Health systems financing: putting together the "back office".

As Africa attempts to achieve ambitious millennium development goals, many critical challenges confront healthcare systems. In advancing towards these goals, African countries need to review and reform their healthcare delivery systems, and they need to devise innovative approaches to deal with daunting problems. 2 Development of healthcare systems and improvement in health outcomes, based on investment in programmes focusing on specific diseases, continues to fragment health systems, leaving the basic infrastructure weak and incapable of delivering equitable, broad based services. There has been much discussion about integrating the primary, secondary, and tertiary tiers of the health system (the “front page”) but inadequate attention has been paid to identifying and strengthening the actions that are required to deliver the basic package of care (the “back office”) at each level of care. Low income countries in Africa face the daunting challenge of improving the performance of their healthcare systems, upgrading their health services to a level that will enable them to deliver services that are effective, efficient, and equitable. They need to build up capacity in a systematic manner, but financial and other constraints make it impossible for them to reproduce exactly the models from affluent developed countries. This paper identifies the main components of the back office that need to be developed and integrated to improve the performance of health systems and strengthen the delivery of healthcare services (box 1), and includes examples of the issues that arise.