This week PLoS Medicine publishes the second in a four-part series of policy papers examining the ways in which global health institutions and arrangements are changing and evolving.
In this second paper, Julio Frenk, Dean of the Harvard School of Public Health, discusses the crucial role of national health systems in making progress in global health.
The increasing interest among the global health community in national health systems signals a positive shift, says Frenk. As funding for global health has grown during the past years, he argues, it has become increasingly clear that national health systems strengthening is "a necessary but not sufficient condition for progress." Frenk proposes a list of determinants that can help improve the performance of national health systems, which are captured by the acronym LIST: Leadership ("without leaders, even the best designed systems will fail," says Frenk); Institutions ("Institution building is always tough, he says, "because it requires long-term investments that are often obliterated by short-term political pressure"); Systems design (to allow the timely conjunction of human, financial, technological, and knowledge resources); and Technologies (such as drugs and vaccines).
Funding: This work was supported by a grant to the Institutional Innovations in Global Health project by the John F. Kennedy School of Government at Harvard University, Cambridge, Massachusetts, United States under its ''Acting in Time'' program. Additional support was received from the Burroughs Wellcome Fund, Research Triangle, North Carolina, United States. The funders had no role the decision to publish or preparation of the manuscript.
Competing Interests: The author has declared that no competing interests exist.
Citation: Frenk J (2010) The Global Health System: Strengthening National Health Systems as the Next Step for Global Progress. PLoS Med 7(1): e1000089. doi:10.1371/journal.pmed.1000089
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