Public Health - The Basics

As explained by the World Bank "Access to health services is reduced by health system inefficiencies and deficiencies, including ill-equipped facilities, drug shortages, too few staff, and gaps in their skills. Poor people are affected most and least able to afford treatment. Illness often drives families (deeper) into poverty.

Health systems are complex. They require high levels of human capital and financing, a clear vision, and strong leadership. Countries must plan and allocate their limited resources efficiently to meet their many pressing needs."

WHO has a number of programmes devoted to health systems, including universal health coverage, which it defines as: "ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship."

WHO identified 6 building blocks to strengthen health systems:
Service delivery
Good health services are those which deliver effective, safe, quality personal and non-personal health interventions to those that need them, when and where needed, with minimum waste of resources.
Health workforce
A well-performing health workforce is one that works in ways that are responsive, fair and efficient to achieve the best health outcomes possible, given available resources and circumstances (i.e. there are sufficient staff, fairly distributed; they are competent, responsive and productive).
Health information system
A well-functioning health information system is one that ensures the production, analysis, dissemination and use of reliable and timely information on health determinants, health system performance and health status.
Medical products, vaccines and technologies
A well-functioning health system ensures equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use.
Health systems financing
A good health financing system raises adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them. It provides incentives for providers and users to be efficient.
Leadership and governance
Leadership and governance involves ensuring strategic policy frameworks exist and are combined with effective oversight, coalition-building, regulation, attention to system-design and accountability.

There are a number of global initiatives to strengthen health systems.

A report in Lancet Global Health, seen in full here Implementing pro-poor universal health coverage - summarises as follows: "Universal health coverage (UHC)—the availability of quality, affordable health services for all when needed without financial impoverishment—can be a vehicle for improving equity, health outcomes, and financial wellbeing. It can also contribute to economic development. In its Global Health 2035 report, the Lancet Commission on Investing in Health (CIH) set forth an ambitious investment framework for transforming global health through UHC. The CIH endorsed pro-poor pathways to UHC that provide access to services and financial protection to poor people from the beginning and that include people with low income in the design and development of UHC health financing and service provision mechanisms."

Health systems and the Sustainable Development Goals

The 17 Sustainable Development Goals (SDGs) were adopted by the UN as a follow-on from the 8 Millennium Development Goals (MDGs).

Within SDG 3: Ensure healthy lives and promote wellbeing for all at all ages, we see

SDG 3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

Quality improvement in healtcare

In 2018, a report Crossing the Global Quality Chasm: Improving Health Care Worldwide was released. As the report states. "Poor-quality health care around the globe causes ongoing damage to human health. In low- and middle-income countries (LMICs), between 5.7 and 8.4 million deaths occur each year from poor quality of care, which means that quality defects cause 10 to 15 percent of the total deaths in these countries. The resulting costs of lost productivity alone amount to between $1.4 and $1.6 trillion each year.

A move toward universal health coverage (UHC) is the central theme of global health policy today, but the evidence is clear: Even if such a movement succeeds, billions of people will have access to care of such low quality that it will not help them—and indeed often will harm them. Without deliberate, comprehensive efforts to improve the quality of health care globally, UHC will be largely an empty vessel."

(From the National Academies of Sciences, Engineering, and Medicine, 2018)

You might want to explore this paper Toward a Consensus on Guiding Principles for Health Systems Strengthening by Swanson et al, which discusses a number of issues about strengthening health systems.

Health Systems Evidence "is a continuously updated repository of syntheses of research evidence about governance, financial and delivery arrangements within health systems, and about implementation strategies that can support change in health systems." It is a great resource where you can search for evidence to support policy making.

You may also be interested to see a number of teaching resources on Health Policy and Systems through the CHEPSAA site.