Health system
Encyclopedia
A health system can be defined as the structured and interrelated set of all actors and institutions contributing to health
improvement. The health system boundaries could then be referred to the concept of health action, which is "any set of activities whose primary intent is to improve or maintain health".
- Health systems should not be expressed in terms of their components only, but also of their interrelationships;
- Health systems should include not only the institutional or supply side of the health system, but also the population;
- Health systems must be seen in terms of their goals, which include not only health improvement, but also equity
, responsiveness to legitimate expectations, respect of dignity, and fair financing, among others;
- Health systems must also be defined in terms of their functions, including the direct provision of services, whether they are medical or public health
services, but also "other enabling functions, such as stewardship
, financing, and resource generation, including what is probably the most complex of all challenges, the health workforce
".
linked to it , insofar as it appeared to depend mostly on the choice of the retained indicators.
Since 2000, more and more initiatives have been taken at the international and national levels in order to strengthen national health systems as the core components of the global health
system. Having this scope in mind, it is essential to have a clear, and unrestricted, vision of national health systems that might generate further progresses in global health. The elaboration and the selection of performance indicators are indeed both highly dependent on the conceptual framework
adopted for the evaluation
of the health systems performances.
An increasing number of tools and guidelines are being published by international agencies and development partners to assist health system decision-makers to monitor and assess health systems strengthening including human resources
development using standard definitions, indicators and measures.
"A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health . This includes efforts to influence determinants of health as well as more direct health-improving activities. A health system is therefore more than the pyramid of publicly owned facilities that deliver personal health services. It includes, for example, a mother caring for a sick child at home; private providers; behaviour change programmes; vector-control campaigns; health insurance organizations; occupational health and safety legislation. It includes inter-sectoral action by health staff, for example, encouraging the ministry of education to promote female education, a well known determinant of better health."
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...
improvement. The health system boundaries could then be referred to the concept of health action, which is "any set of activities whose primary intent is to improve or maintain health".
A wide concept
Too often health systems have been defined with a reductionist perspective, for example reducing it to the health care systems. In many publications, for example, both expressions are used interchangeably. Some authors have developed arguments to expand the concept, indicating how many dimensions participate to it:- Health systems should not be expressed in terms of their components only, but also of their interrelationships;
- Health systems should include not only the institutional or supply side of the health system, but also the population;
- Health systems must be seen in terms of their goals, which include not only health improvement, but also equity
Health equity
Health equity refers to the study of differences in the quality of health and health care across different populations....
, responsiveness to legitimate expectations, respect of dignity, and fair financing, among others;
- Health systems must also be defined in terms of their functions, including the direct provision of services, whether they are medical or public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
services, but also "other enabling functions, such as stewardship
Stewardship
Stewardship is an ethic that embodies responsible planning and management of resources. The concept of stewardship has been applied in diverse realms, including with respect to environment, economics, health, property, information, and religion, and is linked to the concept of sustainability...
, financing, and resource generation, including what is probably the most complex of all challenges, the health workforce
Health Human Resources
Health human resources — also known as “human resources for health” or “health workforce” — is defined as “all people engaged in actions whose primary intent is to enhance health”, according to the World Health Organization's World Health Report 2006. Human resources for health are identified as...
".
International comparisons and performance
Health systems may vary substantially from countries to countries, and in the last years comparisons have been made on an international basis. The goals for health systems, according to the WHO's World Health Report 2000 - Health systems: improving performance (WHO, 2000), are good health, responsiveness to the expectations of the population, and fair financial contribution. There have been several debates around the results of this WHO exercise , and especially based on the country rankingRanking
A ranking is a relationship between a set of items such that, for any two items, the first is either 'ranked higher than', 'ranked lower than' or 'ranked equal to' the second....
linked to it , insofar as it appeared to depend mostly on the choice of the retained indicators.
Since 2000, more and more initiatives have been taken at the international and national levels in order to strengthen national health systems as the core components of the global health
Global health
Global health is the health of populations in a global context and transcends the perspectives and concerns of individual nations. Health problems that transcend national borders or have a global political and economic impact, are often emphasized...
system. Having this scope in mind, it is essential to have a clear, and unrestricted, vision of national health systems that might generate further progresses in global health. The elaboration and the selection of performance indicators are indeed both highly dependent on the conceptual framework
Conceptual framework
A conceptual framework is used in research to outline possible courses of action or to present a preferred approach to an idea or thought. For example, the philosopher Isaiah Berlin used the "hedgehogs" versus "foxes" approach; a "hedgehog" might approach the world in terms of a single organizing...
adopted for the evaluation
Evaluation
Evaluation is systematic determination of merit, worth, and significance of something or someone using criteria against a set of standards.Evaluation often is used to characterize and appraise subjects of interest in a wide range of human enterprises, including the arts, criminal justice,...
of the health systems performances.
An increasing number of tools and guidelines are being published by international agencies and development partners to assist health system decision-makers to monitor and assess health systems strengthening including human resources
Health Human Resources
Health human resources — also known as “human resources for health” or “health workforce” — is defined as “all people engaged in actions whose primary intent is to enhance health”, according to the World Health Organization's World Health Report 2006. Human resources for health are identified as...
development using standard definitions, indicators and measures.
Citations
What is a health system?"A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health . This includes efforts to influence determinants of health as well as more direct health-improving activities. A health system is therefore more than the pyramid of publicly owned facilities that deliver personal health services. It includes, for example, a mother caring for a sick child at home; private providers; behaviour change programmes; vector-control campaigns; health insurance organizations; occupational health and safety legislation. It includes inter-sectoral action by health staff, for example, encouraging the ministry of education to promote female education, a well known determinant of better health."
See also
- Global healthGlobal healthGlobal health is the health of populations in a global context and transcends the perspectives and concerns of individual nations. Health problems that transcend national borders or have a global political and economic impact, are often emphasized...
- Health crisisHealth crisisA health crisis or public health crisis is a difficult situation or complex health system that affects humans in one or more geographic areas, from a particular locality to encompass the entire planet...
- Health workforceHealth Human ResourcesHealth human resources — also known as “human resources for health” or “health workforce” — is defined as “all people engaged in actions whose primary intent is to enhance health”, according to the World Health Organization's World Health Report 2006. Human resources for health are identified as...
- Public healthPublic healthPublic health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
- Social determinants of healthSocial determinants of healthSocial determinants of health are the economic and social conditions under which people live which determine their health. They are "societal risk conditions", rather than individual risk factors that either increase or decrease the risk for a disease, for example for cardiovascular disease and...