In 2017 they died 6.3 million children and adolescents, 5.4 million of which in the first five years of life, in mostly from easily preventable diseases 4. Most of the deaths occur in sub-Saharan Africa and South Asia. A child born in one of these two macro-regions has up to nine less chance to survive in the first month of life than a child born in high-income countries5. One element that contributes to intensify the severity of the health crisis is the one represented by the imbalance between the need and the answers provided by the institutions. Many factors complicate the construction of effective public health systems: the implementation of new health centers cannot happen without equipment, supplies and personnel enough to ensure the basic services. The number of doctors is insufficient (Africa holds only 3% of the world's health personnel) 6. While the poorest countries bear the weight of 85% of the global burden of disease, accounts for only 11% of global health expenditure , while having the need to develop more resilient and efficient health systems.

The main problems of health systems in poor countries thus seem to lie in the shortage of health workers. WHO estimates that in 27 countries, Africa and Asia, at least 4.3 million health workers would be missing 6. The global shortage of health workers and its impact and the high number of people (over 100 million) who are impoverished every year by paying out of pocket health expenses 7 thereby create real failures of health systems. Addressing these problems implies an effort and an investment to improve public health systems, which can guarantee access to the necessary services especially by the poorest and most vulnerable people.

The issue of health is connected to many issues central to people's lives, starting with the construction of local food systems that ensure access to a diverse and nutritious food.

A broader look at the problem of protecting health in the poorest countries should also consider the impact that 'development' is having in those countries. This impact is represented by the increase in deaths from non-communicable diseases (tumors, cardiovascular diseases, diabetes). Non-communicable diseases have a growing and particularly hard impact on the poorest people, in a sort of vicious circle, in which people are exposed to risk factors, causing a spiral that leads families to poverty, given that health care often with high costs, it must be paid by patients out of their own pocket.

It seems important to carry out research on health systems, developing strategies to address the health systems themselves. However, rather than traditionally carry out research regarding aspects relating to the functions of health systems such as governance structures, funding and resource allocation systems, management systems and, above all, the methods of service delivery, the most important aspect is to understand how to offer to potential beneficiaries the available health interventions, through the functioning of health systems, with their policies, organizations and programs 8.

New insights on how to increase access to health services may allow significant improvements in the health of the populations of poor countries. A recent study has shown that, in poor countries, while technological progress would have the potential to prevent about a fifth of deaths in children under five years, improvements in the use of services (constant technology) could prevent almost two thirds of deaths9. Unfortunately, research on health systems is a substantially neglected area of research. Spending on health systems research is estimated to be less than 0.02% of healthcare financing in poor countries

A World Health Organization Task Force recommends an increase in funding for health system research from both poor country governments and the international community (proposing that a percentage of health program funding be invested in health system research as well the establishment, in poor countries, of national research institutes on health systems) 8.

It is clear that poor countries need help to develop their health systems with adequate evidence from good research on health systems. Rich countries can do a lot: allocate adequate resources for research on health systems in the context of international health cooperation programs; organize research training programs specifically aimed at the problems of poor countries, with preferential access channels for citizens of these countries, perhaps in partnership with institutions from these countries. And yet they could form cohorts of researchers and analysts of health systems focused on the problems of poor countries' systems. This would also allow a considerable improvement in the level of technical assistance provided by donor countries to poor ones which will remain an important component of health cooperation in the future

In conclusion, improving the health of the poorest people on the planet requires health system reforms, accompanied by wider social and economic reforms, ensure that health services are accessible and used by those who need it most guaranteeing the right to health 10.