The document discusses health systems as interrelated actors and functions working together to improve health outcomes. It highlights the roles of financing, service delivery, and oversight in shaping health systems and the importance of systems thinking to understand the complex interactions within these systems. Key concepts include the interdependence of system parts and the need to analyze stakeholder interests and responses to changes in the health system.

1. 1Health System Elements & ConnectionsJuly 19, 2011David H PetersJohns Hopkins University

2. 2What Is A System? An interaction of parts and their interconnections that come together for a purpose

3. 3Health System Actors, Functions and OutcomesPeopleFinancingRevenue GenerationRisk PoolingAllocation & PurchasingHealth StatusService DeliveryPublic Health ServicesAmbulatory CareInpatient CareProtection from Health ImpoverishmentInput ManagementHuman Resources KnowledgePharmaceuticals TechnologyConsumables Capital Trust/SatisfactionOversightPolicy Setting Information, Disclosure & Advocacy Regulation Strategic Partnerships & IncentivesThe StatePoliticiansPolicy-makersProvidersPublic/PrivateInformal

4. 4Who Produces Health?

5. The “Control Knobs” of Public Intervention in Health SystemsFinancing: how to raise money, pool funds, allocate and pay for health careOrganization: who delivers services and manages health systems inputs, and how they are deliveredOversight: how do you regulate and use information to change behavior of key actors5

6. 6Health Financing: Key FunctionsRaising revenuesPooling resourcesAllocating and purchasing

7. 7Changes in Organization (who does what, how)Service delivery point (clinics, hospitals)Government administrative area (district)Management unitProfessionCommunity OrganizationPriority program/disease

8. 8Oversight Tools in the Health SectorPolicy-makingEstablish & enforce laws & regulationsPublic disclosureProfessional self-regulationConsumer advocatesIndependent mediaIndependent monitors

9. Effective Regulation in the Health SectorInformal and formal “rules of the game” (incentives) can greatly influence performanceLocal institutions beyond government can be effective: Consumer’s groups, professional organizations, mediaCo-production-regulation may be more effective than government enforcement of rulesPeters & Muraleedharan (2008). Regulating India’s Health Sector: To What End? What Future? Social Sciences & Medicine 9

10. Summary of Health Systems Models: Common Features (1)10

11. Summary of Health Systems Models: Common Features11

12. Making Connections: Systems ThinkingThe process of understanding how things influence each other in a system12

13. 13Systems Thinking:Key ConceptsParts of a system are interdependentActions have multiple-order consequencesOptimizing one part can lead to poor system performanceOrganizational structures drive behaviorMental models influence actions

14. Making ConnectionsWill changes in one part of health system cause changes in other part of health systemOther actorsOther functionsOutcomes14

15. 15Health System Actors, Functions and OutcomesPeopleFinancingRevenue GenerationRisk PoolingAllocation & PurchasingHealth StatusService DeliveryPublic Health ServicesAmbulatory CareInpatient CareProtection from Health ImpoverishmentInput ManagementHuman Resources KnowledgePharmaceuticals TechnologyConsumables Capital Trust/SatisfactionOversightPolicy Setting Information, Disclosure & Advocacy Regulation Strategic Partnerships & IncentivesThe StatePoliticiansPolicy-makersProvidersPublic/PrivateInformal

16. Making Connections: Where to lookFollow people and organizations (actors)Follow the moneyFollow the informationAsk:How will different actors respond?What will happen to health services?What will happen to health system outcomes, for whom?16

17. Following peopleIdentify “interests”Motivations, Incentives and AccountabilitiesIdentify “influence”Power, ResourcesConsider how intervention will affect people:Who will benefit, who will loseWho will “own”17

18. Stakeholder Analysis Matrix (Example)18

19. Following money and servicesWill change in financing affect health services?Volume of servicesQuality of servicesWho will provideWho will benefit from services19

20. Following informationWill information affect health services?Quality of servicesPrices for servicesWho will provideWho will benefit from services20

21. Incorporating Complexity21

22. Model for Understanding Health Systems Changes as Complex Adaptive System22

23. 23SummarySystems thinking in health systems involves:Understand health systems actors, functions, principles, purposeMake changes in financing, organization, oversightLook for responses in actors, health services, money, informationMonitor effects on intended and unintended outcomes