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By Dr Ekiria Kikule
Bachelor of Community Health Uganda Christian University 2013

• A health system also sometimes referred to as health care system or healthcare system • Is the organization of people, institutions and resources to deliver health care services to meet the health needs of target populations.


Health outcomes 3 . Health management & support systems 4. political. etc) characteristics 2. economic. Health needs/problems  determined by demographic & environmental (cultural. Health services 3. Community participation 5.Elements of a Health System 1.

restore or maintain health.WHO Definition "A health system consists of all organizations. people and actions whose primary intent is to promote. This includes efforts to influence determinants of health as well as more direct health-improving activities” A health system is therefore more than the pyramid of publicly owned facilities that deliver personal health services 4 .

g. encouraging the ministry of education to promote female education.WHO Definition (Cont) It includes: • A mother caring for a sick child at home • Private providers • Behaviour change programmes • Vector-control campaigns • Health insurance organizations • Occupational health and safety legislations • Inter-sectoral action by health staff e. a well known determinant of better health 5 .

• However. etc to deliver planned health care services targeted to the populations they serve.History • Variety of health systems around the world • In some countries. health system planning is distributed among market participants. • In others. trade unions. charities. 6 . religious bodies. there is a concerted effort among governments. health care planning has been described as often evolutionary rather than revolutionary.

Goals of a Health System According The World Health Organisation (WHO): • Good health • Responsiveness to the expectations of the population • Fair financial contribution. • Continuity of health care provision 7 .

Resource generation 3. Provision of Health care services 2. Stewardship a) b) c) d) Quality Efficiency Acceptability Equity 8 .Functions of Health Systems 1. Financing 4.

HS evaluation dimensions have also been described in the United States as "the five C's": 1. Coverage 3. Chronic Illness 9 . Consistency 4. Complexity 5. Cost 2.

Health Care Providers • Health care providers are institutions OR individuals providing health care services. Clinic or other health care institutions 10 . • Individuals include  health professionals  allied health professionals • Individuals can be self-employed or working as an employee in a hospital.

• Other health care institution include: • Government operated • Private for-profit • Private not-for-profit (e. NGOs) • Health care Institutions may also work outside of direct patient care such as: • Government health department or agency • Medical Laboratory • health training institution 11 .g.

Examples of health workers: • Doctors • Lab Technologists • Nurses • Midwives • Pharmacists • Optometrists • Community Health • Dietitians • Paramedics • Dentists • Psychologists Workers (CHW) • Trad. Medicine Practitioners 12 .

3. 5.Financial Resources • Generally five 1ry methods of funding health systems: 1. county or municipality Social health Insurance Voluntary or private Health Insurance Out-of-pocket payments Donations to Charities • • Most countries' systems feature a mix of all five models. 13 . 2. 4. all types of health care finance "are compatible with" an efficient health system. General taxation to the state.

14 ..Health Insurance • The term generally used to describe a form of insurance that pays for medical expenses.g. a firm covering its employees) or purchased by individual consumers. • May be provided through a social insurance program or from private insurance companies. • In each case premiums or taxes protect the insured from high or unexpected health care expenses. • Used more broadly to include insurance covering disability or long term nursing care needs. • It may be obtained on a group basis (e.

• These systems can be blended 15 . • 65% .80% renewable health system expenditures spent on wages in most countries.Payment Models 1. • Three ways to pay medical practitioners: • Fee for service • Capitation • Salary.

1. consultations 16 . Fee-for-service arrangements pay general practitioners (GPs) or private practitioners based on the service • Such arrangements are even more widely used for specialists working in ambulatory care e.g.Payment Models 2.

In capitation payment system GPs are paid for each patient on their "list". UK Austria Denmark. usually with adjustments for factors such as age and gender.Payment Models 3. 17 . Ireland (since 1989). the Netherlands and Sweden (from 1994) • Capitation payments have become more frequent in “managed care” environments in the United States. • Capitation payments used in Italy. 2.

• Freedom of consumer choice over doctors. these problems are likely to be less marked than under salary-type arrangements. coupled with the principle of "money following the patient" may moderate some of these risks. 18 . and the allocation of funding among GPs is determined by patient registrations. • Aside from selection. select the better risks and refer patients who could have been treated by the GP directly.Capitation (cont) • Capitation systems allow funders to control the overall level of primary health expenditures. GPs may register too many patients and under-serve them. • BUT under this approach.

19 .Payment Models 4. 3. Salary Arrangements .In some countries general practitioners (GPs) are employed on salaries for the govt. • Salary arrangements allow funders to control primary care costs directly • Salaries they may lead to: • under-provision of services (to ease workloads) • excessive referrals to secondary providers • lack of attention to the preferences of patients • Some countries are moving away from this system.

• Management of any health system is typically directed through policies & plans adopted by govt. private sector business and other groups • Policies encompass: • Personal health care delivery • Financing • Pharmaceuticals • Health human resources • Public health 20 .Health System Management 1.

HT. Diabetes.Health System Management 2. HIV/AIDS. etc 21 . • The rapid emergence of many chronic diseases that require costly long term care & treatment affecting health care delivery practices. • Many health managers & policy makers now re-examine their health care delivery approaches • Examples of emerging health issues of PH concern.

the control of tobacco smoking linked to cancer and other chronic illnesses • Antibiotic resistance is another major concern. e.g. leading to the reemergence of diseases such as Tuberculosis • A WHO campaign is calling for intensified global commitment to safeguard antibiotics and other microbial medicines for future generations. 22 . • PH facing controversies.Health System Management 3.

or as large as all the inhabitants of several continents (e. • Public health is concerned with threats to the overall health of a community based on the analysis of the health of a population • The population can be as small as a handful of people.Public Health 1.g. 23 . in a pandemic) • Public health divided into:  Epidemiology  Biostatistics  Health Services  Other important PH subfields include:  Environmental management  Social & Behavioural health  Occupational Health.

• Today. most govts recognize importance of PH programs in reducing the incidence of disease. the effects of ageing and health inequities • BUT PH still receives less govt funding compared with curative medicine. disability.Public Health 2. • Vaccinations are voluntary in some countries and some govts pay all or part of the costs for vaccines in a national vaccination schedule 24 .

Health Information 1. medicine & health care deals with: • the resources • Devices • Methods required to optimize the acquisition and use of info in health and biomedicine. 25 . • Sound information critical in the delivery of modern health care and efficiency of health systems. • Health informatics .the intersection of information science.

• Necessary tools for proper health information coding and management include: • Clinical guidelines • Formal medical terminologies • Computers & other info & communication technologies • The kinds of data processed may include • Pts’ medical records • Hosp admin & clinical functions • HR information 26 .Health Information 2.

• Increasingly. information and communication technologies are being utilized as tools to improve health systems in developing countries through:     The standardization of health info Computer-aided Dx & Rx Monitoring of health services delivery Info dissemination to population groups on health and treatment 27 . • The use of health information enables evidencebased policy & evidence-based mgt in health care.Health Information 3.

more initiatives have been taken at the international and national levels to strengthen national health systems as the core components of the global health system. vision of national health systems that might generate further progresses in global health. and unrestricted. it is essential to have a clear. 28 . • Since 2000 .Health Systems Strengthening 1. • Having this scope in mind.

• Selection of performance indicators heavily dependent on the conceptual framework adopted for the evaluation of the health systems performance • Tools & Guidelines are being developed by international agencies and development partners to assist health system decisionmakers to monitor and assess health systems strengthening. indicators and measures 29 . These include: • HR development • Use of standard definitions.Health Systems Strengthening 2.