Making decisions about the future of health systems
Introduction: Sustainability of health interventions in developing countries has been limitedby the capacities of their health systems. As a result, efforts have been invested by theinternational community to make health systems thinking coherent.Aim: To examine the sustainability of a health system during and after cessation ofinternational support from the Swiss Red Cross (SRC) in eye care services in the Brong Ahaforegion, Ghana.Methods: Between July 2008 and January 2010, multiple case study approaches were appliedto measure the sustainability of activities, identify the main shocks affecting health systems,and analyse the structure of social networks and their impact on the governance of healthsystems. This involved one-to-one in-depth interviews, dkect observations, document review,and social network analysisFindings: The district health systems were affected by shocks from different origins (local,regional and national). District hospital managers were able to respond to negative shocks oflocal origin but had limited capacity to find solutions to shocks originating from outside theirdistrict. Within the health system studied, it was apparent that health interventions that hadthe greatest observable effects, that were the least complex and the most compatible with themandate of the hospital were more likely to be continued by hospital managers than the otheractivities Further, after the departure of SRC in 2006, the social network shifted from a densenetwork in which all the districts were connected with each other to a centralised networkcomposed of five isolated districts. This led to a negative impact on the capacity of hospitalmangers to respond to regional shocks and find appropriate solutions in a timely manner.Conclusion: International organisations need to transition from the management of healthprojects towards health systems approaches taking into account the governance of healthsystems.
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