What Are Health Systems and How Do We Strengthen Them?

Published July 23, 2009 @ 03:42PM PT

I hate starting posts with WHO definitions, but it seems silly for me to try to re-write this one:

A health system comprises all organizations, institutions and resources devoted to producing actions whose primary intent is to improve health. Most national health systems include public, private, traditional and informal sectors. The four essential functions of a health system have been defined as service provision, resource generation, financing and stewardship.

Here's a little more WHO explanation:

A health system needs staff, funds, information, supplies, transport, communications and overall guidance and direction. And it needs to provide services that are responsive and financially fair, while treating people decently.

And some explanation from me:

Service provision is actual patient care

Resource generation is paying for care

Financing is how the money moves - I wrote about that on Monday

Stewardship is policies and regulations, and using data to develop them

When we talk about health system strengthening, what does that mean? It also breaks down by the four functions.

Strengthening service provision means training and equipping health care providers, improving medical education, building and repairing health facilities, and removing barriers to accessing health care.

Strengthening resource generation means finding ways to pay for health care. That can include user fees, direct budget support from donors, encouraging private sector health care, and increasing the share of government revenue that goes to supporting health care.

Strengthening financing means making choices on how the money moves that support good health care. Making good choices is hard to do, as those of you following the US health reform debate will have noticed.

Strengthening stewardship means setting policies and developing regulations that promote good health care. It also means developing a data collection system for health care, and using that data to inform, improve, and establish policies and regulations.

For More Information

The WHO has an entire resource center on strenghtening health systems.

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Comments (2)

Thanks for the post on this, Alanna! I think that my issue with investing in HSS is that a lot of it is simple infrastructure building - strengthening medical schools, building hospitals and clinics, building better roads - that are more of an economic deveopment issue than a health one. If a country has a thriving economy with sufficient tax revenue then it can build up this infrastructure.

I think int'l donors tend to shy away from HSS because they see it as an issue of development less than health, and as something that a country's government should be supplying. That doesn't mean that it isn't important or shouldn't get a portion of aid money, but that may explain the reluctance of donor countries to invest in HSS.

Posted by Lee Moran on 07/28/2009 @ 08:39AM PT
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I thin that infrastructure is the smallest part of health systems. In many cases, it's not that the medical school needs a building - instead it needs an up to date curriculum and professors who know how to teach. Also, the role of effective financing and regulation has a mssive impact in the quality of health care.

Posted by Alanna Shaikh on 07/29/2009 @ 03:57AM PT
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Author

Alanna Shaikh has spent the last ten years immersed in global health; she has worked for NGOs, companies, universities, and the US government on projects that ranged from preventing antibacterial resistance to improving maternal and child health.