Health System and Its Essential Components

Health System

Block 4.2 is about health system and disaster management in which the two of them shares a relationship that is dependent on each other. Therefore, I would like to take this opportunity to talk about health system as my first post for this blog. Enjoy!

A good health system delivers quality services to all people, when and where they need them. The exact configuration of services varies from country to country, but in all cases requires a robust financing mechanism; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; well maintained facilities and logistics to deliver quality medicines and technologies. (WHO, 2010)

The acting components or the key components of health system consist of health financing, health services, regulation, community empowerment and human resources for health. Besides that, a well functioning health system responds in a balanced way to a population’s needs and expectations by:

· Improving the health status of individuals, families and communities

· Defending the population against what threatens its health

· Protecting people against the financial consequences of ill-health

· Providing equitable access to people-centred care

· Making it possible for people to participate in decisions affecting their health and health system

1. Leadership and Governance

Every country exercises different leadership and governance based on their country’s specific context and history, but common ingredients of good practice in leadership and governance can be identified. Which include:

a. Ensuring that health authorities take responsibility for steering the entire health sector and for dealing with future challenges as well as with current problems.

b. Defining, through transparent and inclusive processes, national health policies, strategy and plan that set a clear direction for the health sector.

c. Effective regulation through a combination of guidelines, mandates, and incentives, backed up by legal measures and enforcement mechanisms.

d. Effective policy dialogue with other sectors.

e. Mechanisms and institutional arrangements to channel donor funding and align it to country priorities.

2. Health Information Systems

Without good information on health challenges, there would not be good governance in this sector. This is because on the broader environment which the health systems operate and on the performance of health system, timely intelligent is require on:

a. Progress in meeting health challenges and social objectives, including but not limited to household surveys, civil registration systems and epidemiological surveillance.

b. Health financing, including through national health accounts and an analysis of financial catastrophes and of financial and other barriers to health services for the poor and vulnerable.

c. Trends and needs for HRH; on consumption of and access to pharmaceuticals; on appropriateness and cost of technology; on distribution and adequacy of infrastructure.

d. Access to care and on the quality of services provided, like national monitoring and evaluation plan that specifies core indicators (with targets), data collection and management, analyses and communication and use; plus also arrangements to make information accessible to all involved, including communities, civil society, health professionals and politicians.

3. Health Financing

Health financing can be a key policy instrument to improve health and reduce health inequalities if its primary objective is to facilitate universal coverage by removing financial barriers to access and preventing financial hardship and catastrophic expenditure.

4. Human Resources for Health

The health workforce is central to achieving health. A well performing workforce is one that is responsive to the needs and expectations of people, is fair and efficient to achieve the best outcomes possible given available resources and circumstances. Countries are at different stages of development of their health workforce but common concerns include improving recruitment, education, training and distribution; enhancing productivity and performance; and improving retention. All this requires:

a. Arrangements for achieving sufficient numbers of the right mix.

b. Payment systems that produce the right kind of incentives.

c. Regulatory mechanisms to ensure system wide deployment and distribution in accordance with needs.

d. Establishment of job related norms, deployment of support systems and enabling work environments.

e. Mechanisms to ensure cooperation of all stakeholders.

5. Essential medical products and technologies

Accessibility to health care is highly dependent on access to affordable essential medicines, vaccines, diagnostics and health technologies of assured quality, which are used in a scientifically sound and cost-effective way. Economically, medical products are the second largest component of most health budgets (after salaries) and the largest component of private health expenditure in low and middle income countries.

6. Service delivery

Health systems are only as effective as the services they provide. These critically depend on:

a. Networks of close-to-client primary care, organized as health districts or local area networks with the back-up of specialized and hospital services, responsible for defined populations.

b. Provision of a package of benefits with a comprehensive and integrated range of clinical and public health interventions, that respond to the full range of health problems of their populations, including those targeted by the Millennium Development Goals.

c. Standards, norms and guidance to ensure access and essential dimensions of quality: safety, effectiveness, integration, continuity, and people –centeredness

d. Mechanisms to hold providers accountable for access and quality and to ensure consumer voice.

As a summary, all six components mentioned above are crucial or vital in the proper functioning and the overall performance of providing healthcare to individuals in a population. The components are dependent on each other during the process of service delivery and each of these components must function properly in order to produce a good outcome which will benefit the health system itself.

References:

• WHO website www.who.int (keyword: health system)
• WHO article titled Key components of a well functioning health system.pdf
• Block 4.2 lecture notes