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Health systems

Germany’s commitment to strengthening health systems


Lab technician in a hospital in Galcayo south in Somalia.

The German gov­ern­ment has set itself the goal of improving access to health services, health-related information and healthy living conditions in its partner coun­tries of de­vel­op­ment co­op­er­a­tion. Particular attention is thereby paid to providing for poor and disadvantaged popu­la­tion groups.

Governments in de­vel­op­ing coun­tries are obliged to respect, protect and guar­an­tee the right to health. They must guarantee access to health care services that meet today’s general quality standards. Germany provides intensive support to its partner coun­tries in fulfilling this obligation.

Building efficient health systems requires time, flexibility and know-how. Success in this regard to a large extent depends on a coun­try’s political culture, on the rule of law and on respect for human rights.

Solidarity and self-administration

In its de­vel­op­ment co­op­er­a­tion, Germany always seeks to motivate partner coun­tries to adopt fair, responsible policies geared to social peace. Principles of the German health care system such as solidarity and self-administration have an im­por­tant role to play when it comes to advising partners in these coun­tries. The priorities of German de­vel­op­ment co­op­er­a­tion in regard to establishing health systems are as follows:

  • Supporting partner coun­tries in elaborating health policy strategies aligned with the economic and overall social conditions prevailing in that coun­try;
  • Supporting partner coun­tries in elaborating staff de­vel­op­ment plans, adapting frameworks and promoting training and advanced training;
  • Strengthening the management skills of personnel in the health system;
  • Involving the public in decision-making on health and social policy;
  • Supporting partner coun­tries in guaranteeing access to and the provision of adequate, high-quality services;
  • Establishing social protection systems (e.g. social health insurance).

Avoiding shortages of qualified staff

There is an estimated global shortage of 4.3 million health workers. Sub-Saharan Africa carries 25 per cent of the global health burden, but has only just over 3 per cent of health care workers available worldwide. The health brain drain is exacerbating the problem. In many coun­tries German de­vel­op­ment co­op­er­a­tion supports measures to counter the shortage of qualified staff, for example es­tab­lishing, equipping and expanding adapted training structures for health care professionals and introducing modern and flexible personnel management tools.

At in­ter­national level the German gov­ern­ment cooperates with the Global Health Workforce Alliance (GHWA), which is hosted by the World Health Orga­ni­sa­tion (WHO).

Social protection and equitable financing

Medicines at a health centre in Madagascar. Copyright: Guy Oliver/IRINAccording to the WHO, every year some 100 million people worldwide encounter financial difficulties due to illness and fall below the pov­er­ty line for that reason. Funding mechanisms such as health insurances are usually still in their infancy in most de­vel­op­ing coun­tries.

The goal of German de­vel­op­ment co­op­er­a­tion is to support partner coun­tries in establishing an equitable, solidarity-based and efficient financing system. That is achieved by, among other things,

  • advising health ministries on, for example, de­vel­op­ing funding systems for tax- or insurance-based health care systems;
  • advising partner coun­tries on introducing innovative funding options for the health care system, such as voucher systems and savings funds;
  • advising governments and subordinate authorities on strengthening their financial administration and establishing trans­pa­rent structures and decision-making processes for using available financial resources;
  • training and advanced training in the fields of health economics and financing for health care professionals and managers.

World Health Report

The Director-General of the WHO, Margaret Chan, presented the World Health Report 2010 ("Health systems financing: the path to universal coverage") in Berlin in late November 2010. The WHO had commissioned the report in response to the need expressed by rich and poor coun­tries alike for a practical set of guidelines on health financing. The BMZ and the German Federal Ministry of Health supported the preparation of the report.

The World Health Report 2013 ("Research for Universal Health Coverage") was published in August 2013.

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