Health Systems - Components

Health System
Health System as a combination of resources, financing, and management that culminate in the delivery of services to the population. No two health systems are exactly alike in the countries

Basic FRAMEWORK of Health Systems

Structure/Inputs

Processes

Outcomes

Framework

Structure--->Process--->Outcome

Structure/Inputs:
*

* * *

Organizational setting in which the care is provided Physical infrastructure: Building, space, furniture, Water supply, Sanitation, Electricity Human Resources: Number, types, qualifications, skills etc Equipment and other material Money

Processes
Set of activities performed to achieve the outcomes or the objectives Whether the defined activities were performed (timeliness and regularity)

Whether the activities were sufficient in scope and amount

Whether according to Standards and Norms Programs and Services

Outcomes
In terms of changes in health status measure by Morbidity Mortality Complications Client Satisfaction

 Industrialized Countries
Entrepreneurial Health Systems (USA) Welfare Oriented Health Systems (Canada,
France, Japan)

Comprehensive Health Systems (Britain, Norway

and Nordic Countries, European Countries)

Socialist Health Systems (Russia, other socialist

countries?)

 Transitional Countries
Entrepreneurial Health Systems (Thailand, Korea) Welfare Oriented Health Systems (Brazil, Mexico,
Argentina, Egypt, Malaysia)

Comprehensive Health Systems (Israel) Socialist Health Systems

 Very Poor Countries

Entrepreneurial Health Systems (e.g. Kenya,
Ghana,Zaire,Pakistan, Indonesia)

Welfare Oriented Health Systems (e.g.India,

Myanmar)

Comprehensive Health Systems (Srilanka,

Tanzania)

Socialist Health Systems (Vietnam,

Mozambique,China)

Oil Rich Countries

Determinants of Health System Designs

Disease Burden and Health Needs Demography and Population Level of Economic development Political systems Socio-cultural Technology

Relation between functions and objectives of health system

Major Components of Health Systems

Production of Resources Organization of programs Economic support mechanisms Management methods Delivery of Services

HEALTH SYSTEM COMPONENTS AND THEIR RELATIONSHIPS

MANAGEMENT

HEALTH NEEDS

HEALTH RESULTS

Figure: Model of a national health system, showing its components and their relationships to health status

RESOURCES

SERVICE DELIVERY

ORGANIZATION

ECONOMIC SUPPORT

Production of Resources
Health Manpower Health Facilities Commodities Medicines and other supplies Technology Finances

Organization of Programs
Organizational Structure Constellation and types of services and programs

Interventions with Large Potential Effect on Health

Economic Support
???

Management
Leadership/ Stewardship Strategic planning and Management Monitoring and Evaluation Other functional areas of management

Delivery of Services
Primary Health Care Secondary Health Care Tertiary

EQUITY IN HEATLH
Creating equal opportunities for health. Bringing health differentials down to the lowest level possible.
Source : The concepts and principles of equity and health by Margaret Whitehead, WHO (2000)

Equal access to Equal utilization Equal quality available care of care for all for equal need for equal need

GLOBAL SCENARIO OF INEQUITY : 1.2 billion people living in extreme poverty People living on less than $1 a day (millions), 1998
(Source : World Bank )

24

278 78 6 522

291

Ranking of Top 10 Richest Countries in the World 1 Luxembourg 2 3 4 5 6 Norway Increasing GNP per capita US San Marino Switzerland Denmark

GNP ( Gross National Product) per Capita, is an international indicator to identify worlds richest nations. Does this ensures equity in health status ?

7 8 9

Iceland Austria Canada

Source: 2005 est. CIA Fact book.

10 Ireland

 Singapore has lowest infant mortality rate though its not among the richest nations of the world.

Ranking of Top 10 Countries with Lowest IMR in the World 2.29 (Per 1 Singapore 1000 2.77 2 Sweden live 2.96 births) 3 Hong Kong 3.26 4 Japan 5 Iceland 3.31 3.57 6 Finland 7 Norway 3.7 8 Malta 3.89 9 Czech Republic 3.93
Decreasing IMR 10 Andorra 4.05

Source: 2005 est. CIA Fact book

Range of Highest and Lowest IMR around the World

IMR per 1000 live births
200 180 160 140 120 100 80 60 SINGAPORE 40 20 0

Source : CIA World Fact Book, 2006 est.

156 129 105 106 108 115 118 160

Rank 1 : ANGOLA IMR = 187 160

Lowest IMR 2.29

Guinea Bissau

2.77

2.96

3.26

3.31

3.57

3.7

3.89

3.93

4.05

Afghanistan

Somalia

Sierra Leone

Tajikistan

ozambique

Angola

Niger

Liberia

Mali

Comparison of Low , Middle and High Income Countries

(Source: World Bank Data 2002)

Expenditure on Health ( Percent of Total GDP)

0
Sri Lanka Indonesia Pakistan Egypt India Russia South Africa Brazil US France Germany Japan UK

10

12

14

16

3.6 3.2 2.6 6 4.9 5.9 8.4 7.7

Low Income Countries

Middle Income Countries

Highest in US 14.7 10.9

High Income Countries

9.7 7.9 7.7

200 180 160 140 120 100 80 60 40 20 0

Indonesia 26 Pakistan 13 Sri Lanka 30 Egypt 20.4 India 23

Low Income Countries Middle Income Countries

S.Africa 198 Russia 141

Brazil 199

Distribution of Expenditure on Health per capita ( US $)

Source : World Bank Data, 2002

6000 5000 4000

High Income countries

5324

2637

3000
2031

2450

2339

2000 1000 0
UK Japan Germany France US

90
Infant Mortality Rate per 1,000 Live Births

Implications of Inequity : Reflecting in Health Indicators

Life Expectancy Infant Mortality Rate

Source : World Bank Data, 2002

80 70 60 50 40 30 20 10 0

70.45 54

62

46.68

32 34.39 31.33 17 13.97

India Sri Lanka Indonesia S. Africa Egypt Pakistan Russia Brazil

7
US

4.4
France

4.2 3.1 5.2

Germany Japan UK

Low Income

Middle Income

High Income

Comparison of Health Level Ranking and Health Expenditure Per Capita Ranking
UK Japan Germany France US Brazil South Africa Russia India Egypt Pakistan Indonesia Sri Lanka

3 3 4

(Source : UNDP Human Development Report - 2002) 14 Health Level Ranking (DALE) 26 JAPAN rank 1 in 13 Health Expenditure per capita DALE 22 US Rank 1 in Per Ranking ( US $) Capita Health 24 Expenditure ( US $) 111 54 160 57 91 75 134 115 133 115 124 103 76 138
100 120 140 160 180

142 154

20

40

60

80