Health System Building

Blocks
Joseline Alice Babirye BDS-3
Outline
• Structure
• Service delivery
• Health workforce
• Information
• Medical products, vaccines and technologies
• Financing
• Leadership and governance
Structure of the health system
• These are based on the functions defined in World health
report 2000.
The building blocks are:
i. Service delivery
ii. Health workforce
iii. Information
iv. Medical products, vaccines and technologies
v. Financing
vi. Leadership and governance (stewardship)
• There is an interdependence of each part of the health system
• The building blocks serve three purposes.
1. They allow a definition of desirable attributes – what a
health system should have the capacity to do in terms
of, for example, health financing.
2. They provide one way of defining WHO’s priorities.
3. By setting out the entirety of the health systems
agenda, they provide a means for identifying gaps in
WHO support.
Service delivery
• Services like prevention, treatment or rehabilitation – may be
delivered in the home, the community, the workplace or in
health facilities.
• The service delivery building block is concerned with how
inputs and services are organized and managed, to ensure
access, quality, safety and continuity of care across health
conditions, across different locations and over time.
• exploring innovative models of service delivery, for example,
involving private providers in the care of TB. Initiatives such as
the Integrated Management of Child, or Adult, Illness (IMCI,
IMAI) are responding to increasing interest in delivering
packages of care.
• In service delivery, attention is needed on the following
I. Demand for services
II. Package of integrated services
III. Organization of the provider network.
IV. Infrastructure and logistics
V. Management
Demand for services
• Raising demand requires understanding the user’s perspective,
raising public knowledge and reducing barriers to care – cultural,
social, financial or gender barriers.
• Doing this successfully requires different forms of social
engagement in planning and in overseeing service performance.
Package of integrated services
• This should be based on a picture of population health needs; of
barriers to the equitable expansion of access to services, and
available resources such as money, staff, medicines and
supplies
Organization of the provider network
• This is to ensure close-to-client care as far as possible, contingent on
the need for economies of scale; to promote individual continuity of
care where needed, over time and between facilities; and to avoid
unnecessary duplication and fragmentation of services.
• This means considering the whole network of providers, private as
well as public; the package of services (personal, non-personal);
whether there is over – or under – supply; functioning referral
systems; the responsibilities of and linkages between different levels
and types of provider including hospitals; the suitability of different
delivery models for a specific setting; and the repercussions of
changes in one group of providers on other groups and functions
(e.g. on staff supervision or information flows
Management
• The aim is to maximize service coverage, quality and
safety, and minimize waste. Whatever the unit of
management (programme, facility, district, etc.) any
autonomy, which can encourage innovation, must be
balanced by policy and programme consistency and
accountability. Supervision and other performance
incentives are also key
Infrastructure and logistics.
• This includes buildings, their plant and equipment;
utilities such as power and water supply; waste
management; and transport and communication. It also
involves investment decisions, with issues of
specification, price and procurement and considering
the implications of investment in facilities, transport or
technologies for recurrent costs, staffing levels, skill
needs and maintenance systems.
• Priority areas for WHO include;
i. Integrated service delivery packages
ii. Service delivery models
iii. Leadership and management
iv. Patient safety and quality of care
v. Infrastructure and logistics
vi. Influencing demand for care
Health workforce
• Health workers are all people
engaged in actions whose
primary intent is to protect and
improve health.
• A country’s health workforce
consists broadly of health
service providers and health
management and support
workers.
• This includes: private as well
as public sector health workers;
unpaid and paid workers; lay
and professional cadres.
• In any country, a “well-
performing” health workforce
is one which is available,
competent, responsive and
productive.
• To achieve this, actions are
needed to manage dynamic
labour markets that address
entry into and exits from the
health workforce, and improve
the distribution and
performance of existing health
workers.
• These actions address the following;
1. How countries plan and, if needed, scale-up their workforce asking questions
that include: What strategic information is required to monitor the availability,
distribution and performance of health workers? What are the regulatory
mechanisms needed to maintain quality of education/training and practice?
2. How countries design training programmes so that they facilitate integration
across service delivery and disease control programmes.
3. How countries finance scaling-up of education programmes and of numbers of
health workers in a realistic and sustainable manner and in different contexts.
4. How countries organize their health workers for effective service delivery, at
different levels of the system (primary, secondary, tertiary), and monitor and
improve their performance.
5. How countries retain an effective workforce, within dynamic local and
international labour markets.
The priorities include;
i. International norms, standards and databases
ii. Realistic strategies
iii. Crisis countries
iv. Costing
v. Training
vi. Evidence
vii. Advocacy
viii.Working with international health professional groups
Information
• A well functioning health
information system is one that
ensures the production, analysis,
dissemination and use of reliable
and timely health information by
decision-makers at different
levels of the health system, both
on a regular basis and in
emergencies.
• It involves three domains of
health information: on health
determinants; on health systems
performance; and on health
status.
To achieve this, a health information
system must:
i. Generate population and facility based
data: from censuses, household
surveys, civil registration data, public
health surveillance, medical records,
data on health services and health
system resources (e.g. human
resources, health infrastructure and
financing);
ii. Have the capacity to detect,
investigate, communicate and contain
events that threaten public health
security at the place they occur, and
as soon as they occur.
iii. Have the capacity to synthesize
information and promote the
availability and application of this
knowledge
Priorities include:
• National information systems
• Reporting
• Stronger national surveillance and response capacity
• Tracking performance
• Standards, methods and tools
• Synthesis and analysis of country, regional and global
data
Medical products, vaccines and
technologies
• 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.
• To achieve these objectives, the
following are needed:
i. National policies, standards, guidelines
and regulations that support policy;
ii. Information on prices, international
trade agreements and capacity to set
and negotiate prices;
iii. Reliable manufacturing practices and
quality assessment of priority
products;
iv. Procurement, supply, storage and
distribution systems that minimize
leakage and other waste;
v. Support for rational use of essential
medicines, commodities and
equipment, through guidelines,
strategies to assure adherence,
reduce resistance, maximize patient
safety and training
• Priorities of these include:
i. Establish norms, standards and policy options-Set, validate, monitor, promote and
support implementation of international norms and standards to promote the
quality of medical products, vaccines and technologies, and ethical, evidence-based
policy options and advocacy.
ii. Procurement- Encourage reliable procurement to combat counterfeit and
substandard medical product
iii. Access and use- Promote equitable access, rational use of and adherence to quality
products, vaccines and technologies through providing technical and policy support
to health authorities
iv. Quality and safety- Monitor the quality and safety of medical products, vaccines and
technologies
v. New products- this emphasizes a public health approach to innovation, and on
adapting successful interventions from high-income countries to the needs of lower-
income countries, with a focus on essential medicines that are missing for children
and for neglected diseases.
 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.
• Health financing systems that achieve universal
coverage in this way also encourage the provision and
use of an effective and efficient mix of personal and
non-personal services.
• In order to achieve this:
i. the collection of revenues – from households,
companies or external agencies;
ii. the pooling of pre-paid revenues in ways that allow
risks to be shared – including decisions on benefit
coverage and entitlement;
iii. purchasing, or the process by which interventions
are selected and services are paid for or providers
are paid.
• The interaction between all three functions
determines the effectiveness, efficiency and equity of
health financing systems.
• Most systems involve a mix of public and
private financing and public and private
provision, and there is no one template for
action.
• However, important principles to guide any
country’s approach to financing include:
I. Raising additional funds where health
needs are high, revenues insufficient,
and where accountability mechanisms
can ensure transparent and effective use
of resources
II. Reducing reliance on out-of-pocket
payments where they are high, by
moving towards prepayment systems
involving pooling of financial risks across
population groups (taxation and the
various forms of health insurance are all
forms of pre-payment);
• Priorities of health financing include:
i. Health financing policy option
ii. Improve or develop pre-payment, risk pooling
iii. Ensure adequate funding from domestic sources
iv. Used funds
v. Promote international dialogue
vi. Increase availability of key information
LEADERSHIP AND GOVERNANCE
• The leadership and governance of
health systems, also called
stewardship, is the most critical
building block of any health system.
• This involves overseeing and guiding
the whole health system, private as
well as public, in order to protect the
public interest.
• It requires both political and technical
action, because it involves reconciling
competing demands for limited
resources, in changing circumstances,
for example, with rising expectations,
more pluralistic societies,
decentralization or a growing private
sector.
• There is increased attention to
corruption, and calls for a more
human rights based approach
to health.
• There is no blueprint for
effective health leadership and
governance. While ultimately it
is the responsibility of
government, this does not
mean all leadership and
governance functions have to
be carried out by central
ministries of health.
Key functions of leadership and governance
• Policy guidance- Formulating sector strategies
and also specific technical policies; defining
goals, directions and spending priorities across
services.
• Intelligence and oversight- Ensuring generation,
analysis and use of intelligence on trends and
differentials in inputs, service access, coverage,
safety; on responsiveness, financial protection
and health outcomes.
• Collaboration and coalition building- Across
sectors in government and with actors outside
government, including civil society, to influence
action on key determinants of health and access
to health services;
• Regulation- Designing regulations and incentives
and ensuring they are fairly enforced.
• System design- Ensuring a fit between strategy
and structure and reducing duplication and
fragmentation.
• Accountability- Ensuring all health system
actors are held publicly accountable.
Transparency is required to achieve real
accountability
Priorities of leadership and governance include:
i. Develop health sector policies and frameworks
ii. Regulatory framework
iii. Accountability
iv. Generate and interpret intelligence
v. Work with external partners.
Conclusion
• In summary, a well-functioning health system relies on six
essential building blocks: service delivery, health workforce,
health information systems, access to essential medicines,
financing, and leadership/governance. Each of these
components is interconnected and plays a critical role in
ensuring quality, accessible, and equitable healthcare for all.
• Strengthening these building blocks leads to improved health
outcomes, increased efficiency, and a more resilient
healthcare system. As future healthcare professionals, it is our
responsibility to advocate for policies and strategies that
enhance these foundations and contribute to a more effective
and sustainable health system
References
• Everybody business : strengthening health systems to
improve health outcomes : WHO’s framework for action
by World Health Organization 2007