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Six Pillars of Health Systems

• A health system consists of all organizations, institutions, resources, and people whose primary purpose is to improve health.
• A successfully running health system improves the health of a population by effectively and efficiently using available resources amidst competing needs.

Health Services

• Good health services deliver effective, safe, quality personal and non-personal health interventions to those who need them, when and where needed, with minimum waste of resources.

Health Workforce

• A well-performing health workforce is one that works in ways that are responsive, fair, and efficient to achieve the best health outcomes possible, with sufficient staff, fairly distributed, competent, responsive, and productive.

Health Information System

• A well-functioning health information system ensures the production, analysis, dissemination, and use of reliable and timely information on health determinants, health system performance, and health status.

Health Financing

• 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.

Medical Products and Technologies

• 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.

Leadership and Governance

• Leadership and governance involves ensuring strategic policy frameworks exist and are combined with effective oversight, coalition-building, regulation, attention to system-design, and accountability.

Criticisms of WHO's Framework

• Criticisms of WHO's framework include neglect of community-level variables to achieve global health outcomes.

ASEAN Health Care Systems

• Some ASEAN member states, such as Singapore, Thailand, Brunei, and Malaysia, have made good progress in terms of providing universal health care.
• Access to healthcare services remains a key challenge for some ASEAN countries, such as the Philippines, due to lack of health infrastructure and human capital.

Health Financing in ASEAN

• Thailand and Brunei's healthcare expenditure relies heavily on public funds, and are also found to lead in terms of coverage breadth, scope, and depth or financial protection.

Health Information Systems in ASEAN

• Modernizing health information systems is crucial in tracking and building predictive models of disease control and prevention.
• Challenges in modernizing health information systems include connectivity and data privacy concerns.

Health Governance

• Health governance is a crucial pillar in a well-functioning health system, and is a key focus of the course.

Six Pillars of Health Systems

• A health system consists of all organizations, institutions, resources, and people whose primary purpose is to improve health.
• A successfully running health system improves the health of a population by effectively and efficiently using available resources amidst competing needs.

Health Services

• Good health services deliver effective, safe, quality personal and non-personal health interventions to those who need them, when and where needed, with minimum waste of resources.

Health Workforce

• A well-performing health workforce is one that works in ways that are responsive, fair, and efficient to achieve the best health outcomes possible, with sufficient staff, fairly distributed, competent, responsive, and productive.

Health Information System

• A well-functioning health information system ensures the production, analysis, dissemination, and use of reliable and timely information on health determinants, health system performance, and health status.

Health Financing

• 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.

Medical Products and Technologies

• 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.

Leadership and Governance

• Leadership and governance involves ensuring strategic policy frameworks exist and are combined with effective oversight, coalition-building, regulation, attention to system-design, and accountability.

Criticisms of WHO's Framework

• Criticisms of WHO's framework include neglect of community-level variables to achieve global health outcomes.

ASEAN Health Care Systems

• Some ASEAN member states, such as Singapore, Thailand, Brunei, and Malaysia, have made good progress in terms of providing universal health care.
• Access to healthcare services remains a key challenge for some ASEAN countries, such as the Philippines, due to lack of health infrastructure and human capital.

Health Financing in ASEAN

• Thailand and Brunei's healthcare expenditure relies heavily on public funds, and are also found to lead in terms of coverage breadth, scope, and depth or financial protection.

Health Information Systems in ASEAN

• Modernizing health information systems is crucial in tracking and building predictive models of disease control and prevention.
• Challenges in modernizing health information systems include connectivity and data privacy concerns.

Health Governance

• Health governance is a crucial pillar in a well-functioning health system, and is a key focus of the course.

Social Determinants of Health (SDOH)

• Health is not just a product of physiological and biological factors, but also socially produced.
• Health is defined as "a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity" (WHO).

Criticism of WHO Building Blocks

• The WHO building blocks lack recognition of social determinants of health (SDOH).

Social Determinants of Health Framework

• Social contexts and social hierarchies affect differential exposure and vulnerabilities to health conditions and differential access to affordable health care.
• A country's socioeconomic and political context influences structural determinants of health inequities (e.g., income, education, occupation, social class, gender, race/ethnicity, etc.).
• Structural determinants influence intermediary determinants of health (e.g., material, psychosocial, behavioral, and biological factors).

Role of Power in Health

• Health inequities flow from patterns of social stratification, which is the systematically unequal distribution of power, prestige, and resources among groups in society.
• The WHO framework emphasizes the political process involved in reducing health inequalities, which involves changing the distribution of power within society to benefit disadvantaged groups.
• Empowering marginalized groups to express their demands and the state's responsibility to provide essential material and social goods are crucial aspects of reducing health inequities.

Key Concepts in Health Policies

• Policies guide decisions, actions, and outcomes, and can come in various forms (e.g., laws, procedures, frameworks) and can be formal/informal or implicit/explicit.
• A policy is a principle or a plan to guide decisions, actions, and outcomes, and can be written documents or unwritten practices.

Policy-Making Process

• The policy-making process involves three non-linear streams: problems, policies, and politics, which interplay to open windows of opportunity for policy decisions.
• A problem must be recognized by politicians, policymakers, and the community before it can be raised in the policy-making agenda.
• Proposals for solutions (policies) are developed by policy communities, and should be technically sound, culturally and ethically acceptable, and financially reasonable.
• Policy change is possible only if the politics environment is right, and policymakers need to recognize appropriate moments for policy change.

The Policy Process

• The policy process involves developing and implementing policy, and is a complex set of decisions and actions.
• The 'stages' model of policy process involves four main stages: agenda setting, policy formulation, policy implementation, and policy evaluation.
• Agenda setting involves identifying problems and setting priorities, and is influenced by policy actors' interests and concerns.
• Policy formulation involves making decisions about policy content, using various decision-making strategies and involving other policy actors through public consultations.
• Policy implementation involves implementing policy content through various strategies and structures, and adapting or non-implementing policy.
• Policy evaluation involves assessing the success of policy, and is often neglected, requiring oversight processes to be embedded in policy design.

Policy Entrepreneurs and Windows of Opportunity

• Policy entrepreneurs, including public health researchers and policymakers, civil society organizations, and the community, raise health issues on policy-making agendas.
• Windows of opportunity are critical periods for policy entrepreneurs to tackle important policy problems, and emerge when a problem is recognized, a solution is available, and the political climate is positive for change.
• Policy-makers can try to keep a policy window open by moving from awareness to proposal of policy alternatives.

Health in All Policies (HiAP)

• HiAP is an approach to public policies that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts to improve population health and health equity.
• HiAP improves accountability of policy-makers for health impacts at all levels of policy-making, and includes an emphasis on the consequences of public policies on health systems, determinants of health, and well-being.
• HiAP is favored in situations such as addressing complex health challenges, reacting to external policy proposals with a significant impact on health, and supporting high-priority government goals that positively affect multiple sectors including health.

Key Concepts in Health Policies

• Policies guide decisions, actions, and outcomes, and can come in various forms (e.g., laws, procedures, frameworks) and can be formal/informal or implicit/explicit.
• A policy is a principle or a plan to guide decisions, actions, and outcomes, and can be written documents or unwritten practices.

Policy-Making Process

• The policy-making process involves three non-linear streams: problems, policies, and politics, which interplay to open windows of opportunity for policy decisions.
• A problem must be recognized by politicians, policymakers, and the community before it can be raised in the policy-making agenda.
• Proposals for solutions (policies) are developed by policy communities, and should be technically sound, culturally and ethically acceptable, and financially reasonable.
• Policy change is possible only if the politics environment is right, and policymakers need to recognize appropriate moments for policy change.

The Policy Process

• The policy process involves developing and implementing policy, and is a complex set of decisions and actions.
• The 'stages' model of policy process involves four main stages: agenda setting, policy formulation, policy implementation, and policy evaluation.
• Agenda setting involves identifying problems and setting priorities, and is influenced by policy actors' interests and concerns.
• Policy formulation involves making decisions about policy content, using various decision-making strategies and involving other policy actors through public consultations.
• Policy implementation involves implementing policy content through various strategies and structures, and adapting or non-implementing policy.
• Policy evaluation involves assessing the success of policy, and is often neglected, requiring oversight processes to be embedded in policy design.

Policy Entrepreneurs and Windows of Opportunity

• Policy entrepreneurs, including public health researchers and policymakers, civil society organizations, and the community, raise health issues on policy-making agendas.
• Windows of opportunity are critical periods for policy entrepreneurs to tackle important policy problems, and emerge when a problem is recognized, a solution is available, and the political climate is positive for change.
• Policy-makers can try to keep a policy window open by moving from awareness to proposal of policy alternatives.

Health in All Policies (HiAP)

• HiAP is an approach to public policies that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts to improve population health and health equity.
• HiAP improves accountability of policy-makers for health impacts at all levels of policy-making, and includes an emphasis on the consequences of public policies on health systems, determinants of health, and well-being.
• HiAP is favored in situations such as addressing complex health challenges, reacting to external policy proposals with a significant impact on health, and supporting high-priority government goals that positively affect multiple sectors including health.

Regional Health Standards in ASEAN

• There are no compulsory health standards in the ASEAN region, but health is a cross-cutting issue discussed in various ASEAN forums.
• The ASEAN is a socio-cultural regional body that agrees on broad strategies, which are not mandatory, and there are no specific sanctions for noncompliance.

ASEAN Economic Community Blueprint 2025

• The Blueprint aims to enhance economic connectivity and sectoral cooperation, including healthcare, to improve the overall competitiveness of ASEAN.
• The healthcare industry in the region will be developed, including traditional knowledge and medicine, with effective protection of genetic resources, traditional knowledge, and traditional cultural expressions.
• Strategic measures include:
  • Opening up the private healthcare market and Public-Private Partnership (PPP) investments in universal healthcare.
  • Harmonizing standards and conformance in healthcare products and services.
  • Promoting health tourism and e-healthcare services that do not negatively impact the healthcare system of each ASEAN Member State.
  • Strengthening health insurance systems in the region.
  • Facilitating the mobility of healthcare professionals in the region.
  • Enhancing the development of ASEAN regulatory framework on traditional medicines and health supplements.
  • Developing and issuing new healthcare product directives to facilitate trade in healthcare products.

Public-Private Partnership (PPP)

• PPP is an important tool for decision makers to strengthen economic and social development through private sector expertise, risk sharing, and additional funding.
• Strategic measures include:
  • Reviewing and scoping national legal and institutional frameworks that support PPP at both national and regional levels.
  • Identifying partners to provide technical assistance to ASEAN Member States to support an enabling environment conducive to PPP.
  • Establishing an ASEAN network of PPP agencies and stakeholders to share experiences and collaborate on joint projects.

ASEAN Socio-Cultural Community Blueprint 2025

• The Blueprint aims to move towards a more inclusive community, promoting equitable access to opportunities for ASEAN peoples, and protecting human rights.
• The promotion of equitable access for all includes:
  • Enhancing the effectiveness of implementation of strategies and programmes under ASCC and promoting their harmonization with those of ASEAN Political-Security Community (APSC) and AEC.
  • Providing mechanisms and enhancing institutional capacity to promote greater access to basic social services for all, such as health services and education.

Introduction to Comparative Health Policies

• Comparative approach helps test assumptions, generate new ideas, and increase explanatory power for inductive and deductive reasoning.
• Comparing countries can suggest new ways of doing things, and increase understanding of what works well in different contexts.

Health Policy Analysis

• Health policy analysis is a well-established field of scientific research.
• Comparisons across countries strengthen the explanatory power of health policy analysis.
• Policy analysis requires understanding of political context, public administration history, and policy-making processes.

The Policy Analysis Triangle

• The Policy Analysis Triangle is a model for understanding factors influencing policy processes.
• The triangle consists of:
  • Actors (who makes decisions and why)
  • Context (environment and situation)
  • Content (policy substance and values)
  • Process (steps and strategies in policy change)

Actors

• Policy actors identify problems, shape policy design, and influence implementation and outcomes.
• Actors may prevent problems from being considered or block policy implementation.

Content

• Policy content includes objectives, structures, mechanisms, resource availability, and monitoring indicators.
• Policy content represents a set of values that may be supported or opposed by different groups.

Context

• Policy context includes structures, resources, ideas, and values.
• Context influences policy development, implementation, and outcomes.

Processes and Strategies

• Policy change processes occur over time and involve specific steps and strategies.
• Process options include:
  • Decision-making style
  • Information and knowledge use
  • Speed and timing of decision-making
  • Consultation and communication strategies
  • Managing actors and stakeholders
  • Venue and location of decision-making