The Health System as a Determinant of Health


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Lecture given during the pre-APRM workshop on Social Determinants of Health and Global Health Equity, September 12, 2012, Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur

The Health System as a Determinant of Health

  1. 1. The Health System as aDeterminant of HealthRamon Lorenzo Luis R. Guinto, MD
  2. 2. What is ahealth system?
  3. 3. Health System“A health system is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health.""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.”
  4. 4. WHO Health SystemsFramework
  5. 5. Governance and Leadershipeffective oversight, coalition building, provision of appropriate regulations and incentives, attention to system- design, and accountability
  6. 6. Informationproduction, analysis, dissemination and use of reliable and timely information on health determinants, health systems performance and health status
  7. 7. Medicines and Technologiesassured quality, safety, efficacy, cost- effectiveness, and availability
  8. 8. Service Deliveryeffective, safe,qualitypersonal andnon-personalhealthinterventions tothose whoneed them
  9. 9. Health Workforceresponsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances
  10. 10. Health Financingraises adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them
  11. 11. Human Resourcesfor Health
  12. 12. Southeast Asia: International Flows ofNurses and Doctors RNs and MDs
  13. 13. Working lifespan strategies tobuild capacity and performance ENTRY: Preparing the workforce Planning WORKFORCE PERFORMANCE Education WORKFORCE: Recruitment Enhancing worker Availability performance Competence Supervision Responsiveness Compensation Productivity Systems support EXIT: Lifelong learning Managing attrition Migration Career choice Health and safety Retirement Source: WHO (2006). The World Health Report 2006 – Working Together for Health. Geneva, World Health Organization
  14. 14. Health Workforce
  15. 15. Health Care Financing
  16. 16. Health Financing Functions
  17. 17. Health System as aRelationship
  18. 18. Financer-Provider• Payment systems o Fee for service Visits, Bed-days Diagnostic Related Groups o Capitation o Global Budget• Integrated financer-provider systems
  19. 19. Current Challenges
  20. 20. Universal Health Coverage
  21. 21. From Phua Kai Hong, NUS
  22. 22. From Phua Kai Hong, NUS
  23. 23. Universal Health Coverage“access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost” World Health Assembly, 2005
  24. 24. "Universal coverage is the ultimate expression of fairness." "Universal coverage is the single mostpowerful concept that public health has to offer."Dr. Margaret ChanWHO Director-General65th World Health Assembly 2012
  25. 25. WHY UHC ADVOCACY IS GAININGMOMENTUM• UHC is relatively easy to understand• Compatible with human rights agenda• UHC is an attainable goal – especially as countries make transition to MIC status• UHC is popular and inherently political• UHC brings politics into health systems agenda – people receiving services• Opportunity to celebrate national successes (perhaps at the expense of others failures) Yates 2012
  26. 26. Public versus Private?
  27. 27. Vertical versus Horizontal?
  28. 28. Summary• The health system is a social determinant of health inequalities.• All building blocks of the health system must be enhanced in order to achieve universal health care.• Reforms in the health system cannot be isolated from action on the broader determinants of health.
  29. 29. Thank you!