Health System Concepts and Frameworks PDF

Health Systems: Concepts and Frameworks Sameen Siddiqi, MD; FCPS; MSc; FFPH; DrMed Professor & Chair, Aga Khan University, Karachi WHO – Harvard Medical School Course on Health Systems Strengthening for Universal Health Coverage 31t...

Health Systems: Concepts and Frameworks Sameen Siddiqi, MD; FCPS; MSc; FFPH; DrMed Professor & Chair, Aga Khan University, Karachi WHO – Harvard Medical School Course on Health Systems Strengthening for Universal Health Coverage 31th March – April 3, 2019 Dubai – United Arab Emirates  What is a System? A system is a set of connected parts or components that interact together for a given purpose to bring about a desired function or achieve a stated objective. Kielmann A A, 1993 2  Examples of Systems Information System System of Food Chain Educational System Computer System Transport System Roads, Vehicles, Speed cameras, Traffic laws, Traffic police, Signals, – Road transport Training schools, R&M, Gas stations, Drivers, Passengers 3  What is a Health System? The World Health Report 2000 defined a health system to include all institutions and activities whose primary purpose is to promote, maintain or restore health. 4  A ‘Transformative’ Paradigm Promote Wellness – Health promotion Maintain – Prevention Restore – Cure Illness – Palliation – Rehabilitation 5 Systems Approach https://www.google.com/search?q=systems+approach+image&rlz=1C1GNAM_enDE683DE683&oq=systems+appr oach+image&aqs=chrome..69i57j0l2.4322j0j9&sourceid=chrome&ie=UTF-8 6  Systems Analysis Problem solving technique that decomposes a system into its component pieces for the purpose of the studying how well those component parts work and interact to accomplish their purpose" http://en.wikipedia.org/wiki/Systems_analysis 7  Systems Thinking An approach to problem solving, by viewing "problems" as parts of an overall system, rather than reacting to specific part, outcomes or events and potentially contributing to further development of unintended consequences 8  Systems Analysis vs. Systems Thinking Systems analysis focuses on separating the individual pieces of what is being studied – analysis means to break into constituent parts Systems thinking focuses on how the thing being studied interact as whole with other constituents of the system – Instead of breaking a system into smaller and smaller parts, systems thinking works by expanding its view into larger and larger interactions 9  Systems vs. Analytic Thinking In Systems Thinking –the whole is primary and the parts are secondary In Analytic Thinking –the parts are primary and the whole is secondary 10  Systems Thinking - Video Systems Thinking and Evaluation.mp4 Systems thinking- a cautionary tale (cats in Borneo).mp4 11 Introduction to Health System Models and Frameworks  What is a Health System? The World Health Report 2000 defined a health system to include all institutions and activities whose primary purpose is to promote, maintain or restore health. 13 Illustrative list of conceptual frameworks for health systems Roemer’s health system model (Roemer, 1981) Actors framework (Evans, 1981) Fund flows and payment framework (Hurst, 1991) Kielmann’s Health Systems Model (Kielmann, 1993) Demand-supply framework (Cassels, 1995) Performance framework (WHO, 2000) Control knobs framework (Hsiao, 2003) Reforms framework (Roberts, Hsiao, Berman, Reich, 2004) Public management framework (Khaleghian, Das Gupta, 2004) Capacity framework (Mills, Rasheed, Tollman, 2006) Building blocks framework (WHO, 2007) Essential public health functions framework (PAHO, 2008) Systems framework (Atun, 2008) Adapted from Shakarishvili et al., 2010 Roemer’s health system model Roemer, 1981 Kielmann’s Model of Health System Input Distribution Service Service Output Inputs Community Participation Service Health Outcome Problems Kielmann A A; 1993 WHO Health System Conceptual Framework: Functions & Objectives Health System Functions Health System Objectives Stewardship Responsiveness (Oversight) (to peoples non-medical expectations) Creating Resources Delivering (Investment Services Health and training) (Provision) Fair Financing (collecting, (financial) pooling, Contribution 17 purchasing) WHR 2000  The Five Control Knobs for Health Sector Reform Roberts et al. (2012) Getting Health Reform Right  The WHO Health System Conceptual Framework WHO 2007 31/3/2019 19  The WHO Health System Conceptual Framework EFFICIENCY 31/3/2019 20 Critique of WHO Health Systems Framework Provider driven framework Populations/communities are passive recipients Role of social, economic, political determinants unclear Efficiency should be an intermediate and not the final outcome Responsiveness is useful conceptually but has not been adequately measured Health infrastructure not explicitly mentioned How health system strengthening contributes to SDGs through UHC Kieny et al. 2017 22  Key Messages Health system include all institutions and activities whose primary purpose is to promote, maintain or restore health Systems approach, analysis and thinking are related concepts but not the same. Important to know the distinctions across these WHO health systems building blocks framework has been adopted by many countries to craft their national policies Countries that have embarked on Health sector reforms have also used the control knob framework There is no perfect health system framework. It is good to know the strengths and limitations of each and use the most appropriate one as the situation demands 23 Questions and Comments! 24  HEALTH SYSTEM CONCEPTUAL FRAMEWORK SYSTEM BUILDING BLOCKS GOALS OF HEALTH SYSTEM Responsiveness Coverage Governance Information Support Service Delivery Provider Health workforce performance Health Quality & Financing Safety Health technology Efficiency Financial protection Equity Siddiqi S, 2007 25