Health system

A health system can be defined as the structured and interrelated set of all actors and institutions contributing to health improvement. The health system boundaries could then be referred to the concept of health action, which is "any set of activities whose primary intent is to improve or maintain health".

A wide concept

Too often health systems have been defined with a reductionist perspective, for example reducing it to the health care systems. In many publications, for example, both expressions are used interchangeably. Some authors have developed arguments to expand the concept, indicating how many dimensions participate to it:

- Health systems should not be expressed in terms of their components only, but also of their interrelationships;

- Health systems should include not only the institutional or supply side of the health system, but also the population;

- Health systems must be seen in terms of their goals, which include not only health improvement, but also equity, responsiveness to legitimate expectations, respect of dignity, and fair financing, among others;

- Health systems must also be defined in terms of their functions, including the direct provision of services, whether they are medical or public health services, but also "other enabling functions, such as stewardship, financing, and resource generation, including what is probably the most complex of all challenges, the health workforce".

International comparisons and performance

Health systems may vary substantially from countries to countries, and in the last years comparisons have been made on an international basis. The goals for health systems, according to the WHO's World Health Report 2000 - Health systems: improving performance (WHO, 2000), are good health, responsiveness to the expectations of the population, and fair financial contribution. There have been several debates around the results of this WHO exercise , and especially based on the country ranking linked to it , insofar as it appeared to depend mostly on the choice of the retained indicators.

Since 2000, more and more initiatives have been taken at the international and national levels in order to strengthen national health systems as the core components of the global health system. Having this scope in mind, it is essential to have a clear, and unrestricted, vision of national health systems that might generate further progresses in global health. The elaboration and the selection of performance indicators are indeed both highly dependent on the conceptual framework adopted for the evaluation of the health systems performances.

An increasing number of tools and guidelines are being published by international agencies and development partners to assist health system decision-makers to monitor and assess health systems strengthening including human resources development using standard definitions, indicators and measures.

Citations

What is a health system?

"A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health . 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. It includes, for example, a mother caring for a sick child at home; private providers; behaviour change programmes; vector-control campaigns; health insurance organizations; occupational health and safety legislation. It includes inter-sectoral action by health staff, for example, encouraging the ministry of education to promote female education, a well known determinant of better health."

See also

• Global health
• Health crisis
• Health workforce
• Public health
• Social determinants of health