Strategizing For Health In The 21st Century: Introduction

The global health environment is becoming increasingly complex. Social, demographic and epidemiological transformations fed by globali - zation, urbanization and ageing populations pose challenges of a magnitude that was not anticipated three decades ago. In addition, recent global health security threats such as the Ebola virus disease or Zika virus outbreak, and the growing mismatch between the low performance of health systems and the rising expectations of societies, are increasingly becoming a cause for political concern. This often leads to countries prioritizing, or re-prioritizing, efforts towards strengthening health systems, moving towards universal health coverage (UHC) and implementing the idea of health in all policies.
Countries recognize that these calls for efficiently strengthening health systems and improving health security must be translated into robust, realistic, comprehensive, coherent and well balanced health policies, strategies and plans. In the post-Millennium Development Goals (MDGs) era, they also recognize that in pluralist, mixed, public-private health systems, these policies, strategies and plans have to relate to the entire health sector and cannot be limited anymore to “command-and-control” plans for the public sector. Functional health systems that deliver high quality services to the population are the main priority for governments. Achieving this requires permanent, well-structured and dynamic processes, with a true consensus between the demand and supply of services, as well as between governments, services providers and the population. A solid, evidence-informed policy dialogue is the only real way to achieve this in the 21st century.
Furthermore, it is now widely understood that national health policies, strategies and plans (NHPSPs) extend much beyond “health care”, i.e. clinical personal services, and cover the broad public health agenda, including disaster preparedness, risk management and the Inter - national Health Regulations, encompassing action on the social determinants of health and the interaction between the health sector and other sectors in society. In the face of both these gradual and acute changes over the past decade, NHPSPs, and more importantly the process of developing the NHPSP, need to be adapted and given a different focus. This handbook attempts to address that need. In the context of the Paris, Accra and Busan principles of effective development cooperation, it is also widely recognized that in countries that receive significant external aid, NHPSPs are increasingly seen as crucial for making aid more effective. It is recognized that, during the MDGs era, plans or policies did not always fulfill their promises; this was often because of design deficiencies or implementation failures. It was common to observe that national plans were not inclusive, not comprehensive enough, often imbalanced and incoherent with the wide variety of health problems to be tackled. Often, there was a disconnect between national plans and the broader national development policies or policy frameworks, health financing strategies and macroeconomic policies.