Strengthening national health systems: a priority for the SDC

Article, 14.03.2014

The Swiss Agency for Development and Cooperation (SDC) devotes 10% of its budget to promoting and improving health care around the world. Debora Kern, health sector policy adviser with the SDC, believes Switzerland has a big part to play in reminding states of their crucial role in the provision of health care.

Debora Kern is health sector policy adviser with the SDC.

The Millennium Development Goals (MDGs) will come to an end in 2015. How does the SDC assess its achievements with respect to providing health care for the most vulnerable?
On the one hand, we are pleased that the MDGs drew international attention to the three major health objectives of reducing infant mortality, improving maternal health and the fight against HIV/AIDS, malaria and other communicable diseases. This enabled a vast amount of money to be raised, with the aim of improving the health of disadvantaged populations. On the other hand, this huge influx of funding led to distortions in the approaches to development that were adopted, making them hard to manage. Vertical funding, i.e. disease-specific funding for illnesses such as HIV/AIDS or malaria, began to flood developing countries with related drugs and materials, sometimes overwhelming existing health structures. This monopolising of health structures was sometimes detrimental to basic health care in the countries concerned.

Detrimental in what ways?
Picture a situation where a large proportion of health-care workers in a country are sucked in to the implementation of ready-made programmes, awash with funding. How many sufficiently qualified doctors and nurses will there be left to treat basic problems like diarrhoea and respiratory infections? Yet, diarrhoea and respiratory diseases are still the principal causes of child mortality among under-fives throughout the world.

What can the SDC do to get things back on track?
I would say our strength lies in the fact that we are a relatively small structure, where everyone just about knows everyone else. This means that information from the field is easily shared, thanks to the close connections between the countries where we work and the main office in Bern. We then use that information to raise awareness among our pool of donors at the multilateral level and the international organisations themselves of the importance of going through locally established health structures. Take two examples: in Tanzania, the SDC has for a long time been providing financial and technical support to a national coordination body fighting malaria. Now fully set up and running, this body has informed donors that all funding for malaria prevention and treatment should henceforth go through it, making it possible to coordinate aid and take decisions at the national level. Second example: the intense lobbying we have undertaken with others in favour of national health systems with the Global Fund to Fight AIDS, Tuberculosis and Malaria has paid off. Calls for project submissions specifically targeting a «strengthening of health systems» have now been published by the fund. As we see it, this is a radical change in thinking.

To take up where the MDGs left off, a post-2015 development agenda is currently being negotiated at the international level. Is that another opportunity for the SDC to make its voice heard?

Absolutely. Currently two different action plans for health post-2015 are on the table. The first restricts itself to the health sector and has as its objective universal health coverage. That is important and we do support this objective as a pertinent indicator for the health sector. Yet, we give our preference to the second approach discussed, which takes on board the multisectoral nature of the issue of health. That means bringing into the mix the social, educational and, for instance, hygiene-related factors that all help determine one’s state of health. This only will ensure that we may one day achieve what stands as our utmost goal: maximising health outcomes for all and at all stages of life.