Health Systems

Learning Objectives:
To define health system
To count components of health system
To recognize functions of health system
To learn a weak health system
To count 6 basic components of the improvement of the health system
Definition:
Health system is “ the combination of resources, organization, financing and
management that culminate in the delivery of health services to the population.”
Roemer (1991). This definition emphasizes the input requirements of a health system.

Health system is the “all the activities whose primary purpose is to promote, restore
or maintain health.” The World Health Organization's (2000). Rather than emphasizing
inputs such as resources, this definition focuses primarily on the outcome aspects of
a health system.
Health system science is defined as the “principles, methods, and practice of
improving quality, outcomes, and costs of health care delivery for patients and
populations within systems of medical care” (Skochelak et al., 2020).
Health systems include all the institutions, organizations, and resources that are
devoted to promote, sustain, or restore health.
 A health system is the way in which all health services are provided. From how they
are financed to the workforce, facilities and supplies available, a strong health
system will ensure that everyone is able to access high-quality healthcare without
financial difficulty.
Everyone has the right to access healthcare. Yet to many people around the world,
this right is denied. In the UK certain groups if people – such as migrants – are being
denied NHS care.
Irrespective of the definition, a health system should include the following two major
components:
1/ The goal of a health system, to address health and illness in society
2/ A set of mechanisms that transform health-related resources into health services in order
to achieve the goal of a health system.
Although health systems vary across countries, all include similar structural components:
 Health-care providers
 Consumers of health-care services
 Health financing agencies
 Resources suppliers
 Government/regulatory entities
Each component is directly linked to the other four components.
For example, health providers provide health-care services to the consumers, receive payments
from a financing agency to recover the cost of health services, obey the regulations imposed
by the regulatory entity, and receive resources from resource suppliers.
Governments Responsibility:
Governments carry the ultimate responsibility for the performance of national health
systems.
Health systems cannot be held responsible for socioeconomic differences in the
population that influence health disparities. However, they can be accountable for
excess deaths and illness resulting from diseases that are preventable and/or
curable.
An analysis of health system performance involves evaluating efficiency and quality
of the provision of care. The roles of providers and health-care managers are an
important component of performance. Without performance evaluation, populations
who experience economic, social, and political marginalization will continue to be
unattended.
 Management

The management of any health system is typically directed through a set

of policies & plans and adopted by government, private sector business and other
groups in areas such as personal healthcare delivery and financing,
pharmaceuticals, health human resources, and public health.

Public health is concerned with threats to the overall health of a community

based on population health analysis.
The population in question can be as small as a handful of people, or as large as
all the
inhabitants of several continents (as in the case of a pandemic).
Public health is typically divided into epidemiology, biostatistics, and health
services.
Environmental, social, behavioral, and occupational health are also important
subfields.
Today, most governments recognize the importance of public health programs in
reducing the incidence of disease, disability, the effects of ageing and health inequities,
although public health generally receives significantly less government funding
compared with medicine.
For example:

Most countries have a vaccination policy, supporting public health programs in

providing vaccinations to promote health. Vaccinations are voluntary in some
countries and mandatory in some countries. Some governments pay all or part of the
costs for vaccines in a national vaccination schedule.

The rapid emergence of many chronic diseases, which require costly long -term care &
treatment, is making many health managers and policy makers re-examine their
healthcare delivery practices.

An important health issue facing the world currently is HIV/AIDS.

Another major public health concern is diabetes. Its incidence is increasing rapidly.

 A controversial aspect of public health is the control of tobacco smoking, linked to

cancer and other chronic illnesses.

Antibiotic resistance is another major concern, leading to the reemergence of

diseases such as TB .
It is critical for public health researchers to consider the health system of the
population as a factor they are investigating on a local, state, and national level.
Health systems are complex and adaptive with a variety of functions (organization,
management, financing, resource generation, and allocation) that can be modified
by policies, politics, and economics These functions create dynamic outputs of
public health services and individual healthcare services, which can be studied by
investigating the output's effectiveness, efficiency, equity, and responsiveness to
challenges.
Health systems can also be investigated on varied scales, from nationally to
regionally.
In the ideal health system, there are abundant resources that are efficiently and
equitably allocated. These resources, however, are not infinite and require
accountable and transparent management.
Public health researchers should help determine how resource management can be
optimized in all areas, including finances, infrastructure, personnel, and technology.
Health Systems and Services
A health system has important functions including the provision of services and the
human, monetary, and physical resources that make the delivery of these services
possible.
These resources can include any contribution whether in informal personal health
care or public or private professional health and medical services.
The primary purpose of all services is to improve health by preventive or curative
measures. A health system should not only strive to attain the highest average level
of the health status of the population but also simultaneously strive to reduce the
differences between the health of individuals and groups.

Each country and community makes different choices in providing health

coverage and health care for their populations. Political systems and socio-
cultural norms help develop a health system, while critical events such as
epidemics or governmental change can create dramatic acute influences on
Human Recourses
A health system is an expensive knowledge-based industry made up of
professionals, paraprofessionals, and administrative and support personnel.
Human resources to provide and manage public health and clinical services
are crucial to developing and sustaining national and global health systems.

 High-income countries are replete with highly trained and motivated

personnel, but face issues such as:
 Increasing costs of care for aging populations
 Using new categories of health workers.

 Low-income countries face severe human resource shortages as

training programs are underdeveloped.
Health workforce issues include:
o Urban–rural differentiation
o Promoting standards and quality of care
o Specialization versus primary care
o Tensions between public and private health systems
o Integrating new health professions.

Migration of health professionals from low-income to high-income countries hampers

the buildup of a critical mass of leaders, providers, and teachers to expand the capacity
of health systems. Strategic policies are crucial to this field.
Financial Recourses:
5 primary methods of funding health systems:
General taxation to the state or country
National health insurance
Private health insurance
Out- of pocket payments
Donations to charities
Information resources
Sound information plays an increasingly critical role in the delivery
of modern health care and efficiency of health systems. Health
informatics – the intersection of information science, medicine, and
healthcare– deals with the resources, devices, and methods
required to optimize the acquisition and use of information in
health.
Necessary tools for proper health information coding and
management include:

• Clinical guidelines
• Formal medical terminologies
• Computers and other information & communication technologies.
The kinds of health data processed may include:
• Patients medical records
• Hospital administration
• Clinical functions
• Human recourses information

The use of health information lies at the root of evidence-based policy and evidence-
based management in health care.

Increasingly, information and communication technologies are being utilized to

improve health systems in developing countries through:
• The standardization of health information
• Computer-aided diagnosis and treatment monitoring
• Informing population groups on health and treatment.
Social determinants of health:
The health system itself as a social determinant of health. The role of the health
system becomes particularly relevant through the issue of access to health services.
Different social groups (for example, higher and lower income groups, women, and men)
have different opportunities to access health services. Health systems can be more or
less enabling and responsive in creating conditions that facilitate access for vulnerable
and excluded groups.
To the extent that the health system incorporates mechanisms to mitigate these
differential consequences, or fails to do so, the system itself operates as a determinant
of health.
Integrating Innovation:
The main objective of any health system is to improve health. One of the key
elements in achieving this is to integrate technological progress in the field and
innovations into the system. The digitization of the healthcare system, remote
management of a medical protocol, a diagnosis or medical equipment, health
services at home and new coordination within the health system.
Western Europe Health System:
Two kinds of health-care system predominate in western Europe:
1/ Social insurance systems: are financed by contributions paid by their members
into what for most of them are compulsory schemes organized according to district,
occupation, or workplace. Funds and groups of funds contract with providers, usually
groups of hospitals and doctors' associations, to provide care to their members This
kind of system is often described as self-governing to the extent that its
management depends on the outcome of negotiations between financing and
provider agencies, while the role of government is to set framework conditions and
directions.
• 2/ National health services (NHS): National health services, by contrast, are financed
for the most part by government from tax revenues. Most hospitals are state-owned
and -run, and most doctors are either public sector employees or independent
contractors to public sector organizations. Patient entitlement to health care is on the
basis of citizenship or residence. As in social insurance systems, there is a limited role
for private insurers and for commercial providers. The system as a whole is clearly a
government responsibility, though it may often be delegated to regional levels.
A weak health system can mean that:
1/ Healthcare facilities do not exist where they are most needed. This is especially true in
rural and remote areas where the distance to travel to a facility – or the cost to do so – is
too great.
2/ Facilities that do exist are under-staffed and under-resourced. This means they are
unable to provide high quality culturally appropriate healthcare or vital services such as
those for mental health.
3/ Service users are charged a fee for seeking healthcare to fill the funding gap. This
pushes many people into poverty or again deters people from seeking healthcare when it is
needed.

This is why WHO work to strengthen health systems around the world in two key ways:
Directly working with poor communities to make robust and accessible health systems
campaigning to make sure governments in wealthy countries commit to strengthening
health systems in poor countries.
Strengthening health system
Requires improvement of the 6 basic components of the health system and the
interactions among them to achieve improvement in services that in turn improve
health outcomes.
The 6 components are:
1. Provision of services: Refers to services offered to meet the needs of the
population and how they are offered, the way of network providers is managed &
organized, the necessary infrastructure & the generation of demand for health care.

2. Health Personnel: The existence of competent and well-performing health

personnel requires adequate regulations and strategies for the development and
strengthening of these personnel, which also take into account important aspects
such as training and economic cost

3. Information: It is necessary that data and research be generated and that this
information be used for better decision making. To this end health systems should be
established that include surveillance, reporting, and monitoring mechanism.
4. Medicine and medical supplies: Access to cost-effective, safe, and quality medicines &
medical supplies is priority for a well – functioning systems. This requires strong
regulatory and supply systems, as well as efforts to ensure the availability of access and
quality.

5. Financing: A good health system collects pools and spends economics recourses on
services and goods in way that ensure access for the entire population to the
services they need without causing them financial hardship

6. Governance and leadership: The governments that mandate and responsibility to

guide all action involved in a health system while protecting the public interest. This
requires the development and implementation of policies, plans and regulatory
frameworks, but also adequate accountability and coordination among actors

A development of the six fundamental components of a health system (inputs) produces

certain desirable characteristics of the system (outputs). These contribute to producing
changes in the system itself and improvements in health (outcomes).