and close-to-community providers are uniquely situated to understand and react to gender and other equity-related issues.
  • Yet close-to-community providers face challenges in relation to remuneration, sustainability and performance and workload management.
  • To improve the function and the impact of close-to-community programmes investment is needed in creating an evidence base on supportive management of programmes, the equity impact of close-to-community programmes, the relationship between close-to-community programmes and the broader health system in priority setting, and the cost effectiveness of these interventions.
  • Existing evidence from different settings should be translated and shared across countries and between academics, policy makers and implementers in order to improve the function of these programmes. This requires funding for multi-stakeholder learning platforms.

What happened next?

On the 24 June the Committee heard oral evidence from a range of health system experts. A video recording of the evidence session is available on the Parliament website. There was some mention of community health workers within the evidence session. Inputs mainly focussed on: the potential role of the UK in providing specialist training to close-to-community providers; the need to rationalise the responsibilities and functions of close-to-community providers so that they are not over-burdened and quality of services suffers as a result; and the caution that community health workers are not a 'magic bullet' and that these programmes need to be considered as part of a broader health system approach. It is great to see a focus on close-to-communty providers in these kinds of discussions and we look forward to the Committee's final report to see what reccomendations they have for the UK Department of International Development on how they can support these programmes.

A lively discussion took place on Twitter while evidence was given! Follow REACHOUT and be part of the debate.


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