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PGZ2025: Summary of CASES + important information
- Instelling
- Maastricht University (UM)
Summary of CASES + important information and additions from the tutorial
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Summary CasesPGZ2025
Public Health Policy
Academic year: 2020-2021
1
,Index
Case 1: The (public) health system............................................................................................. 3
Case 2: Public Health Policymaking .......................................................................................... 22
Case 3: Rational policy making: The Lancet EAT commission .................................................. 42
Case 4 Priority setting in occupational health: rational policy making? .................................. 61
Case 5: The political arena is not a market but a polis ............................................................ 78
Case 6: Use of symbols and numbers to convince in the stage of agenda setting: vaccination,
it’s complicated… ..................................................................................................................... 97
Case 7: Introduction to institutional theory........................................................................... 115
Case 8 Dare to compare in mental health: translation issues ............................................... 129
Case 10: Public Health Policy Evaluation options: an overview ............................................. 162
Case 11: Cooperation and negotiation in Public Health Part V How to do it? ....................... 183
Case 12: PH management or leadership? .............................................................................. 196
2
,Case 1: The (public) health system
Learning goals
1. What are public health systems, health systems and health care systems and what are the
differences/similarities of the structural elements?
2. What are different types of health systems (figure 1)?
3. What is health system resilience and how can this be improved?
4. What type of public health system exists in your country and is this resilient or not?
5. What is ‘Health in All Policies’?
a. What are the challenges for ‘Health in All Policies’?
b. What are the principles of ‘Health in All Policies’?
Literature
Böhm: try to understand the main points, do not go into too much detail
1.What are public health systems, health systems and health care
systems and what are the differences/similarities of the structural
elements?
Wikipedia: A health system, also sometimes referred to as health care system or as healthcare
system, is the organization of people, institutions, and resources that deliver health care services to
meet the health needs of target populations.
Health system = bredere definitie
- Public health system = meer promotie en protectie
- Health care system = meer voor curing en individual care
(Source: WHO)
A health system consist of all organizations, people, and actions whose primary intent is to promote,
restore (herstellen) 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 of better health.
Health system building blocks
To achieve their goals, all health systems have to carry out some basic functions, regardless of how
they are organized: they have to provide services; develop health workers and other key resources;
mobilize and allocate finances, and ensure health system leadership and governance (also known as
stewardship, which is about oversight and guidance of the whole system). For the purpose of clearly
articulating what WHO will do to help strengthen health systems, the functions identified in the
World health report 2000 have been broken down into a set of six essential ‘building blocks’. All are
needed to improve outcomes. This is WHO’s health system framework.
→ A key purpose of the Framework is to promote common understanding of what a health
system is and what constitutes health systems strengthening.
3
, The building blocks serve three purposes: = main purposes
• They allow a definition of desirable attributes – what a health system should have the
capacity to do in terms of, for example, health financing.
• They provide one way of defining WHO’s priorities.
• By setting out the entirety of the health systems agenda, they provide a means for
identifying gaps in WHO support.
The six building blocks of a health system (WHO) (you need to know the indicators):
1. 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.
2. A well-performing health workforce (personeelsbestand) is one that works in ways that are
responsive, fair and efficient to achieve the best health outcomes possible, given available
resources and circumstances (→ there are sufficient staff, fairly distributed; they are
competent, responsive and productive).
3. 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.
4. 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.
5. 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.
6. Leadership and governance (stewardship) involves ensuring strategic policy frameworks
exist (bestaan) and are combined with effective oversight, coalition building, regulation,
attention to system-design and accountability.
Desirable attributes (gewenste attributen)
Irrespective of how a health system is organized, there are some desired attributes for each
building block that hold true across all systems.
• Multiple, dynamic relationships: a health system, like any other system, is a set of inter-
connected parts that must function together to be effective. Changes in one area have
repercussions (gevolgen) elsewhere. Improvements in one area cannot be achieved without
contributions from the others. Interaction between building blocks is essential for achieving
better health outcomes.
• Health system strengthening: is defined as improving these six health system building blocks
and managing their interactions in ways that achieve more equitable and sustained
improvements across health services and health outcomes. It requires both technical and
political knowledge and action.
• Access and coverage: since notions of improved access and coverage lie at the heart of this
WHO health system strengthening strategy, there has to be some common understanding of
these terms.
• Is progress being made? A key concern of governments and others who invest in health
systems is how to tell whether and when the desired improvements in health system
performance are being achieved. Convincing indicators that can detect changes on the
ground are needed.
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,
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