Case Study: Developing Health Systems Resources

Strengthening Healthcare Systems: 20 Percent Reinvestment Initiative, GSK


The chronic shortage of trained frontline health workers in least developed countries (LDCs) is recognized as one of the most fundamental barriers to health care. Since 2009, we have reinvested 20 percent of the profits we generate in LDCs into community programs that strengthen healthcare systems and improve access to health care in these countries, ultimately to support the reduction of child and maternal morbidity and mortality rates.

Working with AMREF in east and southern Africa, Save the Children in west and central Africa, and CARE International in Asia, we invested £5.1 million in 2013 (based on 2012 profits) across 34 countries, and a total of £15 million since 2009 to train and build capacity among health workers. The 20 percent reinvestment program is designed to be truly sustainable; our investment grows as countries themselves continue to invest in healthcare infrastructure.

Lessons Learned?

Since launching our 20 percent reinvestment program, we have worked closely with our NGO partners to establish sustainable in-country programs. Where possible, we conduct in-depth monitoring to track our progress.

Key insights:

  • Delivering through NGO partners has accelerated our ability to initiate programs and invest in existing ones.
  • Projects are fully aligned to country MoH (Ministry of Health)strategies on improving access to health care to ensure that the greatest priorities are identified, the stakeholders are engaged, and the programs have the capacity to be self-sustaining, scalable, and replicable.
  • Working with communities to develop and own health solutions ensures interventions are appropriate and builds post-project sustainability; therefore, a key feature of the programs is that frontline health workers live in and identify with the communities they serve.
  • Working across multiple countries and organizations enables us to pool resources and share what we learn. Data is used with key stakeholders to influence and inform future practices, especially to accelerate scaling up, encourage replication, and share innovative approaches, such as e-learning and mobile health options.

Results to Date?

All projects are reviewed every six months, and data is recorded in a project tracker, enabling us to clearly oversee progress.

A range of key performance indicators (KPIs) have been developed in collaboration with partner NGOs across all programs. Longer term, we also aim to assess how our programs have reduced mortality and morbidity rates in local communities.

Some key achievements:

  • Trained more than 1,000 community health workers and 230 health professionals in the Democratic Republic of the Congo, reaching 240,000 children.
  • Our work training health workers and educating communities has contributed to a decrease from 290 maternal and child deaths to 52 (a reduction of 82 percent) in six months in Nepal.
  • Successfully advocated for the government of Niger to post an additional 627 health professionals to the most understaffed facilities.
  • Empowered community support groups to gain funding (approximately £10,000 per village) from local government to improve maternal and child health in Bangladesh.
  • Nearly doubled the capacity (800 to 1,500 persons per year) of a key training institution in Zambia by building classrooms, purchasing government-approved training materials and computers, and enabling more health workers to receive higher quality training.
  • Developed e-learning content to increase access to training for hundreds of midwives and nurses in remote areas in Tanzania and Uganda, upgrading their status from “enrolled” to “graduate.” Without access to distance learning, many of these individuals would not have been able complete their education, since they are often unable to leave their communities to attend college in major towns.

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