PIH’s Five S’s: Essential Elements for Strong Health Systems

Editor's Note: This article was originally published in June 2021 and has been updated to include the most recent data and information.

When we think of health system strengthening at Partners In Health (PIH), we always refer to five key elements: staff, stuff, space, systems, and social support. We call them the "five S's" and use them to guide our work every day. Each element is equally important in providing high-quality care to our patients across the four continents where we work, responding to emergencies and building and reinforcing strong, long-term health systems, in collaboration with government partners. Each "S" is essential; eliminating just one of them results in a weaker health system.

The following is a definition of each of the 5 S's, with concrete examples of our work:

1. Staff

With more than 17,200 PIH-supported global staff, we make it a priority to have well-trained, qualified teams in sufficient quantity to respond to needs around the globe. The roles of our staff are diverse and fall into nearly two dozen categories, such as community health, mental health, operations, nursing, program management, development, and communications.

We prioritize hiring staff from the country where they work and are proud to note this is true for 99% of PIH's clinical staff, programmatic staff, and community health workers.

Meet some of our staff, including a nurse who manages primary care services in Malawi, midwives who deliver community-based care in Peru, and a surgeon who oversees PIH's care delivery around the world.

2. Stuff

The list of "stuff" we need is vast and includes everything from proper and ample vaccinations and medications, such as antibiotics to treat tuberculosis, to IV fluid and oxygen supplies. PIH's global supply chain team has a list of 6,525 different items staff select to streamline procurement orders, standardize requests from health facilities to warehouses, and align with the different protocols in countries where we work. Because of their efforts, our colleagues have the tools and resources they need for care delivery and administration.

Read more about how PIH tracks resources and shipments.

3. Space

Founded in a single clinic in Haiti, PIH has since expanded to more than 300 facilities globally. In order to treat patients, we need safe, appropriate spaces equipped with electricity and clean water. Sometimes these spaces already exist, but in most cases, facilities need to be renovated or built from the ground up. In collaboration with our partners, PIH creates, expands, and equips spaces so that they meet clinicians' needs and provide a healing environment for patients.

Some examples of our work include:

• Opening the Maternal Center of Excellence, a state-of-the-art facility in Sierra Leone
• Expanding oxygen production and supported isolation for tuberculosis patients in Lesotho
• Improving water, sanitation, and hygiene facilities in Haiti

• Creating youth-friendly reproductive health centers in Liberia

4. Systems

This area of the 5 S's seems invisible, but is no less important. Many systems must work in harmony to ensure consistent, quality care for patients around the world, including: a leadership and governance structure for solid decision-making, financial and accounting systems to track income and expenses, supply chain management to ensure well-stocked health facilities, medical informatics expertise for nimble record-keeping, and more.

Here are some examples of essential systems used across PIH-supported countries:

• An electronic medical record system in Sierra Leone
• A distribution center and software for medical storage in Haiti
• Strong management that uplifts and upholds PIH's global mission

5. Social Support

To ensure effective care, we provide basic necessities and resources including food, housing, transportation, and financial support for patients and their families. PIH's social support programming across all sites focuses on treating the whole patient, not just their condition.

Social support has proven an essential part of patient care and made the difference between a patient's ability to recover from sickness and maintain good health over the long term. This support comes in many forms: healthy food grown in community gardens on the Navajo Nation, travel vouchers for patients on taxing tuberculosis regimens, or safe housing for women living with schizophrenia.

The 5S's of the MCOE

Read PIH's five-part series exploring the Maternal Center of Excellence in Sierra Leone through the five S's framework.

Read the Series