Global Health 4.pptx

4. Global Health Systems and
Frameworks
December, 2022
BahirDar,Ethiopia
12/29/2022 Health system 1

4. Health system
4.1. What is health system?
• A health system is the sum total of all the organizations,
institutions and resources whose primary purpose is
improve health.
A health system needs staff, funds, information,
supplies, transport, communications and overall
guidance and direction.
It needs to provide services that are responsive and
financially fair, while treating people decently.
A health system is all people, institutions, resources,
to
•
•
•
and activities whose
restore, or maintain
primary purposes are to promote,
health.

4. Health system… what is health system?
• A health system primary intent
maintain health.
Health systems strengthening,
Fund support, refers to;
– Activities, and
– Initiatives
is to promote, restore or
• in the context of Global
•
•
Improve the underlying health systems of countries
Manage interactions between them in ways that achieve
more equitable and sustainable health services and
health outcomes related to the diseases.

4. Health System … Health system strengthening
4.2. Health system strengthening
Why it is important?
• The Global Fund recognizes the importance of supporting public,
private and community health systems where weaknesses and
gaps in those systems constrain the achievement
outcomes in reducing the burden of critical disease
of improved
–
–
–
HIV,
TB, and
Malaria
• Inadequate health systems are one of the main obstacles to
scaling up interventions to secure better health

4. Health System… Health system strengthening
• Global Fund has invested in human resources
– Funding both pre-service and in-service training
– Supporting task-shifting to maximize utilization of existing works
– Helping develop informal cadres of health and community
workers.
• The Global Fund has also invested in risk-pooling
mechanisms to alleviate the high costs the poor pay for
health care.
• Also it has supported service delivery through
– Funding community systems that mobilize demand for services
– Providing programs tailored to local needs
– Delivering services to hard-to-reach
– Focus on at-risk and vulnerable populations.

4. Health System …. Health system strengthening
• WHO 2005, advised countries to develop health
financing systems to:
– Ensure all people have access to needed services
– Access needs to be without the risk of financial
destruction linked to paying for care
• Defined this as achieving Universal
– Coverage with health services;
Health Coverage:
– With financial risk protection for
WHO Reconfirmed by 2011
all
•

4.Health system …….universal coverage and Goals
4.3. Universal coverage and goals
• UHC defined as;
• Ensuring that
– All people have access to needed health services (including
prevention, promotion, treatment, rehabilitation, and
palliation)
– Of sufficient quality to be effective
– While also ensuring that the use of these services does
expose the user to financial hardship
• UHC means making quality health services available
all, ensuring people are not pushed into poverty by
healthcare costs.
not
for

4.Health system …….universal coverage and Goals
4.3. Universal coverage and goals …
• UHC2030 provide a global platform and space for multiple stakeholders to
connect, work
commitments
together and influence national and international
Cost Quality
Access

4. Health system … health system components
4.4. Health system components
According WHO (2010), Health
blocks /components/
system has six building
1.
2.
3.
4.
5.
6.
Health service delivery
Health workforce
Health information systems
Access to essential medicines
Health
Health
care financing
leadership/governance

4. Health System …. Health system framework
4.5. Health system framework
The Framework is about ways of working in WHO
cost
efficiency
Leadership/Governance
The six building blocks of the health system, aims & Desired attributes
Improved
Financing
Quality
/safety
Access to essentials
medicine
Social &
financial risk
protection
Health inf. system responsiveness
Health workforce
Access
coverage
Improved
health (level
&equity
Service delivery
Goal/outcome
Building block

4. Health system… Health system framework
Evaluation and monitoring
Monitoring and evaluation framework shows
of:
the effects
• Health inputs and processes (e.g. health
workforce and infrastructure)
on
• Outputs (e.g. interventions
on
Outcomes (e.g. coverage)
On
and available services)
•
•
12/29/2022
Impact (morbidity and mortality).
Health system 11

4.Health system…components
Service delivery:
This refers to effective, safe and high quality public and
private sector services to those who need them, when
and where they are needed, with maximum efficiency
and patient choice.
Health delivery system should be
I.
•
•
1. Comprehensiveness:
– It should be appropriate to the needs of the target population,
including preventative, curative, palliative and rehabilitative
services and health promotion activities.

4.Health system…components
2.
•
Accessibility:
Services are directly and permanently accessible with
no undue barriers of cost, language, culture, or
geography.
Health services are close to the people, with a routine
point of entry to the service network at primary care
level (not at the specialist or hospital level).
Services may be provided in the home, the
•
•
community, the workplace, or health facilities
appropriate.
as

4. Health system…..components
Coverage:
– Service delivery is designed so that all people in a defined
target population are covered, i.e. the sick and the healthy, all
income groups and all social groups.
Continuity:
– Service delivery is organized to provide an individual with
continuity of care across the network of services, health
3.
4.
conditions, levels of care, and over
Quality:
– Health services are of high quality,
centered on the patient’s needs and
the life-cycle
5.
i.e. they are effective, safe,
given in a timely fashion.

4. Health system … components
6. Person-centeredness: Services are organized around the person,
not the disease or the financing.
• Users perceive health services to be responsive and acceptable to
them.
People are partners in their own health care
Coordination: Local area health service networks are actively
coordinated, across types of provider, types of care, levels of
service delivery, and for both routine and emergency preparedness.
•
7.
8. Accountability and efficiency: responsive, financially faire and
decent service providing

4. Health system …components
II. Health workforce (Human resources):
•
•
Human resources refers to;
A healthy, accessible, technically competent,
adequately resourced, motivated,
Well-deployed health workforce provides services
(across health system functions and levels) in
accordance with standards in a timely, patient-centered
manner, without discrimination.
The health workforce can be defined as “all people
engaged in actions whose primary intent is to enhance
health”
•
•

• The ability of a country to meet its health goals
depends largely on the knowledge, skills, motivation
and deployment of the people responsible for
organizing and delivering health services.
• Numerous studies show evidence of a direct and
positive link between the numbers of health workers
outcomes.
and population health

4. Health system ….components
• Effective monitoring and evaluation of human
resources for health in countries requires the
development of an agreed core
• Data can be sourced from
– Population-based sources
– Health facility assessments
– Routine administrative records
set of indicators
• Each of these sources has its strengths and
limitations for health workforce analysis.

4. Health system ………components
Recommended core indicator
1.
•
The health worker density
The number of health workers available
country relative to the total population
Distribution of health workers
in a
2.
• The distribution of health workers according to
selected characteristics — notably, by occupation/
specialization, region, place of work and sex

3. Annual number of graduates of health professions
educational institutions per 100 000 population – by
level and field of education
Number of graduates from health profession educational
•
institutions during the last academic year.

4. Health system……..components
Development of human resources for health in Ethiopia

III. Health information:
• The collection, analysis, dissemination, and use of
timely and high quality information on health status,
financial risk protection, health service use, client
satisfaction with services, health behavior, and health
system performance are the aspects of this function.
Sound and reliable information is the foundation of
decision-making across all health system building
blocks.
•

It is essential for
•
– Health system policy development
implementation
Governance and regulation
Health research
Human resources development
Health education and training
Service delivery and financing
and
–
–
–
–
–

4. Health system ……components
• The health information system provides the underpinnings
for decision-making and has four key functions
–
–
–
–
Data generation
Compilation
Analysis and synthesis
Communication and use.
• Health planners and decision-makers
information including.
need different kinds of
–
–
–
–
–
health determinants
inputs to the health system and related processes
the performance or outputs of the health system
health
health
outcomes
inequities

IV
. Medical supplies (products, vaccines, and
technologies):
• Sustained access to and appropriate use of
essential medical products that are safe,
effective, and of assured quality, and managed
in accordance with best practices, local laws,
policies, and regulations and containment of
antimicrobial resistance are aspects of this
function.

4. Health system …..components
A well-functioning health system ensures equitable access to
essential medical products, vaccines and technologies of assured
quality, safety, efficacy and cost-effectiveness
•
• To
–
achieve this objective, it requires
National policies, standards, guidelines and regulations that
support policy.
Information on prices, the status of international trade
agreements.
Reliable manufacturing practices when they exist in-country
and quality assessment of priority products
Procurement, supply and storage, and distribution systems that
minimize leakage and other waste
–
–
–

4. Health system…..components
V
. Leadership and governance:
• Leadership and governance in building a health system
involve ensuring that strategic policy frameworks exist
and are combined with effective oversight, coalition-
building, regulation, attention to system design and
accountability.
Despite consensus on the importance of leadership
•
and governance in improving health
remain inadequately monitored and
outcomes, they
evaluated

• Two types of indicators have been proposed for
measuring leadership and governance: Rules-based and
Outcome-based
Rules-based indicators measure
Whether countries have appropriate policies, strategies
and codified approaches for health system governance.
1.
•
• In the health systems context, these indicators include
guideline, procedures
–
–
–
–
The existence of national policy,
Decentralization
Stakeholder participation
Contextual factors

4. Health system…. components
2. Outcome-based indicators measure
• Whether rules and procedures are being effectively implemented
or enforced, based on the experience of relevant
• Knowledge mapping
stakeholders.
•
•
•
•
Who
Who
Who
Who
Pays for Care?
Purchases Care?
Provides Care?
Receives Care?
Funders
Public and
Private
Purchasers
Public and
Private
Providers
Consumers
by Type

4. Health system…. components
VI. Health care financing:
• Financing refers to
–
–
Sufficient revenue to pay for health needs;
allocation of resources efficiently, effectively,
equitably;
pooling resources when possible to foster
–
efficiency and to spread risks
purchase of packages of high
services.
and costs; and
quality, high-impact
–

4. Health system…components
Objectives of health care financing
1.
2.
3.
Better health outcomes
Equity among people
Solidarity
another)
(interdependent and should assist one
Concepts of health care financing
–
–
–
–
Risk pooling (pooling risks b/n people )
Risk spreading (spreading of risks over time )
Connection between ill health and poverty
Fundamental importance of health

• Health financing refers to the “function of a health
system concerned with the mobilization, accumulation
and allocation of money to cover the health needs of the
people, individually and collectively, in the health
system.
• The purpose of health financing is to make funding
available, as well as to set the right financial incentives
to providers, to ensure
effective public health
that all individuals have access to
and personal health care

4. Health system ….Health care financing
The need of adequate health care financing mechanism is
challenged by different factors like
• The government and different nongovernmental organizations
are struggling towards the achievement of universal health
service coverage in the community.
There are efforts towards bringing equity in healthcare
services in the community.
There is an alarming rising of medical costs from time to time
The is a rise of medical service needs of the community
To provide medical needs equitably and addressing the needs
of the community requires resources.
•
•
•
•

How do Countries Finance Healthcare?
• Rich Countries
–
–
–
General Taxation: UK, Canada
Social Health Insurance: Germany, Netherlands
Voluntary Private Health Insurance:
Alone
The US Stands
• Middle Income Countries
– General Taxes: Brazil, China, Poland
– Social Health Insurance: Chile
Low Income Countries
•
–
–
12/29/2022
General Taxes: Ghana, Lesotho
Social Health Insurance: Kenya
Health system 34

4. Health system…Health financing sources
1. Public sources:
•
•
•
Direct government budgeting
National health services and public services health system
the
Social health insurance sponsored or
government
Community financing
Private sources
Direct payment by households
Private voluntary health insurance
Employs based insurance
mandated by
•
2.
•
•
•
•
3.
•
Payment by community and other local organizations
External financing
Foreign aid or for development loans

Major Health Financing Models
Model
Revenue
Source
Groups
Covered
Pooling
Organization
Care
Provision
National Health
Service
General
revenues
Entire
population
Central
government
Public providers
Social Health
Insurance
Payroll taxes Specific
groups
Semi-
autonomous
organizations
Own, public, or
private facilities
Community-
based Health
Insurance
Private
voluntary
contributions
Contributing
members
Non-profit
plans
NGOs or
private facilities
Voluntary Health
Insurance
Private
voluntary
contributions
Contributing
members
For- and non-
profit insurance
organizations
Private and
public facilities
Out-of-Pocket
Payments
(including public
u1s
2/
e
29
r/2
f0
e
22
es)
Individual
payments to
providers
Health system
None Public and
private facilities
(public facilities)
36

4. Health system….. Health Care Financing
•
•
2005 WHO resolution on Universal Coverage
Countries should develop health financing systems that:
– Ensure all people have access to needed services
– Without the risk of financial catastrophe
Financial Protection
•
• The risks that each household faces due to the costs of
to
the health system (should be) distributed according
the ability to pay rather than the risk of illness……. World
Health Report 2000

4. Health system…..health insurance
•
•
This is commonly called health insurance
Health insurance is a means of pooling
means
risks across
different population groups as a of avoiding
the financial burden of unanticipated and catastrophic
illnesses.
Health insurance is a way of paying for some or all of
the costs of health care.
•
• It can protect insured persons from paying high
treatment costs in the event of sickness.
Normally it is based on risk aversion and uncertainty
of illness and medical outcomes.
•

4. Health system….Health insurance
• Different rationales can be mentioned for introducing
Health Insurance in the health provision system. The
main rationales of health insurance is to
• Increase total available resources
• Improve stability of resources
• Plan around resources generated
• Create greater equity implications

4. Health system …health insurance problems
1. Adverse Selection: Sicker individuals will choose to
enroll
drive
more
up the
than healthier individuals which will
the
cost of the premium and bankrupt
scheme.
Moral
2. Hazard: People are less fearful of
and
catastrophe once they are protected by insurance
this affects their behavior.
3. Cheating: It is the abuse of membership through
different mechanisms.

Summary
Overall there is a growing recognition that to maintain
and improve the health of the world’s people
governments must shape sound and efficient health
systems that provide effective disease prevention and
treatment to all women, men and children, no matter
who they are or where they live.
Stewardship
Stewardship, sometimes more narrowly defined as
governance, refers to the wide range of functions
carried out by governments as they seek to achieve
national health policy objectives.
•
1.
•

Summary …
2.
•
Financing
The purpose of health financing is to ensure that
adequate funding is available and the right financial
incentives are in place to guarantee that all individuals
have access to needed preventive and personal health
care.
3.Workforce
• The performance of health care systems depends on the
knowledge, skills, motivation and
people responsible for organizing
services.
distribution of the
and delivering

Summary …
4.Information
• Accountability, resource allocation, programme
improvement and management decisions all rely on
sound health information
Knowledge
Fostering environments that encourage the creation,
5.
•
sharing, and effective application of knowledge
for a health system to function well.
is vital

Summary …
Drugs and Technology
The availability, quality, efficacy, safety and rational use
of drugs and health technology are necessary for
effective health service delivery.
Research
There remain many unanswered questions about how
to develop and maintain well-functioning health
systems that progress towards universal coverage.
Research in this area is vital.
6.
•
7.
•
•

Summary …
8.
•
Service delivery
Just as the principal objective of a health system is to
improve people's health, the chief function the system
needs to perform is to deliver health services.
Equity
Reducing health inequities is important because health
is a fundamental human right and its progressive
realization will eliminate inequalities that result from
differences in health status.
9.
•

Summary …
10. Health and Development
• Strengthening health systems and making
them more equitable are key strategies for
fighting poverty and fostering development.

Thank you

Global Health 4.pptx

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