HEALTH SYSTEMS

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HEALTH SYSTEMS

• Conceptual frameworks

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Health systems

• Combination of resources, organization,
  financing, and management that culminates in the
  delivery of health services to the population
•     Roemer MI. National health systems of the
  world, volume 1. New York, Oxford University
  Press, 1991
• All activities whose primary purpose is to
  promote, restore and maintain health
• World Health Report 2000

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Health systems

• All components are interacting with each other in
  a synergy and coherence
• HS components are interacting with the political,
  social, economic environment
• HS are dynamic and evolve over time

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Health systems

• HS boundaries
• in relation to health actions activities with
  indirect impact are to be excluded (investments
  on water supply and sanitation, food subsidies,
  supplementary school health meals, etc)

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Health systems

• Health system comprises three highly
  inter-dependent elements
• Ecosystem - socio-cultural, demographic, economic
  and political surroundings
• Health Care Delivery System based on health
  problems and needs, health inputs, distribution,
  output, utilization and outcomes
• Community Involvement organization, awareness,
  contribution and utilization
• A. A. Kielmann

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Health System Model
Social, cultural, environmental, political,
economic ecosystem
Community Participation
A.A.Kielmann
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Health systemsRoemers model

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Health System Model used to assess HFA
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WHO Health System Conceptual Framework WHR 2000
Health System Functions
Health System Objectives
Stewardship (Oversight)
Responsiveness (to peoples non-medical
expectations)
Creating Resources (Investment and training)
Delivering Services (Provision)
Health
Fair (financial) Contribution
Financing (collecting, pooling, purchasing)
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HEALTH SYSTEM CONCEPTUAL FRAMEWORK
Social Determinants of Health
SYSTEM BUILDING BLOCKS
GOALS OF HEALTH SYSTEM
Information Support
Service Delivery
Responsiveness
Leadership governance
Coverage
Provider performance
Health workforce
Health
Quality Safety
Financing
Health technology
Efficiency
Financial protection
Equity
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HS functions building blocks

• Resource development
• - human resources for health
• - knowledge for health ( health research
• and health system research)
• - technology development
• - physical facilities

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HS functions

• Governance leadership
• - policy analysis development
• - strategic planning management
• - standard setting
• - regulation
• - operational planning
• - organization management

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HS functions

• Health care financing
• -analysis development of HCF options
• - resource mobilization
• - pooling of financial resources
• - purchasing of services
• - monitoring evaluation of HCF

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HS functions

• Service delivery
• - organization of delivery system
• - management of public-private mix
• - quality assurance improvement
• - accreditation systems
• Information and legislation support
• - routine MIS, population based surveys,
• research
• - health legislation

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HS goals

• To improve health and to reduce health
  inequalities ( average distribution)
• To secure fairness of financial contribution (
  equity concerns)
• To be responsive to users needs

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Contribution of health systems

• Health status has improved before HS development
  world wide role of social economic
  determinants of health
• Regression analysis of 6 determinants has shown
  high correlation
• Difficult to disentangle HS contribution
• Comparative analysis
• countries with similar economic status
  similar social determinants of health

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Contribution of health systems

• Life expectancy at birth ( 86)
  GDP per capita
• 75 USA
  17,500
• 77 Canada
  14,000
• 76 Australia
  12,500
• 74 N. Zealand
  7,000
• 70 Venezuela
  2,900
• 73 Cuba
  2,000
• 69 S. Korea
  2,500
• 69 N. Korea
  1,200

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Contribution of health systems

• Studies have shown that HS do matter
• - improved equity
• - increased efficiency
• - improved responsiveness population
• satisfaction
• Health outcomes are related to the HS development
  need to invest in HSD
• Importance of HS performance assessment

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HSP Assessment

• Frameworks
• - HFA measurement of indicators ME
• - social determinants of health MDG
• - Input indicators ( HRH, facilities, funds)
• - coverage by services
• - outcome indicators LE, morbidity,
• mortality, quality of life

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HSP Assessment

• Frameworks
• WHR 2000
• Social determinants are not assessed
• Intermediary goals are not considered
  coverage indicators
• Only outcome indicators
• - LE ( HALE)
• - Fairness of FC index
• - Level and distribution of responsiveness

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HSP Assessment

• Measurement of HSP
• Sources of data routine information systems
  population-based surveys
• Household expenditures utilization surveys
  are important ( NHA, FFC, catastrophic spending
  on health)
• National BOD analysis ( HALE)

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HSP Assessment

• In depth reviews
• - PHC in depth reviews ( joint exercises)
• - Health system reviews ( joint exercise by the
  3 levels of WHO, contribution of major partners
  at country level ) leading to policy dialogue (
  investing in health aid effectiveness

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Conclusions

• HS are important deserve to be strengthened
• HS do interact with surrounding political,
  economic, cultural environments
• HS functions need to be mapped
• - assess strengths weaknesses
• - improve implementation
• HS goals should be monitored evaluated

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• Thank you