ADDIS ABABA UNIVERSITY COLLEGE OF HEALTH

SCIENCES SCHOOL OF PUBLIC HEALTH

INDIVIDUAL ASSIGMENT ON
_____________________________________________

COMMON TYPES OF INTERVENTIONS FOR THE SIX

HEALTH SYSTEM BUILDING BLOCKS

BY: DAGMAWIT FANTAHUN

ID NUMBER GSR1715/08

SUBMITTED TO: DR MESFIN

APRIL 2016
ADDIS ABABA, ETHIOPIA
 Common types of interventions for the six health system building blocks

This are suggested System-level interventions targeting individual or multiple building

blocks to strength the health system in WHO flagship report “system thinking for health
system strengthening ".using systems perspective anticipating how an intervention might flow
through, react with, and impinge on these sub-systems is crucial.

no Building block Common types of interventions

1 Governance
2 Financing
3 Human Resources
4 Information
Medical products ,
5 vaccines and
technologies
 Decentralization
 Civil society participation
 Licensure , accreditation, registration
 User fees
 Conditional cash transfers (demand side)
 Pay-for -performance (supply side)
 Health insurance
 Provider financing modalities
 Sector Wide Approaches (SWAps) and bask et funding
 Integrated T raining
 Quality improvement, performance management
 Incentives for retention or remote area deployment
 Shifting to electronic (versus manual) medical records
 Integrated data systems & enterprise architecture for HIS design
 Coordination of national household surveys (e .g. timing of data
collected)
 New approaches to pharmacovigilance
 Supply chain management
 Integrated delivery of products and interventions

Service delivery  Approaches to ensure continuity of care

6  Integration of services versus centrally managed programs
 Community outreach versus fixed clinics
 Interventions’ potential system-wide effects
A complex intervention by itself is a system, interacting with other building blocks of the
system and setting off reaction that might be unexpected or unpredictable following are the
potential system wide effects of the proposed interventions.

Governance
Incapable or over stretched governance structures can contribute to less than optimal
performance and cohesion among the building blocks and for the system as a whole. the common
interventions on governance building block has an impact on different building blocks and as
whole on the system for instance Decentralization enhances efficient decision-making by cutting
bureaucratic chains as well as the responsiveness of health institutions to their local communities
improving the service delivery in addition helps in effective management of human and financial
resources. Civil society participation increase community empowerment and in return increased
cost effective health care utilization. As Licensure, accreditation and registration give
recognition to the health services increased equitable and quality health service can be gained in
addition the health work force will be accountable for their delivered care.

Financing
User fees have long been one of the main reasons for poor health care utilization among
poor people. One mechanism to address the challenge of high out of pocket (OOP) spending
during use of health services is health insurance. As peoples engaged in a health insurance
system it would be easier to allocate resources in equitable manner and more help in effective
utilization of medical products and equipment.

Conditional cash transfers (demand side) are incentives given to clients of the health
system to encourage them to adapt particular health behavior or for utilizing a specific health
care service and Pay-for -performance (supply side) it is providing cash incentive for health care
providers on achieving pre specified performance it is recently suggested strategy aimed at
boosting performance in a health system. both have a system level effect mostly affecting health
care financing and service deliver one of the difficulty is choosing the program to focus on for
improvement affecting the whole system as this intervention have a positive impact on a selected
service it might affect other services by transferring resources in addition the health workforce
and the information system might also be affected because in a way health care providers might
inflate the data of utilizing the service by people to get the incentives.
Human Resources
Having adequate numbers and mix of motivated and skilled human resources are
essential at all levels of the health system. Integrated Training insures the quantity of health
workers trained being competent to deliver safe and effective practice. Trained worker with
public health competencies is one of the factors to ensure high coverage of essential health
interventions. Health care providers will also be critical thinkers and be able to use health
information and researches for decision making.

Targeted in-service trainings are one mechanism in improving quality of the service.
ethics and competence of health workers at facility, district and regional levels shall always be
monitored for regulation of performance. One main problem in human resource management for
health is retaining health work force at rural area and the suggested intervention is Incentives for
retention or remote area deployment. This intervention has a multi building block effect mostly
on health service delivery, finance and governance.

Information
Missing information flows are often identified as the most common cause of system
malfunction. One of the interventions is shifting to electronic (versus manual) medical records.
EMR have implemented in Ethiopia starting from the last HSDP it has an effect mostly on health
service delivery improving its quality, as one measurement is client satisfaction. other
intervention suggests is Integrated data systems &enterprise architecture for HIS design as
information managed in a useable manner all the sub system could benefit from it for instance
governance for strategic planning, implementation and evaluation, medical supplies unit for
keeping track on stock level and appropriate maintenance of equipment and for human resources
updating the health care providers in planning and implementing the care given. Coordination of
national household surveys was the last intervention focusing on evidence based decision making
which would need systematic arrangement of the household for the survey to be conducted like
woreda transformation one of Ethiopian’s transformation agenda in HSTP this intervention have
an impact on service delivery as it enhance it but it might need lots of system’s budget in
implementing it.

Medical products, vaccines and technologies

 A new approach to pharmacovigilance is a key component for effective drug regulation
system including blood products, clinical practice and public health programs. Detecting adverse
drug effects earlier would improve the service delivery in quality. In pharmacovigilance many
are involved the health workforce, regulatory bodies, governance financial managers and
suppliers which gives it a chance to be seen from different perspective in the system. Integrated
delivery of products and interventions provides accurate and timely data for decision-making.it
improves information recording and reporting, storage and distribution systems as well as the
availability of essential commodities at service delivery points strengthening the health system as
whole.

The last intervention suggested is Supply chain management, the most faced problem in
health system is availing medical products up on request this is mainly due to a problem on
supply chain management where there is a long process for delivery, health facilities were unable
to forecast their pharmaceuticals demand or the capacity of the providers are not good enough as
expected. Costs of these products are one of the factors affecting continuous availability of the
health commodities, the main aim of the health system which is promoting, preventing and
maintaining health of a population is greatly determined by the availability of essential medical
products, vaccines and technologies.

Service delivery
Approaches to ensure continuity of care is concerned with a quality of care over time
where patients experience a continuous caring relationship with a health care provider in a cost
effective manner as this is a multi disciplinary approach it affects’ most units in the health
system like human resource, finance, information and governance.

community outreach health clinics serves the resident of the community with limited
medical care with professionals this will increase access to the health care and it also motivate
the health workers at rural area in doing something meaningful but as for increased quality and
diversified service a fixed clinic services shall also be strengthen. Cost effectiveness in both
outreach and fixed clinic shall also be a concern