Accountability for NGOs
INTERNATIONAL HEALTH SYSTEMS
Module: 1
7
Global Health and Health Systems
What is a “health system”
Total of the organizations, institutions, and resources whose primary purpose is to improve health
Required components of a health system
Staff; Funds; Information; Supplies; Transport; Communications and overall guidance & direction.
Provide services that are: responsive and financially fair, while treating people decently.
8
Concepts to be considered
Health:
“State of complete physical, mental, and social well being and not merely the absence of disease and infirmity”
System:
“Human body is a system comprising of many physiological subsystems (respiratory; circulatory; neurological; endocrine, and musculoskeletal) that are interconnected in a holistic way.”
Identifying ‘inputs’:
As with any system, a health system has inputs (financial, material, and human resources)
Health systems arise within a social, cultural, political, and economic context with considerable diversity in size, scope, and form.
9
Select Health System Financial Input Data (in US dollars)
Financial and Health Care Resources for Selected Countries.
Data from Global Health Facts, and Encyclopedia Britannica Online Academic Edition, World Data, 2007.
Financial and Health Care Resources for Selected Countries, continued
Data from Global Health Facts (http:
globalhealthfacts.org), and Encyclopedia Britannica Online Academic Edition, World Data, 2007.
BUILDING BLOCKS OF HEALTH SYSTEMS
Critical success factors
Service delivery
Health workforce
Health information
Medical technology
Health financing
Leadership and governance
13
Health Systems Building Blocks (Critical Success Factors)
BUILDING BLOCKS OF HEALTH SYSTEMS
One widely accepted way of measuring the building blocks or the overall functioning of a health system is through the lens of:
Cost
Quality
Access
15
The cost, quality, access triangle
BUILDING BLOCKS OF HEALTH SYSTEMS
Measurement of functioning of health system
Cost
Quality
Access
Innovation*
* In the era of rapid globalization, it is increasingly prudent to add a fourth dimension, innovation.
17
The cost, quality, access, innovation diamond
HEALTH SYSTEMS WITHIN LARGER SOCIAL SYSTEMS
Anderson model
Predisposing factors
Family characteristics, social structure, and health beliefs
Enabling factors
Family & Community Resources
Need factors
Illness & Response to Illness
Behavioral Model for Vulnerable Populations’
19
The Behavioral Model for Vulnerable Populations.
Gelberg L, Andersen RM, Leake BD. Health Services Research, 2000; 34(6): XXXXXXXXXXPage 1278.
HEALTH SYSTEMS WITHIN LARGER SOCIAL SYSTEMS
Impact of social circumstances
Behavioral
Socioeconomic status influences behaviors
Material
Lack of food, shelter, and safety can lower health status.
Psychosocial
Complex pathway requiring connection between social structure and health.
21
Summary of some of the social determinants of health status.
Summary of some of the social determinants of health status.
Summary of some of the social determinants of health status.
Summary of some of the social determinants of health status.
CONCLUSION
Health systems evolve
Challenges to health systems
Determinants
Impact of globalization
Need for sustainability
26
Introduction to Health Systems
James A. Johnson and Carleen H. Stoskopf
▸ Introduction
A health system as described by the World Health Organization (WHO) is the sum total of all the organizations, institutions, and resources whose
primary purpose is to improve health. A health system
needs staff, funds, information, supplies, transport, com-
munications, and overall guidance and direction. Fur-
thermore, it needs to provide services that are responsive
and financially fair, while treating people decently.1
Within this definition, there are several concepts
that need to be understood before one embarks on the
task of studying health systems. First and foremost, an
agreed-on definition of health is paramount. Health is
too often seen as a concept that applies only to physi-
cal well-being or the absence of disease; however, the
most widely accepted definition of health is the one
first published by the WHO in 1948.
Health is a state of complete physical, men-
tal, and social well-being and not merely the
absence of disease or infirmity2
This comprehensive concept of health is the one
used in this book and serves to inform discussions on
health systems.
The other key word that needs to be explored here
is the word “system.” The human body is a system com-
posed of many physiological subsystems that are inter-
connected in a holistic way. The subsystems, including
espiratory, circulatory, neurological, endocrine, and
musculoskeletal systems, communicate and are inter-
dependent. They work together for the purposes of
survival, adaptation, growth, and development. They
also interact with the environment and respond to
feedback from within and outside the system. In many
ways, the interconnectivity of the various subsystems
and its extension as a whole into the environment form
the building blocks of larger systems, such as family,
community, and nation. Thus a natural (biological)
system, such as a human being, is also a participant
in and a creator of larger social systems. The human-
created systems have many of the same attributes of
iological systems. Additionally, it can be said that
these larger systems are characterized by
■ A structure that is defined by its parts and
processes.
■ Generalizations of reality.
■ A tendency to function in the same way, involving
the inputs (material, human resources, finances, etc.)
and outputs (products and services) that are then
processed, causing them to change in some way.
■ A system’s various parts, which have functional as
well as structural relationships.
Human-created systems can be small, as in the
three-person family, or quite large, as in a nation-
state such as India with a billion people. The most
widely dispersed human-created systems are orga-
nizations. As with the other examples described
previously, organizations share the same attributes
3
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One of the major “inputs” into any healthcare
system is patients. Patients present with a variety of
symptoms/diseases/injuries; however, they also come
with a myriad of characteristics, such as personal-
ity, life experiences, knowledge, attitudes, cultural
norms, education level, income level, intellect, preju-
dice, religious and other belief systems, emotions, bio-
logical strengths and weaknesses, and genetic makeup.
In addition, patients may or may not be plugged into
society’s infrastructure, such as having access to trans-
portation, childcare, or health insurance. The com-
plexity these many factors create cannot be overlooked
y healthcare systems nor should they be overlooked
y health policymakers. It has been well established
that income is perhaps one of the best predictors of
health. The income gradient within a population is
highly associated with health status of individuals or
groups in that population, and the per capita incomes
and the GDP of nations are also highly co
elated with
the health status of that country’s population. Taken
from this perspective, health policy makes us also be
and adapt accordingly to their environments. In
fact, organizations are complex human systems
that have evolved over time and continue to do so.3
The natural emergence of human-created systems,
such as organizations and communities, proba-
ly grew out of instinct for survival. In the hostile
world of early humankind, food, shelter, and safety
needs usually required cooperative efforts. In turn,
cooperative efforts typically require some form of
organization.4 This is no less true in the case of pro-
viding health. In order to meet the criteria of health
as a state of complete physical, mental, and social
well-being, individuals, communities, organiza-
tions, and nation-states have worked together to
form elaborate and diverse health systems through-
out the world.
As with any system, a health system has inputs.
These include financial, material, and human
esources that differentiate one health system from
another. The data in TABLE 1-1 clearly demonstrate
some of these differences.
TABLE 1-1 Select Health System Financial Input Data, 2015 (in U.S. dollars)
Data from World Health Organization. (2014).
Total global expenditure for health $6 .5 trillion plus
Total global expenditure for health per person per year $948
Country with highest total spending per person per year on health United States ($8,362)
Country with lowest total spending per person per year on health Eritrea ($12)
Country with highest government spending per person per year on health Luxembourg ($6,906)
Country with lowest government spending per person per year on health Myanmar ($2)
Country with highest annual out-of-pocket household spending on health Switzerland ($2,412)
Country with lowest annual out-of-pocket household spending on health Kiribati ($0 .02)
Average amount spent per person per year on health in countries belonging to
the Organisation for Economic Co-operation and Development (OECD)
$4,380
Percentage of the world’s population living in OECD countries 18%
WHO estimate of minimum spending per person per year needed to provide basic,
life-saving services
$44
Countries where total health spending was lower than $50 per person per year 34
Countries where health spending was lower than $20 per person per year 7
4 Chapter 1 Introduction to Health Systems
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size, scope, and form. As a result, health systems have
structure, processes, and outcomes that vary consider-
ably. TABLE 1-2 shows some of the variation along these
three dimensions for the countries selected for this
ook. As you will see here and in subsequent chapters,
financial and human resource inputs do inte
elate
with health outcomes.
concerned with poverty and lifting populations out of
poverty through social policies designed to improve
education, housing, infrastructure, job creation, and
the environment.
Health systems arise within a social, cultural,
political, and economic context. As with all human
constructed systems, there is considerable diversity in
TABLE 1-2 Healthcare Resources for Selected Countries
Spent per capita
on health
% of total health expenditure
Percent
of GDP
US $ PPP $ Government Private Out-of-pocket % of total
government
expenditures
spent on health
Australia 9 .4 6,110 4, XXXXXXXXXX1 18 .7
Bangladesh XXXXXXXXXX XXXXXXXXXX
Botswana XXXXXXXXXX XXXXXXXXXX
Brazil 9 .7 1,085 1, XXXXXXXXXX8 6 .9
Canada XXXXXXXXXX,718 4, XXXXXXXXXX1 18 .5
China XXXXXXXXXX XXXXXXXXXX
DR Congo XXXXXXXXXX XXXXXXXXXX
France XXXXXXXXXX,864 4, XXXXXXXXXX9 15 .8
Germany XXXXXXXXXX,006 4, XXXXXXXXXX6 19 .4
Ghana XXXXXXXXXX XXXXXXXXXX
India XXXXXXXXXX XXXXXXXXXX
Ireland 8 .9 4,233 3, XXXXXXXXXX1 14 .1
Israel 7 .2 2,599 2, XXXXXXXXXX5 10 .5
Japan XXXXXXXXXX,966 3, XXXXXXXXXX2 20 .0
Jordan XXXXXXXXXX XXXXXXXXXX
Korea 7 .2 1,880 2, XXXXXXXXXX6 11 .5
Mexico XXXXXXXXXX, XXXXXXXXXX5 15 .4
Nigeria XXXXXXXXXX76