The Commission on the Social Determinants of Health defines a health system as ‘the condition in which people are born, grow, living, work and age. These conditions are shaped by the distribution of money, power and resources, at global, national and local levels, which are themselves influence by policy choices.’ [i] For many, the systems they are born into are inadequate, poorly funded, and understaffed. There have been many articles published on disparities and inequalities in health care, health systems, and how we can overcome these obstacles to reach the Millennium Development Goals by 2015[ii]. Functioning health systems are a key ingredient in attaining good health globally. Unfortunately, many developing countries do not have a governmental infrastructure to meet the needs of their growing populations. Even in the United States, the health system in place for the general population is incredibly lacking in services, trained staff and adequate facilities.
A multitude of articles exist defining health systems, their roles in varying countries, the disparities amongst developed and developing countries, and accountability and assessment. I am sure we can all agree on the necessity of health systems, the disagreement seems to come in how to set them up and ensuring they function efficiently and effectively. So then, what can be done for developing countries who’s governments are understaffed, underfunded and incapable of providing adequate health services to their centralized population let alone their rural communities. Murray and Frenk propose ‘a framework for assessing the performance of health systems’ designed to address the health needs of a community, reduce inequalities, without increased cost to the population. The paper acknowledges the challenges to creating functioning health systems as well as the policy changes required to achieve these goals. The four goals discussed in their paper seem to me to only work in a country with the financing available for health care and an existing system to build on or from. Many countries in Africa lack these basic resources. Many countries health systems are funded through donors and are focused on specific diseases rather than reforming systems.[iii]
As a future global public health leader I constantly consider what is the best or right health system and is it necessarily a right fit for all nations? Health care has become a global concern and entity but is the solution a global one or a community one? I feel it is a community (country-specific) problem that should be addressed locally. Too many countries lack the stable foundations to build a functioning health system on so it would not be effectual to take a model health system like Canada or Sweden and fit it to a West African country. It would seem more fitting to have country or region specific health system that could address the needs of its inhabitants. The Commission for Social Determinants of health outlined 3 recommendations to ‘Closing the gap’, I was particularly struck by the third, ‘Measure and Understand the Problem and Assess the Impact of Action: …Creating the organizational space and capacity to act effectively on health inequity requires investment in training of policy-makers and health practitioners and public understanding of social determinants of health. It also requires a stronger focus on social determinants in public health research.i” This line of thinking fits in with the assessment criteria outlined by Murray and Frenk and would provide a great platform of integration with Mills, et. Al.
[i]CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization.
[ii] Travis, P., Bennet,S., Haines, A., et al. Overcoming health-systems constraints to achieve the Millennium Development Goals The Lancet – 4 September 2004 ( Vol. 364, Issue 9437, Pages 900-906 ) DOI: 10.1016/S0140-6736(04)16987-0
[iii] Murray, CJL, Frenk, J. (2000) “A framework for assessing the performance of health systems.” Bulletin of the World Health Organization 78(6): 717-731.