Key components of a well functioning health system

A well functioning health system responds in a balanced way to a population’s needs and expectations by: ƒ improving the health status of individuals, families and communities ƒ defending the population against what threatens its health ƒ protecting people against the financial consequences of ill-health ƒ providing equitable access to people-centred care ƒ making it possible for people to participate in decisions affecting their health and health system.

Without strong policies and leadership, health systems do not spontaneously provide balanced responses to these challenges, nor do they make the most efficient use of their resources. As most health leaders know, health systems are subject to powerful forces and influences that often override rational policy making. These forces include disproportionate focus on specialist curative care, fragmentation in a multiplicity of competing programs, projects and institutions, and the pervasive commercialization of health care delivery in poorly regulated systems. Keeping health systems on track requires a strong sense of direction, and coherent investment in the various building blocks of the health system, so as to provide the kind of services that produce results.

Leadership and governance ƒ Effective regulation through a combination of Each country’s specific context and history guidelines, mandates, and incentives, shapes the way leadership and governance is backed up by legal measures and exercised, but common ingredients of good enforcement mechanisms; practice in leadership and governance can be ƒ Effective policy dialogue with other sectors. identified. These include: ƒ Mechanisms and institutional arrangements ƒ Ensuring that health authorities take to channel donor funding and align it to responsibility for steering the entire health country priorities. sector (not merely public sector service delivery); and for dealing with future Health information systems challenges (including unanticipated events Good governance is only possible with good or disasters) as well as with current information on health challenges, on the broader problems environment in which the health system operates, ƒ Defining, through transparent and inclusive and on the performance of the health system. processes, national health policies, strategy This specifically includes timely intelligence on: and plan that set a clear direction for the ƒ Progress in meeting health challenges and health sector, with: social objectives (particularly equity), • A formulation of the country’s including but not limited to household commitment to high level policy goals surveys, civil registration systems and (health equity, people-centeredness, epidemiological surveillance sound public health polices, effective ƒ Health financing, including through national and accountable governance) health accounts and an analysis of financial • A strategy for translating these policy catastrophes and of financial and other goals into its implications for financing, barriers to health services for the poor and human resources, pharmaceuticals, vulnerable technology, infrastructure and service ƒ Trends and needs for HRH; on consumption delivery, with relevant guidelines, plans of and access to pharmaceuticals; on and targets appropriateness and cost of technology; on • Mechanisms for accountability and distribution and adequacy of infrastructure adaptation to evolving needs ƒ Access to care and on the quality of services provided. This, in turn, requires a variety of institutional Essential medical products and mechanisms: technologies ƒ A national monitoring and evaluation plan Universal access to health care is heavily that specifies core indicators (with targets), dependent on access to affordable essential data collection and management, analyses medicines, vaccines, diagnostics and health and communication and use technologies of assured quality, which are used ƒ Arrangements to make information in a scientifically sound and cost-effective way. accessible to all involved, including Economically, medical products are the second communities, civil society, health largest component of most health budgets (after professionals and politicians salaries) and the largest component of private health expenditure in low and middle income Health financing countries. Key components of a functioning Health financing can be a key policy instrument system are: to improve health and reduce health inequalities ƒ A medical products regulatory system for if its primary objective is to facilitate universal marketing authorization and safety coverage by removing financial barriers to monitoring, supported by relevant legislation, access and preventing financial hardship and enforcement mechanisms, an inspectorate catastrophic expenditure. The following can and access to a medical products quality facilitate these outcomes: control laboratory ƒ A system to raise sufficient funds for health ƒ National lists of essential medical products, fairly national diagnostic and treatment protocols, ƒ A system to pool financial resources across and standardized equipment per levels of population groups to share financial risks care, to guide procurement, reimbursement ƒ A financing governance system supported and training by relevant legislation, financial audit and ƒ A supply and distribution system to ensure public expenditure reviews, and clear universal access to essential medical operational rules to ensure efficient use of products and health technologies through funds public and private channels, with focus on the poor and disadvantaged Human resources for health ƒ A national medical products availability and The health workforce is central to achieving price monitoring system health. A well performing workforce is one that is ƒ A national programme to promote rational responsive to the needs and expectations of prescribing. people, is fair and efficient to achieve the best outcomes possible given available resources Service delivery and circumstances. Countries are at different Health systems are only as effective as the stages of development of their health workforce services they provide. These critically depend on: but common concerns include improving ƒ Networks of close-to-client primary care, recruitment, education, training and distribution; organized as health districts or local area enhancing productivity and performance; and networks with the back-up of specialized and improving retention. This requires: hospital services, responsible for defined ƒ Arrangements for achieving sufficient populations numbers of the right mix (numbers, diversity ƒ Provision of a package of benefits with a and competencies) comprehensive and integrated range of ƒ Payment systems that produce the right kind clinical and public health interventions, that of incentives respond to the full range of health problems ƒ Regulatory mechanisms to ensure system of their populations, including those targeted wide deployment and distribution in by the Millennium Development Goals accordance with needs ƒ Standards, norms and guidance to ensure ƒ Establishment of job related norms, access and essential dimensions of quality: deployment of support systems and enabling safety, effectiveness, integration, continuity, work environments and people -centeredness ƒ Mechanisms to ensure cooperation of all ƒ Mechanisms to hold providers accountable stakeholders ( such as health worker for access and quality and to ensure advisory groups, donor coordination groups, consumer voice. private sector, professional associations, communities, client/consumer groups). WHO, May 2010