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What is a health system? What is health system strengthening?
The document defines a health system as consisting of all organizations, people, and actions whose primary purpose is to promote, restore, or maintain health. It discusses health systems as complex adaptive systems with many interacting elements. It presents several conceptual frameworks for analyzing health systems, including the WHO health system building blocks and the Antwerp health system dynamics framework. It then discusses the concept of health system strengthening and changing global approaches to improving health systems over time, moving from a disease-focused approach to a more holistic health system strengthening approach.
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The presentation introduces health systems, defines them, and outlines frameworks for strengthening.
According to WHO, health systems consist of all entities promoting health, functioning as complex adaptive systems.
Discusses various frameworks that illustrate the interactions within health systems, emphasizing governance and people.
Traces evolution of global health focus since the 1970s towards comprehensive health system strengthening.
Highlights the need for holistic approaches beyond disease-specific programs, using successful case studies.
Explains health policies as crucial actions to enhance health system performance but warns of political complexities.
Mentions partnerships across academic institutions for health policy and systems research, promoting shared goals.
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What is a health system? What is health system strengthening?
- 1. What is ahealth system? What is health system strengthening? IHPSR Presentation 2 www.hpsa-africa.org @hpsa_africa www.slideshare.net/hpsa_africa Introduction to Health Policy and Systems Research
- 2. Outline • Definition ofa health system • Conceptual frameworks that help us to think about health systems • Considering policy for health system strengthening
- 3. ‘A health systemconsists of all organizations, people and actions whose primary intent is to promote, restore, or maintain health.’ WHO, 2007, p.2 http://www.who.int/healthsystems/strategy/en/
- 4. A health system Health •Beyond sickness – mental and physical health – social wellbeing • Beyond the individual – actors/agents promoting health and wellbeing – domestic/national AND international factors impacting on health and health system agents A complex adaptive system • A set of interacting elements • More than the sum of the parts • Acts in ways that are not fully predictable, e.g. feedback loops • Influenced by history • Self-organising • Resistant to change
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- 8. Antwerp model: VanOlmen et al. 2010 Figure 1 The health system dynamics framework in its generic form
- 9. Frenk, 1994 COLLECTIVE MEDIATOR HEALTH CARE PROVIDERS ORGANISATION POPULATION ORGANISATION RESOURCE GENERATORS OTHER SECTORS Basisfor eligibility Degree of control Degree of control Degree of control Taxes, Demands for services Services with health effects Subsidies, Information, Ideologies Potential personnel, money, data Schemes for interpreting human experience Formal health services Community participation Competition for responsibilities and resources Human resources, Payment mechanisms, Scientific information, Technology
- 10. Health systems aredynamic and interconnected systems at whose heart are people ‘It is the multiple relationships and interactions among the building blocks ... that convert these blocks into a system’ de Savigny & Adam, 2009 People governance Information financing service delivery human resources medicines & technology
- 11. Macro, meso andmicro levels
- 12. Health system: hardwareand software
- 13. ‘Health system’ asa focus in global health … • Not new ... … but • in a ‘see-saw’ with focus on disease control programmes
- 14. Changing global trendsin thinking about how to improve health systems • 1970s: whole system focus > comprehensive PHC, Alma Ata 1978 • 1980s: focus on interventions > selective PHC, GOBI-FFF • 1990s: health system reform – focus on overall financing+organisation (efficiency+equity) • mid-1990s–2000s: focus on priority diseases, e.g. HIV/AIDS > Global Fund plus • 2000s: health system strengthening
- 15. 2000s move towardshealth systems strengthening because … ‘Effective interventions exist for many priority health problems in low income countries; prices are falling, and funds are increasing. However, progress towards agreed health goals remains slow. There is increasing consensus that stronger health systems are key to achieving improved health outcomes.’ Travis et al., 2004
- 16. Health system strengtheninggoes beyond dedicated disease/condition-specific programmes Travis et al., 2004
- 17. Good health atlow cost: Thai experience
- 18. Sustained action toaddress access barriers over time Patcharanarumol et al., 2011
- 19. Whole system change:achieving good health at low cost Good governance, effective institutions and bureaucracies, planning and leadership e.g. Thai case: use of evidence in decision making Fair and sustainable financing Effective primary care as entry point to referral network New cadres, large numbers, new roles; payment mechanisms (values) Drug supply, low cost technologies (ORS) PHC UHC Balabanova et al., 2011
- 20. Why and howsustained action over time? Hardware interventions to tackle access barriers Software: values-driven & dedicated health professionals How and why? 3) Decision-making processes that have ensured consistent vision and persistent development towards goals How and why? 1) HS features: 1. public sector strengthened 2. integrated service provision 3. limited reliance on external resources 1. Values-based and charismatic political leadership 2. Elite and interest groups support 3. Competent, values- based and distributed technical leadership 4. Generation and use of evidence in decision-making 5. Decentralised authority 6. Flexible implementation 7. Communication and feedback, learning through doing 2) Community factors: 1. community awareness & acceptance of health programmes 2. public trust & confidence in DHS 3. public status of health professionals How and why? Socio-cultural values; positive experiences Pro-poor, pro- rural ideology How and why? Pro-poor ideology; Use of evidence; Economic context Health system
- 21. Health policies aredeliberate actions to strengthen health systems and improve performance
- 22. Polices are morethan documents! Not just the output of decision making but rather the entire process of decision-making across the full range of people and organisations that translate policy documents/statements into policy-as-experienced • It is important to understand: – the politics of influencing ‘policy agendas’ and – the organisational dynamics through which policies take effect: actors, relationships and driving forces
- 23. Caveat No easy answersto improve a health system! Politics and values matter …
- 24. • The US:Obamacare • The UK: – born out of a political moment • with particular underpinning values – but undergone endless reforms over its life • Could current changes compromise initial values? • Will they improve system performance?
- 25. Copyright Funding You are free: ToShare – to copy, distribute and transmit the work To Remix – to adapt the work Under the following conditions: Attribution You must attribute the work in the manner specified by the author or licensor (but not in any way that suggests that they endorse you or your use of the work). Non-commercial You may not use this work for commercial purposes. Share Alike If you alter, transform, or build upon this work, you may distribute the resulting work but only under the same or similar license to this one. Other conditions For any reuse or distribution, you must make clear to others the license terms of this work. Nothing in this license impairs or restricts the authors’ moral rights. Nothing in this license impairs or restricts the rights of authors whose work is referenced in this document. Cited works used in this document must be cited following usual academic conventions. Citation of this work must follow normal academic conventions. Suggested citation: Introduction to Health Policy and Systems Research, course presentation, Presentation 2. Copyright CHEPSAA (Consortium for Health Policy & Systems Analysis in Africa) 2014, www.hpsa-africa.org www.slideshare.net/hpsa_africa This document is an output from a project funded by the European Commission (EC) FP7-Africa (Grant no. 265482). The views expressed are not necessarily those of the EC.
- 26. The CHEPSAA partners Universityof Dar Es Salaam Institute of Development Studies University of the Witwatersrand Centre for Health Policy University of Ghana School of Public Health, Department of Health Policy, Planning and Management University of Leeds Nuffield Centre for International Health and Development University of Nigeria Enugu Health Policy Research Group & the Department of Health Administration and Management London School of Hygiene and Tropical Medicine Health Economics and Systems Analysis Group, Depart of Global Health & Dev. Great Lakes University of Kisumu Tropical Institute of Community Health and Development Karolinska Institutet Health Systems and Policy Group, Department of Public Health Sciences University of Cape Town Health Policy and Systems Programme, Health Economics Unit Swiss Tropical and Public Health Institute Health Systems Research Group University of the Western Cape School of Public Health