FOUNDATIONS OF HEALTH SYSTEMS

POST BASIC HSM: MODULE 1 UNIT 1

DR J. MASWAN
2023
 Unit Introduction
• Welcome to unit 1 of postbasic HSM course.
• Unit provides a foundation essential for understanding how
health systems work.
• Covers the basic concepts of health systems, which will
enable you approach health service delivery as a system.
• The unit has 3 topics namely:
• overview of health systems,
• principles of healthcare delivery
• organization of health system and services.
Unit Objectives
By the end of this unit, you should be able to:
1. Explain the concept and context of health systems
2. Explain the key principles of health service delivery
3. Describe the organization of health systems and
services
 Definitions & concepts
Definition of a system
“A system is a group of related elements that function together as a whole to
produce a certain outcome” (biology online dictionary, 2022)

What is a health system?

“A health system consists of all organisations, institutions, people and actions
whose primary purpose is to promote health. (WHO, 2010). This includes
determinants of health as well as more direct health-improving activities.

Health care systems

It is narrower than a health system. A healthcare system is an organised social
response to health conditions of a population and health actions.
Health system
 Health system goals
A good health system is:
• People-centred – equity and fairness.
• Results-oriented – quality management system for continual quality
improvement.
• Evidence-based – technocrats, academicians, politicians,
community/local context and change.
• Community-driven – leadership, governance accountability,
transparency and sustainability.
• Context-specific – consider resource constraints
• Ethically sound – human rights and dignity, safety for the client,
community and environment.
• Systems thinking – holistic view of the health system.
 Systems Thinking
• Systems thinking is an approach to problem solving those views
“problems” as part of a wider dynamic system.
• Systems thinking involves much more than a reaction to present
outcomes or events.
• Involves a deeper understanding of linkages, relationships, interactions
and behaviors among the elements that characterize the entire systems.
• All health interventions have system-level effects to a greater or lesser
degree on one or more of the system’s building blocks.
• The application of systems thinking in health is accelerating a more
realistic understanding of what works, for whom and under what
circumstances.
 Characteristics of systems thinkers
• Seek to understand the big picture.
• Observe how elements within a system change over time, generating
patterns and trends.
• Recognize that a system’s structure generates behavior.
• Identify the circular nature of complex cause-and-effect relationships.
• Make meaningful connections within and between systems.
• Change perspectives to increase understanding.
• Test assumptions.
 Characteristics of systems thinkers
• Consider the issue fully and resist coming to a quick conclusion.
• Use understanding of system structure to identify possible actions.
• Consider short-term, long-term and unintended consequences of
actions.
• Pay attention to rates change.
• Recognize the impact of time delays when exploring cause-and-effect
relationships.
• Check results and change actions if needed
 WHO Framework
• Acknowledging the health system strengthening agenda, WHO has
formulated a health systems framework that describes health systems in
terms of six building blocks.
• These may also be referred to as the components of a health system or
the pillars of a health system.
• WHO health system framework is instrumental in strengthening the
overall health system
• It’s catalyst for achieving global health targets such as the SDGs.
• The WHO framework has six (6) components BUT in Kenya two (2)
pillars were added
 Health System Building blocks/pillars
1)Service delivery;
2)Health workforce;
3)Health information;
4)Medical products, vaccines and technologies;
5)Financing
6)Leadership and governance
• WHO has 6, Kenya added 2 bring the total to 8.
1)Research and development
2)Infrastructure
• The building blocks need to be functioning well for the health system
to produce the expected health outcomes
 Building blocks/pillars
• Service delivery -including effective, safe, and quality personal and non-
personal health, interventions that are provided to those in need, when and
where needed (including infrastructure), with a minimal waste of resources.
• Health Workforce - responsive, fair and efficient given available resources
and circumstances, and available in sufficient numbers (sufficient numbers,
fairly distributed, competent, responsive and productive)
• Health information - ensuring the production analysis, dissemination and
use of reliable a n d timely information on health determinants, health
systems performance and health status. Enables linkages -local, national,
regional and global
 Building blocks
• Medical products and technologies – including medical
products, vaccines and other technologies of assured quality,
safety, efficacy, and cost-effectiveness and their scientifically
sound and cost-effective use. Medical products include medicine,
reagents etc. Technologies include infrastructure (X-ray, lab, etc)
• Health financing – raising 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. Provides incentives for providers and users to be
efficient. Includes policies that support sustainable options/social
protection, use of information, sound financial management/
dialogue
 Building blocks
• Leadership and Governance – ensuring strategic policy frameworks,
combined with effective oversight, coalition building, accountability,
regulations, incentives and attention to system design
• Infrastructure - includes the built environment and supporting
elements: equipment, access, information technology (IT), systems and
processes and sustainability initiatives. It should enable patients to
move seamlessly, with their privacy and dignity maintained at all
times.
• Research and development - critical to ensuring that high-impact,
affordable health technologies reach the people who need them most
Interconnectedness of the Health System Building Blocks

GOVERNANC
E
RESEARCH &
INFORMATIO
DEVELOPME
N
NT

INFRASTRUC
TURE PEOPLE FINANCING

MEDICINES
and SERVICE
TECHNOLOGI DELIVERY
ES
HUMAN
RESOURCES
 Interconnectedness
• Health systems are a dynamo of interactions, synergies and shifting
subsystems.
• All systems are contained within larger systems.
• Within the heath system is the sub- system for service delivery;
• Within that system may be a hospital system, and within that a
laboratory system;
• And among all of these sub-systems are reactions, synergies and
interactions to varying degrees with all of the health system’s other
building blocks.
 People
• people are not just at the center as mediators, and beneficiaries but as
actors in driving the system itself.
• This includes their participation as individuals, civil society
organizations, and stakeholder networks, and also as key actors
influencing each of the building blocks, as health workers, managers
and policy makers.
• Placing people in the center emphasizes commitment to the principles
and values of primary health care (fairness, social justice, participation
and intersectoral collaboration).
 Kenya Health Policy and Building blocks

Investment areas are based on Building blocks

1.Organisation of Service Delivery: Organisational arrangements
required for delivery of services;
2.Health Leadership and Governance: Oversight required for
delivery of services
3.Health Workforce: Human resources required for provision of
services
4.Health Financing: Financial arrangements required for provision
of services
5. Health Products and Technologies: Essential medicines, medical
supplies, vaccines, health technologies, and public health commodities
required for provision of services
6. Health Information: Systems for generation, collation, analysis,
dissemination, and utilisation of health-related information required for
provision of services
7. Health Infrastructure: Physical infrastructure, equipment, transport,
and information communication technology (ICT) needed for provision
of services
8. Research and Development: Creation of a culture in which research
plays a significant role in guiding policy formulation and action to
improve the health and development of the people of Kenya.
 Summary
• A health system is the organization of people, institutions, and resources
that deliver health care services to meet the health needs of target
populations.
• Systems thinking is an approach to problem solving those views
“problems” as part of a wider dynamic system
• Health system building blocks: service delivery, human resources,
medicines and technologies, finance, information, leadership &
governance, infrastructure and research and development.
• The Kenya Health policy is based on the 8 building blocks, as key
investment areas