Reply To: Topic Discussion 1 : Improving health system

[Alex Zayar Phyo Aung]

The primary goal of strengthening health systems in fragile and conflict affected settings is to build resilience which will enhance the health equity across different populations. From my experience in leading health system strengthening initiatives in fragile and conflict settings, our focus was on improving system resilience to withstand any disaster such as manmade, natural or even health threat. We adopted WHO’s Health System Strengthening framework that includes six key building blocks. Among these, leadership and governance (referred to as stewardship in Dr. Piya’s lecture) and health financing are the most significant challenges. In fragile settings, the involvement of multiple stakeholders in managing local health systems often results in system fragmentation due to political dynamics. In that case, we cannot provide “one size fit for all” approach in system strengthening and it is more resource intensive. Meanwhile, implementing health financing and revenue pooling mechanisms remains a goal far to achieve as communities struggle with financial hardships that make meeting even basic needs a challenge.