ABSTRACT
Health systems have been described as complex adaptive systems comprising numerous component agencies, each of which makes decisions about how to behave. These decisions change with context and time and interact with each other in predictable and unpredictable ways. Together, they take on characteristics that cannot be understood by simply looking at its individual parts. Building system capacity is, therefore, far more complex than training different actors. It requires considerations of institutional designs that make for a system continually learning and adapting. Here, I discuss two case studies that are not only interesting narratives but are also great examples of health system capacity building.
The first of these, the Mitanin (a Chhattisgarhi word meaning ‘female friend’) programme, is the story of taking to scale a community health worker programme in the newly created under-developed state of Chhattisgarh. This involved continuously developing protocols of selection, training, support, and remuneration of community health workers. The understanding of their roles and their fit with the rest of the health systems was also dynamic and evolving. Capacity building required the creation of an institution, the State Health Resource Centre, that also became the centre of systematic learning and feedback into strategy and implementation.
The second case study is of the National Health Systems Resource Centre (NHSRC). The National Rural Health Mission (NRHM) was India’s grand plan to strengthen public health systems across the country, but to do so while respecting federalism and decentralisation was a challenge. It is within such a context that the role played by the NHSRC in capacity building of state and national public health systems and its own capacity to deliver has to be understood. As the nation moves towards achieving universal health coverage and the right to health, it would be useful to reflect on these experiences.
