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HEALTH SYSTEMS:

HEALTH SYSTEMS:. Conceptual frameworks. Health systems. Combination of resources, organization, financing, and management that culminates in the delivery of health services to the population Roemer MI. National health systems of the world , volume 1. New York, Oxford University Press, 1991

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HEALTH SYSTEMS:

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  1. HEALTH SYSTEMS: Conceptual frameworks

  2. Health systems • Combination of resources, organization, financing, and management that culminates in the delivery of health services to the population Roemer MI. National health systems of the world, volume 1. New York, Oxford University Press, 1991 • All activities whose primary purpose is to promote, restore and maintain health World Health Report 2000

  3. Health systems • All components are interacting with each other in a synergy and coherence • HS components are interacting with the political, social, economic environment • HS are dynamicand evolve over time

  4. Health systems • HS boundaries: in relation to health actions: activities with indirect impact are to be excluded (investments on water supply and sanitation, food subsidies, supplementary school health meals, etc…)

  5. HS goals • To improve health and to reduce health inequalities ( average & distribution) • To secure fairness of financial contribution ( equity concerns) • To be responsive to user’s needs

  6. HS functions & building blocks • Governance • Financing • Human resources • Service delivery • Health technology support • Health information support

  7. Health systems • Health system comprises three highly inter-dependent elements: • Ecosystem- socio-cultural, demographic, economic and political surroundings • Health Care Delivery System– based on health problems and needs, health inputs, distribution, output, utilization and outcomes; • Community Involvement– organization, awareness, contribution and utilization A. A. Kielmann

  8. Management and Organization Input Distribution Support Systems Service Output Service Inputs Service Outcome Health Problems Health System Model * Social, cultural, environmental, political, economic ecosystem Community Participation ® A.A.Kielmann

  9. Health Needs Health Results Resources Management Service delivery Organization Economic support Health systemsRoemer’s model

  10. Political, social and cultural values • INPUTS • Financing • Human resources • Public/private mix • PROCESS • Organization and management • Resource allocation • Selection of technology • OUTPUTS • Coverage by health services • Utilization of health services OUTCOMES Morbidity Mortality Quality of life Healthneeds Environment Health System Model used to assess HFA

  11. Stewardship (Oversight) Responsiveness (to peoples non-medical expectations) Creating Resources (Investment and training) Delivering Services (Provision) Fair (financial) Contribution WHO Health System Conceptual Framework: WHR 2000 Health System Functions Health System Objectives Health Financing (collecting, pooling, purchasing)

  12. HEALTH SYSTEM CONCEPTUAL FRAMEWORK Social Determinants of Health SYSTEM BUILDING BLOCKS GOALS OF HEALTH SYSTEM Information Support Service Delivery Responsiveness Leadership & governance Coverage Provider performance Health workforce Health Quality & Safety Financing Health technology Efficiency Financial protection Equity

  13. GOALS OF HEALTH SYSTEM Responsiveness Health Financial protection Building Blocks Combine to meet Health System Goals SYSTEM BUILDING BLOCKS Leadership & governance Coverage Information, Health workforce Medical products, technology Financing Provider performance Quality, safety, efficiency Service delivery Service delivery Equitable distribution

  14. Contribution of health systems • Health status has improved before HS development world wide: role of social & economic determinants of health • Regression analysis of 6 determinants has shown high correlation • Difficult to disentangle HS contribution • Comparative analysis: countries with similar economic status & similar social determinants of health

  15. Contribution of health systems • Life expectancy at birth ( 86):GDP per capita 75 USA17,500 77 Canada14,000 76 Australia12,500 74 N. Zealand7,000 70 Venezuela2,900 73 Cuba2,000 69 S. Korea 2,500 69 N. Korea 1,200

  16. Contribution of health systems • Studies have shown that HS do matter: - improved equity - increased efficiency - improved responsiveness: population satisfaction • Health outcomes are related to the HS development : need to invest in HSD • Importance of HS performance assessment

  17. HSP Assessment • Frameworks : - HFA measurement of indicators : ME - social determinants of health MDG( literacy, income, access to water & sanitation, etc..) - Input indicators ( HRH, facilities, funds) - coverageby services - outcomeindicators : LE, morbidity, mortality, quality of life

  18. HSP Assessment • Frameworks : • WHR 2000: Social determinants are not assessed Intermediary goals are not considered : coverage indicators Only outcome indicators: - LE ( HALE) - Fairness of FC index - Level and distribution of responsiveness

  19. HSP Assessment • Measurement of HSP: Sources of data : routine information systems & population-based surveys Household expenditures & utilization surveys are important ( NHA, FFC, catastrophic spending on health) National BOD analysis ( HALE)

  20. Conclusions • HS are important & deserve to be strengthened • HS do interact with surrounding political, economic, cultural environments • HS functions need to be mapped: - assess strengths& weaknesses - improve implementation • HS goals should be monitored & evaluated

  21. Conclusions • Need to strengthen information support to HS : routine & population-based surveys • Need to invest in capacity building: - development of analytical tools : NHA, BOD, CEA - health system research - policy analysis & policy dialogue

  22. Thank you

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