Health systems vary widely in performance, and countries with similar levels of income, education...

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Health systems vary widely in performance, and countries with similar levels of income, education and health
expenditure differ in their ability to attain key health goals. This paper proposes a framework to advance the
understanding of health system performance. A first step is to define the boundaries of the health system, based on the
concept of health action. Health action is defined as any set of activities whose primary intent is to improve or maintain
health. Within these boundaries, the concept of performance is centred around three fundamental goals: improving
health, enhancing responsiveness to the expectations of the population, and assuring fairness of financial
contribution. Improving health means both increasing the average health status and reducing health inequalities.
Responsiveness includes two major components: (a) respect for persons (including dignity, confidentiality and
autonomy of individuals and families to decide about their own health); and (b) client orientation (including prompt
attention, access to social support networks during care, quality of basic amenities and choice of provider). Fairness of
financial contribution means that every household pays a fair share of the total health bill for a country (which may
mean that very poor households pay nothing at all). This implies that everyone is protected from financial risks due to
health care. The measurement of performance relates goal attainment to the resources available. Variation in
performance is a function of the way in which the health system organizes four key functions: stewardship (a broader
concept than regulation); financing (including revenue collection, fund pooling and purchasing); service provision (for
personal and non-personal health services); and resource generation (including personnel, facilities and knowledge).
By investigating these four functions and how they combine, it is possible not only to understand the proximate
determinants of health system performance, but also to contemplate major policy challenges.

David · Accepted Answer

P a g e  | 1
D I S C U S S I O N    
P a g e  | 2
Though strengthening of health system is included in the agenda of all the countries in the 
world but it is a complex phenomenon for middle and low income countries due to poor 
financial position and high disease rate (Murray & Frenk, 2000). Total health expenditure in 
low income countries is very low, according to WHO report, out of pocket payment accounts 
for 22 percent in low income countries. Research conducted to implement positive health 
outcomes in low and middle income countries state that beside revenue collection problem, 
there is issue of irregular drug supply, inefficient use of scare resources, revenue based 
system of fund raising, volatile market of external funds etc (World Health Organization, 
2000).  
To provide universal coverage government have to ensure minimum availability of required 
funds, To achieve this goal The Joint Learning Network for Universal Health Coverage was 
formed in the year 2010 for the purpose of implementing joint effort for achieving the goal of 
universal health coverage by nine countries. In low and middle income countries government 
needs to ensure financial protection to all household so that they does not fall into poverty 
due to health problems,

Health systems vary widely in performance, and countries with similar levels of income, education and health expenditure differ in their ability to attain key health goals. This paper proposes a...

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