Key Issues of Health System
in Developing Countries
Presented by:
Nirmala Bista (21)
What is health system?
• The term “health system” encompasses the
personnel, institutions, commodities, information,
financing and governance strategies that
support the delivery of prevention and treatment
services.
• Main objectives of a health system are to
respond to people’s needs and expectations by
providing services in a fair and equitable
manner.
Contd…
• The World Health Organization defines a health
system as “all the activities whose primary
purpose is to promote, restore, or maintain
health.”
• The World Bank defines health systems more
broadly to include factors interrelated to health,
such as poverty, education, infrastructure and
the broader social and political environment.
Contd…
• It is a fairly complex system of inter-related
elements that contribute to the health of people -
in their homes, educational institutions, in work
places, the public (social or recreational) and the
psychological environments as well as the
directly health and health-related sectors.
• It encompass clean water and sanitation, health-
related education, financial sustainability and
security, effective management and leadership,
and appropriate technology in addition to actual
provision of services.
Contd…
• Like many complex entities, health systems are
influenced by factors such as education,
infrastructure, poverty, and the overall social and
political environment.
• The performance of a heath system is measured
by its scale, scope, distribution, quality, safety
and capabilities.
Contd…
• In 2007, the World Health Organization (WHO)
drafted a framework to guide efforts to
strengthen health systems.
• This framework identifies six components
needed to establish, sustain and strengthen a
health system, while the issues of health system
are also identified on the basis of these
components:
Key issues of health system
Lack of leadership and good governance:
This has imposed a poor policy frameworks
upon the people. These policies fail to define the
role of State with regard to other players. In this
scenario, proper monitoring and management of
health programs isn’t possible. Likewise, poor
governance results in corruption and social
injustice throughout the health sector.
Contd…
Inadequate funding of the health system: The
total budget allocation for health sector in any
developing country is less than 10% of the total
budget. This is not enough for providing
essential health care services to all citizens.
Contd…
• Improper functioning of health information
system: There is no production, analysis,
dissemination, and use of reliable and timely
information on health determinants, health
systems and health status. This reduces
responsiveness of the concerned authority and
stakeholders towards surveying the health
problems
Contd…
Lack of quality health workforce: The health
workforce isn’t properly trained and equipped to
provided equitable access to needed health
services. This is mainly due to lack of health
human resource producing institutions and
“brain drain” to an extent. The qualified human
resource migrate to developed countries for
better income and opportunities.
•
Contd….
Expensive medical products and
technologies: Poverty is quite an issue in
developing countries. People work hard to make
their ends meet. They cannot afford the
expensive medical procedures and medications
to restore their health.
Contd….
Lack of efficient service delivery: There’s lack
of co-ordination and management in providing
health services to those in need with a minimum
wastage of resources. Efficient service delivery
is essential to prevent duplication of efforts and
maintain a healthy balance of services
Recommendations:
• Develop a plan for health systems with supportive
policies and laws with monitoring and evaluation
mechanisms
• Leaders should ensure that the ministry of finance
releases money in time for health systems to pay
salaries, bills and purchase necessary
pharmaceuticals.
• Ensure that managers have necessary training and
skills for the job and are held accountable for
successes or failures.
Contd…
• Developing risk-pooling insurance schemes,
such as community-based health financing.
• Develop payment and other incentives for
providers
• Develop a plan for human resources;
standardize job descriptions, ensure that job
duties are clear to employees
• Train workers properly on basic medical and
nursing skills; assess knowledge, review
performance
Contd…
• Ensure that supplies of drugs, antibiotics,
diagnostics, gloves, and other necessary
commodities are always in stock and they aren’t
expired.
• Mass drug administration campaigns; social-
marketing methods or free government provision
of goods
Contd…
• Training and equipping village health teams to
provide home-based care where no facilities
exist
• Implement clean water and sanitation,
environmental safety and health-related
education programs, e.g. collaborate with
schools to improve access to health and
education jointly.