1. CORE Group Global Health Practitioner Conference
Advancing Community Health Across the Continuum of Care
WHO Building Blocks Platform
for Health Systems Strengthening:
Adding Communities to the Mix
Alexandria, Virginia
Wednesday, April 15, 2015
2:00 – 3:30 PM

2. Session Agenda
• David – Problem Summary
• Emma – First Thoughts (Pre-First Draft)
• Eric – Evidence and Advocacy
• Small group work here to stimulate further
development and commitment

3. Problem Summary
• Civil society, communities and community health are minimally
represented in existing health system strengthening (HSS) models
• As the Maternal and Child Survival Program (MCSP) and CORE
Group, we seek to end preventable child and maternal deaths in 24
high priority countries
• Our objective: Articulate and advocate for the roles that
‘communities’ can play in HSS in order to stimulate dialogue and
address gaps in global health care
• Where to begin? There are multiple HSS models, and who is to say
there is a best one? World Bank? GAVI? Global Fund? WHO? We
chose the WHO Building Blocks model as our starting point,
somewhat arbitrarily. We are not married to this, we simply wanted
to begin the discussion.

4. Scope of Activity to Date
Concurrent panel was held at the Fall 2014 CORE Group Global
Health Practitioner Conference: Where is the “C” in Health
Systems Strengthening?
• Joseph Petraglia, Pathfinder International
• Alfonso Rosales, World Vision US
• Eric Sarriot, USAID Maternal and Child Survival Program
• Karen Cavanaugh, USAID
• Amalia Del Riego Abreu, Pan American Health Organization
• Ngashi Ngongo, UNICEF

5. Scope of Activity to Date
• Building iteratively, we started a small working group
in early 2015 from MCSP and CORE Group, and are
expanding our network/coalition outward
• Reviewed the six building blocks and considered
additional ‘blocks’
• Considered each block and reflected upon how
communities could/should be incorporated building
on the work of Karen LeBan, Emma Sacks & USAID/W
• Began a literature review and developed a glossary of
terms – A sub-theme of this activity is: ‘What
constitutes evidence?’

7. WHO’s original objectives for the six
building blocks
• Promote common understanding
• Address new challenges and set priorities
• Address questions of health system financiers
• Strengthen WHO’s role in health systems, in a
changing world

8. USAID Definition of
Health System Strengthening (HSS)
• Strategies, interventions and activities designed
to sustainably improve health system
performance.

12. Let’s consider the Building Blocks,
One at a Time
1. Service Delivery – Good health services are
those which deliver effective, safe, quality
personal and non-personal health interventions
to those that need them, when and where
needed, with minimum waste of resources.
Questions & Comments – What are non-
personal health interventions? (Population
based?) Where is infrastructure? This is clearly
aspirational rather than explicit in nature.

13. Let’s consider the Building Blocks,
One at a Time
2. Health workforce – A well-performing health workforce
is one that works in ways that are responsive, fair and
efficient to achieve the best health outcomes possible,
given available resources and circumstances (i.e. there are
sufficient staff, fairly distributed; they are competent,
responsive and productive).
Questions & Comments – What about community and/or
informal staff? Paid versus volunteer? Full-time versus
part-time? Should they be from the communities they
serve? They need to live and work very near their service
populations, and be focused on overcoming inequity.

14. Let’s consider the Building Blocks,
One at a Time
3. Information – A well-functioning health
information system is one the ensures the
production, analysis, dissemination and use of
reliable and timely information on health
determinants, health system performance and
health status.
Questions & Comments – Dissemination to
whom? Communities receiving services? Health
determinants are usually limited to SES, if that is
collected. How is equity access really assessed?

15. Let’s consider the Building Blocks,
One at a Time
4. Medical Products, Vaccines and Technologies – A
well-functioning health system ensures equitable
access to essential medical products, vaccines and
technologies of assured quality, safety, efficacy and
cost-effectiveness, and their scientifically sound and
cost-effective use.
Questions & Comments – Who may use these
technologies in communities? Is selected task
shifting embraced by the national medical
community? Timeliness and availability of essential
medicines is a huge challenge for community based
health care; iCCM rollout is an example of a strategy
facing many barriers within national supply chains.

16. Let’s consider the Building Blocks,
One at a Time
5. Financing – A good health financing system raises
adequate funds for health, in ways that ensure
people can use needed services, and are protected
from financial catastrophe or impoverishment
associated with having to pay for them. It provides
incentives for providers and users to be efficient.
Questions & Comments – Out-of-pocket expenses
continue to be a major barrier to health service use
worldwide. Full funding of basic services for people
in low/no resource settings is urgently needed.

17. Let’s consider the Building Blocks,
One at a Time
6. Leadership/Governance – Leadership and
governance involves ensuring strategic policy
frameworks exist and are combined with effective
oversight, coalition building, regulation, attention to
system-design and accountability.
Questions & Comments – ‘Strategic policy
frameworks exist’ may imply a top-down approach,
rather than an epidemiologically driven, bottom-up
approach to inform priorities and investment.

18. What’s Missing?
• Community - Whether community is rarely mentioned, or
frequently mentioned, it is not explicit and often disappears during
the planning and budget process.
• Community based health services - run by, and for communities,
with limited or no access to national health services. This is the
reality in many parts of the world, and planning for more facility
based care will not make unmet health needs (and inequity, and
preventable death) go away.
• Health production - of households and communities, based on
meeting basic public health needs (often outside the medical model
of service), and practicing healthy behaviors.
• Civil society engagement - for resource generation, active
participation in advocacy, planning, implementing, managing and
measuring, and accountability of public resources, at multiple levels
(local, regional, and national).

19. For more information, please visit
www.mcsprogram.org
This presentation was made possible by the generous support of the American people through the
United States Agency for International Development (USAID), under the terms of the Cooperative
Agreement AID-OAA-A-14-00028. The contents are the responsibility of the authors and do not
necessarily reflect the views of USAID or the United States Government.
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