title: Strengthening health systems by health sector reforms.
abstract: BACKGROUND
  The rising burden of disease and weak health systems are being compounded by the persistent economic downturn, re-emerging diseases, and violent conflicts. There is a growing recognition that the global health agenda needs to shift from an emphasis on disease-specific approaches to strengthening of health systems, including dealing with social, environmental, and economic determinants through multisectoral responses.
  
  
  METHODS
  A review and analysis of data on strengthening health sector reform and health systems was conducted. Attention was paid to the goal of health and interactions between health sector reforms and the functions of health systems. Further, we explored how these interactions contribute toward delivery of health services, equity, financial protection, and improved health.
  
  
  RESULTS
  Health sector reforms cannot be developed from a single global or regional policy formula. Any reform will depend on the country's history, values and culture, and the population's expectations. Some of the emerging ingredients that need to be explored are infusion of a health systems agenda; development of a comprehensive policy package for health sector reforms; improving alignment of planning and coordination; use of reliable data; engaging 'street level' policy implementers; strengthening governance and leadership; and allowing a holistic and developmental approach to reforms.
  
  
  CONCLUSIONS
  The process of reform needs a fundamental rather than merely an incremental and evolutionary change. Without radical structural and systemic changes, existing governance structures and management systems will continue to fail to address the existing health problems.
authors.affiliation: Health Policy and Management, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa; Flavia.Senkubuge@up.ac.za.
authors.forename: Flavia
authors.initials: F
authors.lastname: Senkubuge
authors.affiliation: Health Policy and Management, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
authors.forename: Moeketsi
authors.initials: M
authors.lastname: Modisenyane
authors.affiliation: Alliance For Brain Gain and Innovative Development (ABIDE), Addis Ababa, Ethiopia; African Federation of Public Health Associations (AFPHAs), Addis Ababa, Ethiopia; Ethiopian Public Health Association, Addis Ababa, Ethiopia.
authors.forename: Tewabech
authors.initials: T
authors.lastname: Bishaw
mesh_terms: D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D017598:Efficiency, Organizational; D014943:Global Health; D018166:Health Care Reform; D063005:Health Information Systems / Q000458:organization & administration; D006280:Health Workforce / Q000458:organization & administration; D061889:Healthcare Financing; D006801:Humans
keywords: efficiency; equity; global health; global public health; health sector reforms; health systems; systems thinking; systems-level interventions