Decision-making and health system strengthening: bringing time frames into perspective.

Area of Science:

• Health policy and systems research
• Global health governance
• Health system strengthening

Background:

• Decision-makers in low- and middle-income countries face increasing complexity, including citizen and staff discontent, impacting health plan execution.
• The traditional building-blocks framework has limitations in structuring decision-making for health system strengthening.

Purpose of the Study:

• To propose an analytical framework for understanding and strengthening health systems by incorporating diverse temporalities.
• To evaluate the limitations of existing frameworks and offer a more realistic approach to health system strengthening.

Main Methods:

• Development of a novel analytical framework based on practical experience and literature review.
• The framework integrates five key dynamics: services, programming, political, reform, and capacity-building.
• Analysis of the Moroccan health system to illustrate the framework's application.

Main Results:

• Health system management is influenced by multiple, distinct temporalities.
• The proposed five dynamics are differentiated by their temporalities, actor roles, and activities.
• Recognizing these temporalities enables a more accurate assessment of health system strengthening initiatives.

Conclusions:

• Strengthening health systems requires acknowledging the interplay of various temporalities in decision-making and system functioning.
• The proposed framework provides a more nuanced understanding of health system dynamics beyond traditional models.
• The Moroccan experience demonstrates the potential of this approach for improving health system performance.