What is a Health System and Do They Matter? How should the performance of Health Systems be measured?

 A health system is defined by the World Health Organization as including, “all actors, institutions and resources that undertake health actions – where a health action is one where the primary intent is to improve health.1” A health system can be viewed as a highly interdependent system. It is the product of interaction and coordination of efforts, activities and resources of “various organizations, people delivering primary health care (i.e. doctors, nurses, village health workers etc) and those providing specialized inputs into the health care process (i.e. medical and nursing schools, drug and device manufacturers etc)” 1. A recent video posted by the World Bank called “Making Maya Cry” http://blogs.worldbank.org/health/making-maya-cry-why-health-systems-matter  stresses on the importance of health systems and reinforces the need for the identification of the various determinants of health, followed by the establishment and implementation of effective measures and procedures to ensure that successful health systems are in place to meet the desperate health care needs around the world 3.  In addition, it must be noted that there exists a stark difference in the overall attainment of improved health service when comparing the adoption of a “Health Systems /Systemic Approach” to the adoption of a “Disease/Service Specific Approach” 2.  The strengthening of existing health systems would serve to provide a stable and long-term solution by working on the root causes of diseases/conditions as compared to the more immediate and short-term solutions proposed by the “disease specific approach 2.”

Health systems play a vital role in achieving key health goals. It is thus necessary to establish a structure that not only measures the performance of various health systems but also permits acknowledgement of major policy challenges.  The performances of health systems vary from country to country due to differences in design, content, management procedures, income, education and health expenditure 4.  According to The World Health Report 2000, performance of a health system should be centered on the accomplishment of three primary goals: “improving health”, “enhancing responsiveness to the expectations of population”, and “ensuring fairness of financial contribution” 1,4. Murray and Frenk have contributed in expanding upon the aforementioned goals by elaborately describing the major components of responsiveness and fairness. Measuring the responsiveness of a health system according to these authors, includes focusing on a number of factors “dignity, confidentiality, autonomy of individuals and families to decide about their own health, quality of basic amenities, choice of provider, prompt attention, and access to social support networks.”4. Measuring the fairness of financial contribution entails focusing on the notion of “fair share” which stresses that, poor households should be protected from the costs of ill-health and disability by ensuring that they contribute less of their income towards health care in comparison to the rich 4. This would prevent them from compromising on basic needs of food, shelter and education and being pushed into further impoverishment 1, 4.  Fairness in financial contribution is important in ensuring reduction in the inequity in availability of health care. Furthermore, the authors suggest that the existence of variation in performance depends on the manner in which health systems organize the functions of stewardship, financing, service provision and resource generation 4.

Effective health systems are pivotal in ensuring the attainment of improved health. The  constant monitoring of performance is  imperative in measuring progress  and implementing changes when necessary. Given that well designed health systems have the potential to reduce inequity in distribution of health care services, should health systems primarily be founded on the principle that everyone has the right to healthcare irrespective economic status?


1. Skolnik Richard. (2008). “Essentials of Global Health”

2.  World Health Organization.“ Health Systems Strengthening”. (2011). http://www.searo.who.int/linkfiles/rcphd_fs2.pdf

3.  Baeza Christian. (2011). “Making Maya cry: why health systems matter.” http://blogs.worldbank.org/health/making-maya-cry-why-health-systems-matter

4.Murray, Christopher and Julio Frenk. “A Framework for Assessing the Performance of Health Systems”. Bulletin of the World Health Organization. Vol 78, Issue 6. 2000. 717-729.



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