The Sustainable Development Goals call for significant action on health by 2030: reduce premature mortality from non-communicable diseases by one-third, end preventable deaths of newborns and children under the age of five, and end the epidemics of water-borne diseases and other communicable diseases, just to name a few[i]. No small feat, to be sure. What’s more, these are complex problems that require holistic solutions. Strengthening health systems – the dynamic network of people and organizations that work to improve the health of a given population – is a key step for making effective progress towards these and other health targets, and policy research institutions (also known as think tanks) can help.
Why are health systems important? A strong health system enables environments and practices that promote health, and effectively responds to existing and emerging health issues within a population. It has the potential to prevent disease, while delivering healthcare services in a timely and reliable way to those in need.
However, these systems often struggle to stay strong and stable, largely due to fluctuations or limitations in available resources, be they financial, structural or human. These systems are also impacted by political motivations, economic shocks, security concerns, and natural disasters, as well as strength of leadership and partnerships. A weak health system usually manifests as providing inadequate quality, quantity, or delivery of services – particularly in remote areas.
In an ideal setting, actors from all sectors would be involved in a health system and would work together to enhance its overall approach to delivering quality, equitable, and efficient health services. However, that is often not the case. Given their interdisciplinary nature and ability to engage stakeholders around key public policy issues, think tanks can play an important role in strengthening health systems. But first, let’s dive a bit deeper to better understand the underlying complexity of both health and health systems.
Health is complex, and so are health systems
Health is multidimensional. It takes into account the many physical, mental, and social factors that affect the wellbeing of people and communities. What’s more, these factors are influenced by a combination of different environmental, biological, cultural, and socio-economic contexts. By examining these factors and their interconnectedness, researchers and public health practitioners can gain a better understanding of the root causes behind what makes individuals in a population sick or sicker.
To help with grasping the complexity of a health system, one might refer to the World Health Organization’s Health Systems Framework, which identifies six core building blocks. It is important to note that these are interdependent – any policy action that targets one particular building block would have rippling effects on the others. For example, an intervention that focuses on improving governance might lead to more efficient health care financing and more extensive service delivery.
The building blocks approach also helps with identifying gaps in a given health system, such as inequitable delivery of health services between rural and urban communities. These missing pieces hinder the ability of a given health system to improve the health of the population it ultimately serves. This approach helps those involved in the system to narrow in on specific areas where investments or policies are most needed and can have the greatest impact.
Shaping informed policy responses to improve health
Through their interdisciplinary research and engagement with different stakeholders, think tanks are often in tune with local realities. They have a good understanding of how various factors can influence the health of people. Also, think tanks are themselves actors in health systems, and can contribute to strengthening them by using evidence to inform policy decisions relating to health. A number of think tanks supported by the Think Tank Initiative (TTI) are focusing their research on policy action that, for example, is helping to enhance leadership and governance, strengthen information systems and accountability, and improve service delivery.
Consider, for instance, the work of the Consortium pour la recherche économique et sociale (CRES) in Senegal. Their research contributed to an increase in the tax on tobacco products by the national government, as well as the passing of a national tobacco law that limits its production, use, and sale. Research shows that tobacco taxation is an effective strategy for reducing smoking, thereby also reducing the incidence of related diseases and deaths. CRES also provided research-based recommendations for a new directive on tobacco taxation to the Economic Community of West African States (ECOWAS), which is an excellent illustration of how a think tank can contribute to improving health outcomes at a regional level.
To highlight yet another example, research by the Grupo de Análisis para el Desarrollo (GRADE) in Peru helped to inform a new infrastructure investment program by the Ministry of Development and Social Inclusion. Between 2013 and 2016, USD $225 million per year was invested in rural infrastructure, with parallel investments in clean water, sanitation, electricity, telecommunications, and roads. These investments are expected to provide approximately 2 million rural Peruvians with access to basic infrastructure. Thinking back to the WHO’s building blocks approach, these investments contribute to strengthening health systems through improved delivery of basic services, which can have positive impacts on people’s health.
Think tanks are important players in health systems
Think tanks are members of a larger network of organizations and individuals that can contribute to shaping policy action at various levels, from the local through to the international, which help to improve health outcomes.
For a health program to be sustainable and effective, communities must get behind it. Health solutions are more likely to be adopted when they take into consideration the particular social, cultural, and environmental dynamics of a particular community. Given their ability to engage citizens and other stakeholders around policy issues, think tanks often well understand different underlying needs and can help to communicate these to policymakers. This, combined with their research, can inform decision-making on how to make health policies and programs effective and impactful for the populations they are targeting. What’s more, think tanks can help to adapt successful programs or policies to other regions, and scale up proven solutions to higher levels, benefitting an even greater number of people.
It is clear that the work that think tanks are doing can go a long way in strengthening health systems. They are helping to identify and close policy gaps, as well as shape and implement inclusive and holistic policies that can improve health outcomes for many. Thinking back to the Sustainable Development Goals, all of this work is certainly making meaningful contributions towards the important and ambitious health targets that have been set.