Health System Framework

Concept of Health System

• A health system consists of all organizations, institutions, resources, and people whose primary purpose is to improve health.
• It delivers preventive, promotive, curative, and rehabilitative interventions through a combination of public health actions and the pyramid of health care facilities.

WHO Health System Framework

• The framework describes health systems in terms of six core components or "building blocks":
  • Service delivery
  • Access to essential medicine
  • Financing
  • Health workforce
  • Health information system
  • Leadership and governance

Service Delivery

• Key characteristics of good service delivery:
  • Comprehensiveness: a comprehensive range of health services is provided, appropriate to the needs of the target population.
  • Accessibility: services are directly and permanently accessible with no undue barriers of cost, language, culture, or geography.
  • Coverage: service delivery is designed to cover all people in a defined target population.
  • Continuity and coordination: service delivery is organized to provide an individual with continuity of care across the network of services, health conditions, levels of care, and over the life-cycle.
  • Quality: health services are of high quality, i.e., effective, safe, and according to the patient's needs.
  • Person-centredness: empowering people to take charge of their own health rather than being passive recipients of services.
  • Accountability and efficiency: health services are well-managed to minimize wastage of resources.

Health Workforce

• The health workforce includes all people engaged in actions whose primary intent is to enhance health.
• This includes clinical staff, management and support staff, such as physicians, nurses, pharmacists, dentists, managers, ambulance drivers, and accountants.
• Shortages of health workers can be perceived from inadequate numbers and skills, maldistribution, and losses caused by death, retirement, career change, or out-migration.

Health Information Systems

• Sound and reliable information is the foundation of decision-making across all health system building blocks.
• The four key functions of health system information are:
  • Data generation
  • Organization
  • Analysis and synthesis
  • Communication and use

Access to Essential Medicine

• Access has been defined as "having medicines continuously available and affordable at public or private health facilities or medicine outlets that are within one hour's walk of the population".
• A well-functioning health system ensures equitable access to essential medical products, vaccines, and technologies of assured quality, safety, efficacy, and cost-effectiveness.

Health System Financing

• The function of a health system concerned with the mobilization, accumulation, and allocation of money to cover the health needs of the people in the health system.
• The financing system is often divided conceptually into three inter-related functions:
  • Revenue collection
  • Fund pooling
  • Purchasing/provision of services

Leadership and Governance

• Leadership and governance in building a health system involve ensuring that strategic policy frameworks exist and are combined with effective oversight, alignment, regulation, attention to system design, and accountability.