Proloy Barua*, Dr Phudit Tejativaddhana**, Reggie Dalman Hinoguin***
* PhD student, College of Health Systems Management (CHSM)
** Assistant Professor, CHSM
*** Lecturer, CHSM
The key purpose of this post is to understand health system and its basic components. To understand health system, we have to know first the meaning of health and system because these two keywords will lead us to understand health systems.
Health: According to World Health Organization (WHO), “health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”.
System: System is defined as “group of interacting, interrelated, or interdependent elements forming a complex whole. An organism or body considered as a whole, especially with regard to its vital processes or functions. A group of physiologically or anatomically complementary organs or parts” (Dictionary.com, n.d.).
Health System: According to Dr. Prawase Wasi “Health means perfect happiness in physical, mental and social aspects, which is the ultimate goal of life and development, and the linkage of all factors affecting health is called health system.” A health system of a country or a region is dependent on its specific cultural, governmental, social, economic and political factors. So it is impractical to use the knowledge of health system from one country or region to other country or region. So, health care system is part of the health system.
In 2000, WHO articulated a comprehensive definition of health systems that is now widely adopted. A health system “consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health”. The goal of health system is to improve health and health equity in ways that are responsive, financially fair and make the best, or most efficient, use of available resources.” This definition leads to following six health system components or building blocks.
Health system building blocks: As mentioned earlier health systems are highly context-specific, there is no single set of best practices that can be put forward as a model for improved performance. But health systems that function well have certain shared characteristics as illustrated in Fig. 1 which is self-explanatory. Table 1 briefly define each of six building blocks along with examples. Individual users or patients are the centre of any health system. The intermediate outputs of health system building blocks are to ensure access, coverage, quality, and safety; while overall outcomes are to improve population health, response to health needs of the population, give social and financial risk protection to especially vulnerable population, and improve the efficiency of health care.
Fig. 1: WHO six building blocks of health system Source: Adapted from Ezra (2018) Table 1: Health System Building Blocks and corresponding examples
Table 1: Health System Building Blocks and corresponding examples
|Governance||Leadership and governance involve ensuring strategic policy frameworks exist and are combined with effective oversight, coalition-building, regulation, attention to system-design and accountability.||Government (central, provincial and local)|
|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, given available resources and circumstances (i.e. there are sufficient staff, fairly distributed; they are competent, responsive and productive).||Doctors, nurses, dentists, pharmacists, physiotherapists, community health workers, health managers, ambulatory service providers|
|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. It provides incentives for providers and users to be efficient.||General tax, payroll tax, payments by patients,, health insurance, salary and benefits for health workforce|
|Technology||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||Essential drugs for infectious and non-infectious diseases, vaccines at reasonable price|
|Information||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.||Health outcomes (mortality), health determinants (socioeconomic), health inequities (by sex, socioeconomic status),|
|Service||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.||Comprehensive (preventive, curative, palliative, rehabilitative, and promotive services), Accessible (close to people), Coverage, continuity, quality, accountability, people-centred not diseases centered|
Source: Derived from (WHO, 2008; Ezra, 2018)
– de Savigny D, Adam T (2009) Health systems thinking for health systems strengthening. Geneva: World Health Organization. – Dictionary.com (n.d.). System. Retrieved from http://www.dictionary.com/browse/system – Ezra, O. (2018). Health System Six Building Block. Retrieved from http://www.omokeezra.co.ke/index.php/2-uncategorised/6-health-system-six-building-block
– Figueras, J. & McKee, M. (2012).Health Systems, Health, Wealth and Societal Well-being. Retrieved from http://apps.who.int/medicinedocs/documents/s19262en/s19262en.pdf – Labonté R. (1993). Health Promotion and Empowerment: Practice Frameworks. Toronto: Centre for Health Promotion/Participation.
– Ronald, L. (2010). Health Systems Governance for Health Equity: Critical Reflections. Rev. salud pública [online]. 12(1), pp.62-76. ISSN 0124-0064. Retrieved from http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0124-00642010000700005
– Saúde E.M. (2015). What is a health system? What is health system strengthening? Retrieved from https://pt.slideshare.net/hpsa_africa/what-is-a-health-system-what-is-health-system-development/10
– The malERA Consultative Group on Health Systems and Operational Research (2011). A Research Agenda for Malaria Eradication: Health Systems and Operational Research. PLoS Med 8(1): e1000397. doi:10.1371/journal.pmed.1000397. Retrieved from http://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1000397&type=printable – WHO (2000) World health report 2000 – Health systems: Improving performance. Geneva: World Health Organization.
– WHO (2007) Everybody’s business: Strengthening health systems to improve health outcomes: WHO’s Framework for Action. Geneva: World Health Organization.
– WHO (2008) World health report 2008 – Primary health care: More than ever. Geneva: World Health Organization.
– WHO (2010). A handbook of indicators and their measurement strategies. Geneva: WHO; Monitoring the building blocks of health systems. Retrieved from http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf
– WHO (2010, May). Key components of a well functioning health system. Retrieved from http://www.who.int/healthsystems/EN_HSSkeycomponents.pdf