What are the Health System Building

Blocks?

Definition: Health System

A system is an arrangement of parts and their interconnections that come
together for a purpose.
A health system consists of all organizations, people and actions whose
primary intent is to promote, restore or maintain health. Like any other
system, it is a set of interconnected parts that have to function together to
be effective.
A health system is composed of many parts. In particular:
 Patients
 Families
 Communities
 Ministries of Health
 Health providers
 Health financing bodies
 The Six Health System Building Blocks

The World Health Organization recommends supporting and

strengthening a health system based on the framework.
When you strengthen a health system, you improve the six
health system building blocks and manage their interactions
in ways that achieve more equitable and sustained improvements
across health services and health outcomes. PEOPLE are often
listed as the seventh building block. “People” refers to individuals,
households, and communities as civil society, consumers,
patients, payers, and producers of health through knowledge,
attitudes, behaviors, and practices.
LEADERSHIP AND
GOVERNANCE
Accountability is therefore an intrinsic aspect of governance that concerns the
management of relationships between various stakeholders in health, including
individuals, households, communities, firms, governments, nongovernmental
organizations, private firms and other entities that have the responsibility to
finance, monitor, deliver and use health services

Accountability involves, in particular:

• delegation or an understanding (either implicit or explicit) of how services are supplied;

• financing to ensure that adequate resources are available to deliver essential services

• performance around the actual supply of services;

• receipt of relevant information to evaluate or monitor performance

; • enforcement, such as imposition of sanctions or the provision of rewards for

performance.
Core indicators
1a: Existence of an up-to-date national health strategy linked to national needs and priorities

1b: Existence and year of last update of a published national medicines policy

1c: Existence of policies on medicines procurement that specify the most cost-effective medicines
in
the right quantities; open, competitive bidding of suppliers for quality products

1d: Tuberculosis—existence of a national strategic plan for tuberculosis that reflects the six principal
components of the Stop-TB strategy as outlined in the Global Plan to Stop TB 2006–2015

1e: Malaria—existence of a national malaria strategy or policy that includes drug efficacy
monitoring, vector control and insecticide resistance monitoring
HEALTH INFORMATION
SYSTEM
4 KEY FUNCTIONS

(data generation

compilation

analysis and synthesis

communication and
use.
Health planners and decision-makers
need different kinds of information
including:
health determinants (socioeconomic, environmental, behavioral and genetic factors) and the contextual
environments within which the health system operates);

• inputs to the health system and related processes (policy and organization, health infrastructure,
facilities
and equipment, costs, human and financial resources and health information systems);

• the performance or outputs of the health system (availability, accessibility, quality and use of health
information and services, responsiveness of the system to user needs, and financial risk protection);

• health outcomes (mortality, morbidity, disease outbreaks, health status, disability and wellbeing); and

• health inequities (determinants, coverage of use of services, and health outcomes, and including key
stratifiers such as sex, socioeconomic status, ethnic group and geographical location).

• A good health information system brings together all relevant partners to ensure that users of health
information have access to reliable, authoritative, usable, understandable and comparative data.
Methods for assessing country health
information system performance

Self-assessment approaches
Independent assessment is
is the degree of country
generally based on
ownership generated that
existing sources, such as
enables the assessment to
databases of international
serve as the basis for the agencies, so as to minimize
development of a plan for the reporting burden on
improvement. countries.
Core indicators

Indicators related to data generation using core sources

and methods (health surveys, civil registration, census,
facility reporting, health system resource tracking).

Indicators related to country capacities for synthesis,

analysis and validation of data. These measure key
dimensions of the institutional frameworks needed to ensure
data quality, including independence, transparency and
access.
Summary of core indicators and scoring for Health
Information Systems Performance Index (HISPIX)

• Birth registration of • Death registration of

at least 90% of all at least 90% of all •ICD-10 used in
Birth and death births (intermediate deaths (intermediate district hospitals and
registration: goal goal 50%). Indicator: causes of
50%). Indicator: percentage of deaths death reported to
percentage of births registered. national level.
registered.
Summary of core indicators and scoring for Health
Information Systems Performance Index (HISPIX)

• Number of institutional
• HIV prevalence for relevant • Country web site for
deliveries available, by
surveillance populations health statistics, with latest
Health facility district, and published within
published within 12 months report and data available
reporting 12 months of the preceding
of the preceding year. to the
year.
general public.

• At least 90% of the districts •Data quality

•Reporting of
submit timely, complete, assessments carried out •International Health
notifiable diseases
accurate reports to national and published within the
makes use of modern Regulations implemented
level. Indicator: percentage past three years, using
communication according to international
of districts that submit timely, internationally agreed
technology and reporting standards.
of complete, accurate reports to quality criteria, such as Data
statistics from district to national level. Quality Assessment
national levels is web- Framework (DQAF).
based.
Summary of core indicators and scoring for Health
Information Systems Performance Index (HISPIX)
• National database with
• At least one national public and private
Health system health accounts exercise sector health facilities
resource completed in the past and geocoding,
tracking five years. available and updated
within the past three
years.

• Annual data on
• National database with
availability of tracer
health workers by
medicines and
district and main cadres
commodities in
updated within the past
public and private
two years.
health facilities
HEALTH SYSTEM
FINANCING
Health financing refers to the “function of a health system
concerned with the mobilization, accumulation and allocation of
money to cover the health needs of the people, individually and
collectively, in the health system… the purpose of health
financing is to make funding available, as well as to set the right
financial incentives to providers, to ensure that all individuals
have access to effective public health and personal health
care”
Objectives:

to raise sufficient funds

to provide financial risk

protection to the population

efficiency in resource
utilization
3 Inter-Related Functions

Revenue Collection

Fund fooling

Purchasing/Provision of services
Sources of information on
health systems financing

MINISTRY OF HEALTH DEPARTMENT OF

HEALTH
Core indicators

Total expenditure on health

General government expenditure on health as a

proportion of general government expenditure
(GGHE/GGE)

The ratio of household out-of-pocket payments for health

to total expenditure on health
HEALTH WORKFORCE
 THE HEALTH WORKFORCE CAN BE DEFINED AS “ALL PEOPLE
ENGAGED IN ACTIONS WHOSE PRIMARY INTENT IS TO ENHANCE
HEALTH” . THESE HUMAN RESOURCES INCLUDE CLINICAL STAFF, SUCH
AS PHYSICIANS, NURSES, PHARMACISTS AND DENTISTS, AS WELL AS
MANAGEMENT AND SUPPORT STAFF, I.E. THOSE WHO DO NOT
DELIVER SERVICES DIRECTLY BUT ARE ESSENTIAL TO THE
PERFORMANCE OF HEALTH SYSTEMS, SUCH AS MANAGERS,
AMBULANCE DRIVERS AND ACCOUNTANTS
Core Indicators
Number of health workers per 10 000 population

Distribution of health workers – by occupation/

specialization, region, place of work and sex

Annual number of graduates of health professions

educational institutions per 100 000 population – by level and
field of education
MEDICAL PRODUCTS
AND TECHNOLOGIES
OBJECTIVES
• national policies, standards, guidelines and regulations that support policy;

• information on prices, the status of international trade agreements and the

capacity to set and negotiate prices;

• reliable manufacturing practices when they exist in-country and quality

assessment of priority products;

• procurement, supply and storage, and distribution systems that minimize

leakage and other waste; and

•support for rational use of medicines, commodities and equipment,

through guidelines and strategies to assure adherence, reduce resistance,
maximize patient safety and training.
Sources of information on access to
essential medicines
Facility
surveys

A general facility survey usually focuses on a wide range of key health services and
collects information on facility infrastructure, equipment and supplies, support
systems, management systems and providers’ adherence to standards.

Key informant surveys

Surveys by experts with extensive knowledge about the medicines situation in a

country can be used to generate information about pharmaceutical policies and
practices related to regulation, selection of essential medicines, as well as
procurement and use.
Core Indicators

Average availability of 14 selected essential

medicines in public and private health
facilities

Median consumer price ratio of 14

selected essential medicines in public and
private health facilities
Additional indicators for a
full pharmaceutical profile
Access to essential medicines/technologies as part of the fulfillment of the right to health, recognized in the constitution
or
national legislation

Existence and year of last update of a published national medicines policy

Existence and year of last update of a published national list of essential

medicines Legal provisions to allow/encourage generic substitution in the private

sector Public and private per capita expenditure on medicines

Percentage of population covered by health insurance

Percentage mark-up between manufacturers and consumer prices

HEALTH SERVICE
DELIVERY
Key characteristics of good
service delivery
1. Comprehensiveness
2. Accessibility
3. Coverage
4. Continuity
5. Quality
6. Person-centeredness
7. Coordination
8. Accountability and
efficiency
Core indicators
◦ General service availability
◦ Number and distribution of health
facilities per 10 000 population
◦ Number and distribution of
inpatient
beds per 10 000 population
◦ Number of outpatient department
visits per 10 000 population per
year
Core indicators
◦General service readiness
◦General service readiness
score for health facilities
 Core indicators
◦Service-specific availability
◦Proportion of health facilities
offering specific services
◦Number and distribution of
health facilities offering specific
services per 10 000 population
 Core indicators

◦Service-specific
readiness
◦Service-specific
readiness score for
health facilities
 Core indicators
◦Service quality
◦Assessing quality of care can be
difficult because it can cover
both the complex processes of
evaluating, diagnosing and
treating a patient as well as the
outcomes of that treatment for
the patient.