Health system

A health system, health care system, or healthcare system, is a set of organizations, institutions and resources whose primary goal is to produce actions for the promotion, restoration or maintenance of health. There is a wide variety of health systems around the world, with as many histories and organizational structures as there are countries. Implicitly, countries must design and develop health systems in accordance with their needs and resources, although common elements in virtually all health systems are primary healthcare and public health measures. In certain countries, the orchestration of health system planning is decentralized, with various stakeholders in the market assuming responsibilities. In contrast, in other regions, a collaborative endeavor exists among governmental entities, labor unions, philanthropic organizations, religious institutions, or other organized bodies, aimed at the meticulous provision of healthcare services tailored to the specific needs of their respective populations. Nevertheless, it is noteworthy that the process of healthcare planning is frequently characterized as an evolutionary progression rather than a revolutionary transformation. As with other social institutional structures, health systems are likely to reflect the history, culture and economics of the states in which they evolve. These peculiarities bedevil and complicate international comparisons and preclude any universal standard of performance.

Goals According to the World Health Organization (WHO), the directing and coordinating authority for health within the United Nations system, healthcare systems' goals are good health for the citizens, responsiveness to the expectations of the population, and fair means of funding operations. Progress towards them depends on how systems carry out four vital functions: provision of health care services, resource generation, financing, and stewardship. Other dimensions for the evaluation of health systems include quality, efficiency, acceptability, and equity. They have also been described in the United States as "the five C's": Cost, Coverage, Consistency, Complexity, and Chronic Illness. Also, continuity of health care is a major goal.

Definition The World Health Organization defines health systems as follows:

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.Some authors have developed arguments to expand the concept of health systems, indicating additional dimensions that should be considered: 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."

Health system frameworks There are many ways to understand health systems. All of them are key to help understand their functions and elements, as well as the relationships between them. These frameworks, besides, can serve as guides to analyze and study specific health systems and their performance, in all their complexity.

The WHO health system framework In 2000, the World Health Organization proposed a clear health system framework in the annual World Health Report. It featured 4 functions (stewardship, creating resources, financing, and delivering services), together with three objectives (responsiveness, fair financial contribution, and health). In 2007, this initial model evolved towards the most common health system framework to date: the "building blocks" framework. According to this new model, strengthening health systems consisted on improving six building blocks and the interactions between them, with the aim of improving access, coverage, quality and safety, to ultimately achieve improved health, responsiveness, social and financial risk protection, and improved efficiency. The six building blocks of a health system, in line with this framework, are:

Service delivery: Services being offered, demanded by the population and used. It requires adequate infrastructure and management. Health workforce: Competent and well-performing health professionals, supported by relevant regulations. Health information system: Generation of data about the performance of services and the health status and risks of the population that, in turn, is used for evidence-based decision-making. Medicines, supplies, and vaccines: Medical products that are accessible, safe, and of enough quality, thanks to adequate regulatory systems and supply chains. Health financing: Resources collected and pooled, used to purchase health services that the population uses. Governance and leadership: Stewardship and relationships among authorities, healthcare providers and users that help protect the public interest. Despite the widespread adoption of this framework, it has also been criticized over the years, due to the apparent segmentation of components, with inadequate emphasis on their relationships, and its limited focus on health services, without enough attention to the community and their role within the health system.

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