Case 1: ‘What is a health system?’
See introduction lecture II
Learning goals and answers:
1. What is a health system and what are its elements (building blocks)?
Literature WHO (2007):
What is a health system? a health system consists of all organizations, people and actions whose
primary intent is to promote, restore or maintain health. This includes efforts to influence
determinants of health as well as more direct health-improving activities. A health system is
therefore more than the pyramid of publicly owned facilities that deliver personal health services. It
includes, for example, a mother caring for a sick child at home; private providers; behaviour change
programmes; vector-control campaigns; health insurance organizations; occupational health and
safety legislation. It includes inter-sectoral action by health staff, for example, encouraging the
ministry of education to promote female education, a well known determinant for better health.
The building blocks are: service delivery, health workforce, information, medical products, vaccines
and technologies, financing, and leadership and governance (stewardship).
The six building blocks of a health system
- Good health services are those which deliver effective, safe, quality personal and non-
personal health interventions to those that need them, when and where needed, with
minimum waste of resources.
- A well-performing health workforce is one that works in ways that are responsive, fair and
efficient to achieve the best health outcomes possible, given available resources and
circumstances (i.e. there are sufficient staff, fairly distributed; they are competent,
responsive and productive).
- A well-functioning health information system is one that ensures the production, analysis,
dissemination and use of reliable and timely information on health determinants, health
system performance and health status.
- A well-functioning health system ensures equitable access to essential medical products,
vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their
scientifically sound and cost-effective use.
- A good health financing system raises adequate funds for health, in ways that ensure people
can use needed services, and are protected from financial catastrophe or impoverishment
associated with having to pay for them. It provides incentives for providers and users to be
efficient.
- Leadership and governance involves ensuring strategic policy frameworks exist and are
combined with effective oversight, coalition-building, regulation, attention to system-design
and accountability.
,The building blocks serve three purposes. First, they allow a definition of desirable attributes – what
a health system should have the capacity to do in terms of, for example, health financing. Second,
they provide one way of defining WHO’s priorities. Third, by setting out the entirety of the health
systems agenda, they provide a means for identifying gaps in WHO support (also for question 2).
a. What is the role of a health system?
Literature WHO (2007):
Health system goals health systems have multiple goals. The World health report 2000 defined
overall health system outcomes or goals as: improving health and health equity, in ways that are
responsive, financially fair, and make the best, or most efficient, use of available resources. There are
also important intermediate goals: the route from inputs to health outcomes is through achieving
greater access to and coverage for effective health interventions, without compromising efforts to
ensure provider quality and safety.
2. What types of health systems frameworks exist?
a. Explain each element
Literature WHO (2007):
- 11th General Programme of Work (2006-2015) and the Medium-term Strategic Plan (2008-
2013) this framework spells out in more detail the policy challenges faced by countries,
and the steps for a more effective institutional response by the WHO Secretariat.
- Framework for Action the framework is about ways of working in the WHO. Two sets of
issues are particularly important. How can we develop more synergistic working relationships
between the technical programmes, which focus on particular health outcomes, and the
specialist health systems groups in the organization? And, how can we ensure better links
between WHO’s engagement in policy processes at country level and the health systems
strengthening activities that flow from them?
o A single framework with six clearly defined building blocks
o Systems and programmes: getting results
o A more effective role on systems for WHO at country level
o The role of WHO in the international health systems agenda
The WHO Health system Framework (see also question 1)
Key purpose
- Promote common understanding of what a health system is
- What constitutes health systems strengthening
, - Define a discrete number of ‘building blocks’ that make up the system
General build up
- Six building blocks
o Allow a definition of desirable attributes
o Way of defining the WHO’s priorities
o Provide a means for identifying gaps in WHO support
The six building blocks
- Health Services: how inputs and services are organized and managed, ensuring access,
quality, safety and continuity across different locations and over time
o Goal: deliver effective, safe, quality personal and non-personal health interventions
to those that need them, when and where needed, with minimum waste of
resources
o Attention towards
The demand for services and how to deal with it
Delivering integrated services based on population health needs and
available resources
Organizing a provider network
- Health workforce: consist broadly of health service providers and health management and
support workers (private and public sector, paid and unpaid, lay and professional)
o Goal: responsive, fair and efficient to achieve the best health outcomes possible,
given available resources and circumstances
o Attention towards
Planning and scaling-up workforce
Designing training programs
Financing of health workforce and their training
Organizing of workforce in terms of effective service delivery
Retaining an effective workforce
- Health information: generation and strategic use of information, intelligence and research on
health and health systems; development of health information and surveillance systems;
development of standardized tools and instruments and international health statistics
management
o Goal: ensures the production, analysis, dissemination and use of reliable and timely
information on health determinants, health system performance and health status
o Attention towards
Generating population and facility based data
Having the capacity to detect, investigate, communicate and contain events
that threaten public health security
Synthesizing information and promoting the availability and application of
this knowledge
- Medical products, vaccines and technologies
o Goal: well functioning health system ensures equitable access to these products and
ensures quality, safety, efficacy and cost effectiveness and their correct use
o Attention towards
National policies, standards, guidelines and regulations that support policy
Information on prices, international trade agreements and capacity to set
and negotiate prices
Reliable manufacturing practices and quality assessment of priority products
Procurement, supply, storage and distribution systems that minimize leakage
and other waste
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